Clinicians Overwhelmingly Agree Primary Care Has Not Rebounded

While patient volumes are creeping back to pre-pandemic levels for some providers, clinicians overwhelmingly agreed in a recent survey that primary care has yet to rebound and it is unlikely to reach pre-pandemic volumes for a while.

The survey conducted Sept. 4 through 8, 2020, by the Larry A. Green Center, a research organization, in collaboration with the Primary Care Collaborative (PCC) received responses from 489 primary care clinicians.

Of those respondents, 81 percent disagreed with the notion that primary care has rebounded.

Fewer than half of practices have the same number of clinicians working the same hours compared to before the pandemic, the survey also found. Additionally, 1 in 3 clinicians reported that fee-for-service volume was still down between 30 to 50 percent compared to levels from before the pandemic.

It could take over a year to bounce back from the position practices are finding themselves in, according to some survey respondents. Challenges presented by the upcoming flu season and new surges of COVID-19 cases are also not helping practices rebound.

“The vast majority of primary care practices have not returned to their pre-pandemic status. The primary care system is fragile and shrinking as we approach the cold and flu season,” said Ann Greiner, president and CEO of the PCC, said in a press release. “Practices need state, federal, and private-sector support to address disruptions to primary care funding so that they can safeguard the health of the public. Primary care is pandemic preparedness.”

Financial support from the federal and state sources is running out for primary care practices. About 27 percent of clinicians said previous pandemic financial support has run out or will soon.

About 18 percent also said payers are pulling pack on telehealth, meaning less reimbursement for virtual care services which have helped to boost patient volumes as in-person visits remain low.

The financial position primary care practices are currently in is a marked improvement from previous surveys in which 1 in 5 clinicians anticipated closing their practices because of the COVID-19 pandemic. However, the current position is still not ideal.

About 35 percent of clinicians in the most recent survey said revenue and clinician pay are still significantly lower than pre-pandemic levels and net losses threaten current and future viability. Another third of clinicians also stated that “the financial picture has been slowly improving, but the workforce is fragile and in trouble.”

Additionally, 1 in 5 practices reported they have clinicians who have chosen early retirement or left their jobs as a direct result of the pandemic.

Still, only 3 percent of clinicians in the survey said their practice will likely close before December without additional state or federal support.

“Practice clinicians and staff are working longer hours to keep up with patient needs and still have yet to reach pre-pandemic capacity,” said Rebecca Etz, PhD, co-director of the Larry A. Green Center, in the release. “Significant furloughs, practice members out for child and elder care, and clinicians out due to illness and self-quarantine have caused the primary care platform to shrink.”

“The past six months have shown us what short-term planning and lack of investment yields during times of crisis – devastation of a critical workforce. But the question is now: Are we committed enough to do something about it,” Etz asked.

The authors of the survey report called for “state, federal, and private sector leadership to address disruptions to primary care funding and supply chains to safeguard the health of the public.”

In previous surveys, the authors have explicitly urged all payers to keep or advance payment parity for video- and phone-based care. They also advised payers to test new payment models to “sustain and grow a reliable health care system.”