Primary care docs, facing ‘existential’ threat, fear for profession’s future

Dive Brief:

  • After months of being sidelined in the COVID-19 vaccination effort and plunging volumes last year threatening financial solvency, primary care doctors are now giving more vaccinations but are still worried about the future of their profession, according to a new survey.
  • Data released Monday from the Larry A. Green Center and Primary Care Collaborative found more than half of practices say they’re receiving enough vaccinations for their patients, while roughly a third are partnering with local groups or governments to prioritize people for inoculation, though vaccine hesitancy is a key concern and is contributing to burnout.
  • However, 40% of clinicians worry primary care will be gone in just five years, leading the groups behind the survey to call for new policies propping up the sector.

Dive Insight:

Despite plunging case rates as vaccination efforts ramped up in 2021, the COVID-19 landscape has shifted dramatically as the highly infectious delta variant continues to take root in the U.S., forcing the return of mask mandates and social restrictions in some hard-hit areas of the country.

Roughly half of the U.S. population has been fully vaccinated for the coronavirus, with administration rates peaking in early April. However, that’s sharply declined since, according to a tracker maintained by NPR. Roughly one-third of U.S. adults has yet to receive a single shot, and are more likely to be young, Republican or Republican-leaning and have lower levels of education and income than the vaccinated population, according to the Kaiser Family Foundation.

The federal strategy for getting shots in arms has pivoted from centralized mass vaccination sites to more targeted local efforts, with President Joe Biden stressing primary care’s role as trusted community physicians in a briefing in early July.

However, the new survey of more than 700 respondents fielded in mid-July found community doctors are now more involved in vaccinations, but are reporting challenges getting holdouts to change their minds about getting the shot — and continue to report major concerns about the stability of the sector.

More than half of respondents said hesitancy among unvaccinated people is “high and hard to counter,” which is contributing to rising levels of stress and burnout.

“I am exhausted from trying to counter the myths about covid and the vaccine,” one front-line Tennessee doctor wrote in response to the survey, while another physician from Kentucky reported patients are “not receptive to obtain.” States in the South and Midwest are currently lagging in vaccine uptake.

Overall, primary care doctors are reporting lower stress after intense COVID-19 surges in 2020, with 76% of respondents ranking the pandemic strain on their practice as low or moderate. However, 36% of doctors say they’re constantly lethargic, having difficulty finding joy in their life and struggle at times to think clearly.

That ongoing fatigue hints at potential threats to the U.S.’ primary care workforce, which has already shrunk in size in recent years due to rampant consolidation, closures and neglect that likely only worsened last year — threats the report deemed as “existential.” By one estimate, America’s primary care practices lost over $15 billion in 2020 during a catastrophic plummet in patient visits.

Of the respondents, 40% of doctors worry primary care will disappear in five years while 21% say they plan to leave primary care within three years.​

While the pressure is now on primary care to convert the most vaccine-hesitant, little has been done to support primary care to date,” Rebecca Etz, co-director of the Larry A. Green Center, said in a statement.

Clinician respondents to the poll called for the federal government to change policy around primary care to protect it as a common good and change how it’s financed and paid, so that it doesn’t compete directly with specialty care and moves away from fee-for-service models.