Primary health care in times of crisis: a recipe for recovery and resilience

COVID-19 has impacted the workforce across every industry in the US, from hospitality to manufacturing to retail, and healthcare is certainly no exception. System stress, increased costs, labor shortages, and increased personal risk of disease have created the perfect storm for higher burnout and reduced resilience among primary care providers.

The work of primary care physicians as the most reliable source of medical information for patients should be highly valued. The field is too critical to collapse. Unfortunately, it can do just that.

The crisis we face today

In March 2020, the Larry A. Green Center at Virginia Commonwealth University launched a series of national surveys tracking the impact of COVID-19 on primary health care. Our latest study, two years after the start of the pandemic—a sample of 73% of family physicians and 27% of other professionals such as internists, pediatricians, nurse practitioners, and psychologists—showed that the number of primary care workers is declining. In fact, one in four clinicians said they plan to leave the field within the next three years, and 62% know of a colleague who has already left during the pandemic.

Clinicians are working beyond their means, with more than a third (35%) reporting burnout rates at historic highs, and more than half (53%) saying their ability to recover from or adjust to adversity has become limited. Almost half of the respondents (46%) support the view that primary health care is “collapsing”.

Here’s the message for top health leaders: act now to ease the burden on primary health care or it will fail on your clock.

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Stretched to the limit

Primary health care practices are usually the first stop for patients. Whether it’s routine checkups or acute problems such as respiratory infections, more than 500 million visits a year occur in these settings – more than half of the total number of outpatient visits. Despite this critical role, primary care received less than 3% of emergency federal financial support as loans and assistance programs were rolled out early in the pandemic.

More resources would be helpful to address the challenges of the pandemic, such as the lack of personal protective equipment, the inability to administer vaccines, increased health risks, and the rapid shift to telemedicine. According to a 2021 study, primary care physicians are five times more likely to die from COVID-19 than physicians in any other specialty, including emergency and intensive care physicians.

Despite staff shortages, many practitioners have had to expand services. They have expanded patient populations, included mental health services, helped with food and housing insecurity, and taken on the responsibility of monitoring COVID-19 patients at home. According to our data, 40% of clinics reported higher workloads due to previous patient rooms being closed; 44% stated that they have open vacancies for doctors; and 68% have non-clinical positions they cannot fill.

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