Primary Care & COVID-19: Round 35 Survey

• Two years into the pandemic, primary care practices—those still open—continue to feel the strain of COVID-19. Close to half (>46%) say that “U.S. primary care is crumbling.” Only a fifth of clinicians report that their practice is fully staffed, with 68% saying they have open staff positions that cannot be filled. 29% say they have personal knowledge of practices that have closed during the pandemic. And a majority (52%) report that their practice staffing ratios have changed to fewer staff per clinician.
• Clinician burnout remains strikingly high. Despite the development of COVID vaccines, better testing, and reopened doors, primary care clinicians continue to experience high levels of stress and fatigue. Over a third (36%) still say their level of burnout is at an all-time high, and over half (53%) say their ability to bounce back and/or adjust to adversity has become limited. Two-thirds (62%) have personal knowledge of clinicians who have retired early or quit during the pandemic.
• Patients are flooding into clinics, many with unmet needs. 40% of respondents say they are "flooded to overwhelmed" by patient needs. This may be, in part, due to patients needing to find new sites of care: 40% of clinicians report getting more new patients because of practice closures. And nearly 60% of respondents say that patient visits take longer than they used to because of unresolved or exacerbated concerns from delayed access to care during the pandemic.
• Primary care is adapting to meet patients’ needs in new and creative ways. Close to half (47%) of all respondents report adding or extending services not usually provided in order to prevent patients’ use of hospital or specialty care; 70% say they monitor COVID-19-positive patients at home or in the practice to prevent the use of hospital or specialty care. Notably, 72% of clinicians say they have become more involved in mental health support.
• Telehealth is one of those ways—and is likely here to stay. A quarter (24%) of respondents report relying on telehealth (either phone or video) for at least 30% of patient visits. A big driver of this may be patient preference: nearly half (49%) say they are motivated to use telehealth because their patients really like it. Another factor is reduced staffing. 20% of clinicians say lack of sufficient staffing has caused expanded use of telehealth in their practice.
• Still, barriers to telehealth remain a challenge. Over half (52%) of surveyed clinicians say that computer illiteracy makes it difficult to use telehealth with at least a fifth of their patients. About a third (30%) point to lack of broadband as a barrier for at least a fifth of their patients. And over a quarter (28%) blame insufficient payment as an obstacle that limits their practice’s use of telehealth.
• Primary care practices are playing a role in vaccine distribution, but it could be much bigger. Fewer than half of all respondents (44%) say their state has actively engaged primary care to help with vaccination distribution; and the same low percentage of respondents say patients view their practice as a COVID vaccination site. Well over a year since vaccine distribution began, less than 60% of clinicians report having adequate access to COVID vaccines that meets their needs.
• Overall vaccine hesitancy is on the rise. Primary care clinicians are seeing a decline in the use of vaccines generally, with 32% noticing a “year-over-year reduction in use of general vaccines by our patients” and 22% noticing “a year-over-year reduction in childhood vaccinations delivered at our practice.” Over a quarter (25%) of respondents say they have lost clinicians or staff because of a vaccine mandate in the practice.
• Comprehensive primary care is stepping up. Over 45% of clinicians say either they or their practice spoke publicly on the topic of COVID-19 or volunteered at mass vaccination sites. And they are expanding care to fully meet patients’ needs during the pandemic and beyond: A third of clinicians have increased their support for patients with food or housing insecurities; a quarter (26%) have increased offers of assistance to those with financial insecurity; and another quarter (26%) ask more screening questions about domestic violence and child abuse. 

Learn more: Download the Round 35 Clinician Survey Executive Summary (includes select open-ended answers to survey questions)