Primary Care & COVID-19: Week 15 Survey

Check back weekly for the latest survey results and updates.
For data from the previous survey, see Week 14 Results.

Who replied to the survey in Week 15?

The Larry A. Green Center, the Primary Care Collaborative and 3rd Conversation are partnering to regularly survey primary care clinicians and patients to better understand the impact of COVID-19 in real time.

The most recent survey, fielded June 26-29, had 735 respondents from 49 states. Over 63% of the clinicians reported their practice as family medicine, 17% as internal medicine, 8% as pediatrics, and 6% as geriatrics. Consistent with previous surveys, over 64% of the respondents practice in a setting with fewer than 10 clinicians, and 22% practice in rural communities. Over 34% report owning their practice, 39% practice in a setting owned or operated by a health system or hospital, and 12% are part of a larger independent group practice.

Results at a glance

Uncertainty pervades as cases migrate, outbreaks surge, and economic relief may expire.

In recent weeks, COVID-19 cases have migrated to the South and West, with outbreaks occurring in both urban and rural communities. According to the Kaiser Family Foundation, 26 states had 14-day upward trends in cases and positivity rates on June 25. At the same time, practices are reopening to in-person visits in all parts of the U.S., while clinicians express great uncertainty and concern over the duration and severity of COVID-19’s impact on their practice.

When asked to look ahead to the next 6 months and evaluate their practice’s readiness for changes in patient volumes and payment policies, over 30% feel unready or “spent” from the demands of the pandemic, and over 40% feel unready for another wave.  

The pressures on primary care practices are multifaceted. 45% of practices don’t have PPE, and 61% are reusing PPE. Fewer than 50% of practices report having enough cash on hand to stay open, over one-third have laid off or furloughed staff in the last 4 weeks, and 53% report that patients are not scheduling well visits or chronic care visits despite their availability in the practice.

In addition, nearly 70% of practices are not ready for reduced or terminated payment for audio and video visits, which CMS will terminate when the national emergency is declared over unless Congress acts to extend payments. Only 17% expect to receive prospective payment from any payer in the next 4 weeks, indicating how dependent practices  continue to be on fee-for-service revenue.

Overall, 70% of clinicians report a level of strain on their practice of 4 or 5 out of a 5-point scale, and 38% of practices agree with the statement that “burnout in my practice is at an all-time high.” The level of strain has been consistently at 4 or 5 for at least 60% of practices since the first surveys were taken more than three months ago.

There is a growing toll, including social isolation, economic stress, and deferred patient care.

More than 83% of clinicians report “higher than normal” rates of emotional and mental distress among their patients, and 56% report the exacerbation of health issues among patients due to lack of appropriate care during the most recent four weeks of the pandemic. Almost 25% report seeing higher than normal dental issues due to the closure of dental practices.

Almost 60% of practices report limitations in making referrals because other medical offices are closed. COVID-19 testing result delays (beyond 3 days) are reported by 55% of respondents.

Learn more: Download:

• Series 15 Clinician Executive Summary (includes select open-ended answers to survey questions)

• Infographic

Voices from Clinicians on the Primary Care Front Lines

Clinicians' mental and financial stress is mounting.

Heartbroken that our office is being closed due to impact of coronavirus on financial picture. (Massachusetts)

Seeing fewer patients per day to keep waiting area socially distanced… even so, everyone is overworked/burned out because patients coming in are often overdue for mgt of chronic conditions, and we have to order/review labs, etc. (North Carolina)

Everyone is getting close to breaking due to long term anxiety. (Ohio)

We do not have a program to assist with any employee burnout/depression; myself and another provider have been treating our staff for mental health issues for months but there is nowhere for us to go to help ourselves. (Washington)

I give up trying to navigate all this, AND follow all regulatory demands, AND use an EMR, AND risk spreading disease to my family. I'm retiring and leaving my practice at the end of the year. (Oregon)

There is still a lack of leadership.

Cases have been surging for the past couple of weeks. I am frustrated at the lack of state leadership not allowing local elected officials to stop the phased reopening, reinstate stay at home orders, and require masks. (Texas)

Aside from clinic admin not treating this as a pandemic situation and not developing proper screening policies, the public appears very uninformed about infection control/prevention. (Tennessee)

The abuse and exploitation of primary care practitioners and the marginalized communities we serve is such a breech of the social compact. (Colorado)

Clinicians are worried about the lack of time for recovery when there are new surges of COVID-19.

We're exhausted but have to play catch up with care delayed. I do not have enough appointments to do the basics. (Michigan)

Needs due to previous deferred care are mounting to more than we can handle. Very stressful to be constantly overbooking to give appropriate care. (Wisconsin)

We are starting to see more patients in the office to accommodate their needs now that PA is in the green phase, yet the cases in our state are starting to increase again… I am worried about the fall and winter surge. We have no plan in place to address this. No access to N95… All providers in my office continue to take a pay cut... Primary care continues to be forgotten, especially privately-owned practices, yet we are vital to the medical care of our communities! (Pennsylvania)