Key Points
Question Is the presence of a primary care physician (PCP) associated with the likelihood of emergency department visits or hospitalization for patients with end-stage kidney disease receiving dialysis?
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The finding that nearly half of patients had no prior treatment supports the importance of primary care as a crucial component of MOUD. Practices in HOMER were similar to practices across the country. Patients enrolled were typical of family practice patients. Policies that support primary care MOUD may improve access to patients.
The search for health care providers has become common in Washington and spans specialties, from surgery to psychiatry, but the state’s primary care landscape faces a particularly wide range of challenges that continue to worsen. Several factors are related to the long-looming reality of an aging population that’s older, on average, than the U.S. has ever been. This means providers are retiring, while patients are starting to require more complex care.
“It’s not just one thing people are coming in for,” said Dr. Adam Jayne-Jensen, an internal medicine doctor who oversees five UW Medicine clinics in Seattle. “It’s five different things. You’re trying to manage diabetes when they’re there for a cough.”
The onset of the COVID-19 pandemic in March 2020 was a major disruption to many industries and businesses, including primary care. Primary care practices saw most patients in person before the pandemic, but the sudden shutdowns as a global pandemic was declared forced many practices to find a different way of operating. For some, the pivot to providing virtual visits was quick, while others took longer to adapt. This report shows the evolution of primary care’s adaptation to telehealth services in the first months of the pandemic. Data to construct the following graphs was from primary care clinician surveys conducted by the Larry A. Green Center and the PCC, specifically the surveys conducted from March 2020 to May 2021.
The graph below shows the percentage of clinicians who reported that their patients were unable to access telehealth services due to lack of equipment and/or broadband issues. During just the month of April, there was a gradual decline that starts, from 72% to 65%, meaning more patients were gaining access to telehealth. However, from the end of April to the middle of May, there is a steep increase, from 65% to 85%, meaning patients were unable to access telehealth services. This is most likely due to the sudden rise in COVID cases and lack of resources to respond. Nonetheless, toward the end of May, there is a drastic decline, where only 29% of patients were having no or limited access to telehealth. The data shown is from the first months of the pandemic – from the beginning of April to the end of May – where we go from 72% of patients reporting lack of access to telehealth to only 29%.
The graph below shows the percentage of non-telehealth usage reported among practices. There was an increase in telehealth video usage from March to May; however, there was fluctuating use of virtual visits and patient portals. Among both, there was an increase in usage in March; however, at the beginning of April, there was a decline in telehealth use and then a gradual rise in usage until May.
The graph below shows the percentage of majority telehealth used between video and phone. There is an increased use in phone service for telehealth, which shows the increasing adoption and expansion of telehealth.
In conclusion, the data shows that primary care was able to quickly move to viritual visits but had scarce resources to maintain it at the time. Nonetheless, in the September 2021 survey, it was noted that 36% of practices had adopted new telehealth software – a change that happened during the pandemic. The data shown in the graph below illustrates the tremendous progress in adopting and sustaining telehealth from the start of the pandemic in March 2020 until September 2021.
WASHINGTON, April 19, 2022 The Larry A. Green Center, in partnership with the Primary Care Collaborative (PCC), today released new survey data showing that 25% of primary care clinicians plan to leave the field within the next three years. In fact, the same survey revealed 62% of primary care clinicians have personal knowledge of clinicians who retired early or quit during the pandemic.
This data comes at a critical time when primary care clinicians are working on the front lines of preventive medicine, yet no official database exists to track the number of active primary care practices or clinicians in the U.S., and 36% of primary care physicians report burnout levels at an all-time high.
Nearly half of respondents (46%) believe that primary care is crumbling, and more than half (53%) report that their ability to bounce back from or adjust to adversity has become limited increasing from 29% a year ago.
Two years into the COVID-19 pandemic, primary care clinicians are overwhelmed with patient needs and are seeing more unresolved or exacerbated health concerns from delayed access to care resulting in longer-than-usual patient visits.
Primary care practices are a crucial component of our health system, yet they receive an extremely small amount of federal funding, and we have no national tracking system for oversight and to identify what support they need, said Rebecca Etz, PhD, co-director of The Larry A. Green Center. Since the onset of the pandemic, primary care clinicians have faced PPE and supply shortages, more COVID-19 health risk than any other specialty, and the huge challenge of moving from in-person visits to telehealth within the span of three weeks. It is time to reduce stress on clinicians as well as stabilize and strengthen the primary care system overall, through formal federal support that includes adequate funding.
While we applaud primary care s resilience and commitment to patients, it is still facing a policy crisis, even if the official COVID-19 public health emergency is soon declared over, said Ann Greiner, PCC s President and CEO. Policymakers must respond or else watch primary care collapse on their watch. The recommendations for policy changes in last year s report, Implementing High-Quality Primary Care, from the National Academies of Sciences, Engineering, and Medicine are a key launch pad for this response and are supported by a wide cross section of stakeholders.
Since March 2020, the Larry A. Green Center and Primary Care Collaborative have collected data from primary care clinicians indicating drastic staffing cuts, closures and other financial setbacks that could be alleviated with policy changes that better realize the potential for primary care as an essential function of the healthcare system. The latest data shows that primary care continues to operate in crisis, with understaffed practices seeing an influx of new patients as other practices close. Practices are also struggling financially, with nearly one-third (32%) reporting having current billing either denied or well overdue from insurers or health plans.
The survey of clinicians was fielded from February 25 to March 1, 2022, and received 847 responses from clinicians in 49 states and Washington, D.C. Respondents were made up of: 63% who identified their practice as family medicine, 11% as internal medicine, 5% as pediatrics, 3% as geriatrics, and 4% as other.
More information about the survey
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About the Primary Care Collaborative
About The Larry A. Green Center:
The Larry A. Green Center for the Advancement of Primary Health Care for the Public Good is a thought collective founded by Rebecca Etz, PhD at Virginia Commonwealth University and Kurt Stange, MD, PhD at Case Western Reserve University. The Green Center works to reclaim and reconstitute the intellectual foundations of primary care, to advance the science of medicine learned and practiced within layered and competing social frameworks of meaning, and to deliver on a now 50 year old promise: better health and improved health care through a synergistic focus on both humanism and healing. We are nimble, inquisitive, curious, and open. We make personal doctoring and innovation visible.
Responses came from 847 clinicians in 49 states and Washington, D.C.
Specialties: 63% family medicine, 11% internal medicine, 18% pediatrics, 3% geriatrics, 5% other
Type: 73% MDs, 6% DOs, 11% NPs, 4% PAs, 5% other
Settings: 28% community health centers or similar, 19% rural, 17% residencies
Practice size: 27% had 1-3 clinicians, 42% had more than 10 clinicians
Ownership: 28% self-owned, 42% system-owned, 6% government-owned, 4% membership-based
The survey was conducted February 25-March 1, 2022
Most people get their medical advice from their doctors. But many may soon get it from state legislators, a frightening prospect that has already become law in two states and may happen in 24 more, with 47 pieces of active legislation under consideration.
