Family medical practices suffer under the strain of the COVID-19 pandemic
.jpg "Women wearing face masks in a tramway during a media presentation in Jena, Germany, Friday, April 3. Jena became first German city to make wearing a face mask mandatory.")
Just months ago, I was practicing family medicine as I have for more than a dozen years, providing women’s health services, chronic disease management, and other preventive and primary care services to my patients. I didn’t predict that by spring, I would be on the front lines of a pandemic that will have a devastating impact on our country.
COVID-19 has placed a tremendous strain on our economy and our health care system — touching everyone in some way. It also has provided a clear line of sight into disparities, shortcomings and failures of our current health care system, including the chronic underfunding of primary care.
Our commitment to our patients remains our top priority, but it’s becoming increasingly difficult to keep our doors open to serve their needs. In addition to providing essential health care, we are also small businesses. Our small practice has two physicians, three nurse practitioners and 20 other staff. Before the coronavirus, we saw about 100 patients per day, which has been drastically cut by more than half. On an average day now, we see about 40 patients. Even as guidance is anticipated to allow for more non-COVID care, patients are nervous and will likely continue to delay the primary and preventive care in which I specialize.
The truth is, the future is uncertain as we see fewer patients, and we simply don’t know when or how that might change.
Our practice is not alone. Last month, the California Academy of Family Physicians (CAFP) fielded a survey to members inquiring if and how the financial sustainability of their practices has been impacted by the COVID-19 pandemic. The early results of this member survey are stark:
▪ 91 percent of respondents reported that the COVID-19 pandemic has negatively affected the financial sustainability of their practice.
▪ Of those, 42 percent indicated that the impact is “extreme.”
▪ 92.5 percent reported that the reason for financial instability is a significant reduction in patient visits.
Family physicians specialize in keeping people healthy. We provide the care that keeps people out of emergency rooms and other care facilities. If family practices shut their doors, it will not only have a direct impact on our ability to manage the COVID-19 pandemic, but will further undermine the stability of our system.
An increase of one primary care doctor per 10,000 people has been shown to result in:
▪ 5% decrease in outpatient visits
▪ 5.5% decrease in inpatient admissions
▪ 10.9% decrease in emergency room visits
▪ 7.2% decrease in surgeries
Despite the clear benefits of primary care, on average, health insurers spend only about 5% of health care dollars on primary care. Many organizations are sounding the alarm that even this minor investment may be undermined during the pandemic, which would put more stress on an already fragile system, and harm patients in the process.
While we work to help our patients recover from COVID-19, we also need help ensuring family practices remain available to patients. Things will not go back to normal once we have flattened the curve. We need solutions that will respond to the immediate and severe threat to the financial sustainability of primary care physician practices.
Moreover, health plans should be taking Medicare’s lead and providing family physicians with temporary, predictable payments that would allow us to continue serving our communities. This Medicare program was an essential lifeline and helped many family physicians continue to serve their patients.
Together we can reinvent a future health care system that supports, encourages primary care and makes us better prepared to handle any future pandemic.