ORIGINAL RESEARCH
Jacqueline B. Britz, MD, MSPH; Alison N. Huffstetler, MD; E. Marshall Brooks, PhD; Alicia Richards, BS; Roy T. Sabo, PhD; Ben K. Webel, BA; Neil McCray, PhD, MPP; Alex H. Krist, MD, MPH
Corresponding Author: Jacqueline B. Britz, MD; Virginia Commonwealth University - Department of Family Medicine and Population Health
Email: jacqueline.britz@vcuhealth.org
DOI: 10.3122/jabfm.2023.230145R2
Keywords: COVID-19, Family Medicine, Health Policy, Health Services Accessibility, Health Workforce, Medically Underserved Area, Medicaid, Pandemics, Practice-based Research, Primary Health Care, Surveys and Questionnaires, Virginia
Dates: Submitted: 04-15-2023; Revised: 06-26-2023; 07-14-2023; Accepted: 07-24-2023
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BACKGROUND: Primary care is the foundation of healthcare, resulting in longer lives and improved equity. Primary care was the frontline of the COVID-19 pandemic public response and essential for access to care. Yet primary care faces substantial structural and systemic challenges. As part of a longitudinal analysis to track the capacity and health of primary care, we surveyed every primary care practice in Virginia in 2018 and again in 2022.
METHODS: Surveys were emailed or mailed up to six times and non-responders received a phone call. Questions assessed organizational characteristics, scope of care, capacity, and organizational stress in the prior year. From respondents, 39 clinicians, nurses, staff, administrators, and practice managers were interviewed.
RESULTS: 526 out of 2,296 primary care practices (23% response rate) completed the survey, with broad representation across geography, ownership, and payer mix. Compared to 2018, in 2022 there were increases in practices owned by health systems (25% vs. 43%, p<0.0001) and average percent of patients with Medicaid per practice (12% vs. 22%, p<0.0001). The percent of practices reporting any major stressor increased from 34% to 53% (p<0.0001). The main increased stress was losing a clinician, with 13% of practices in 2018 vs. 42% in 2022 reporting losing a clinician (p< 0.0001).
CONCLUSIONS: Primary care practices are resilient and continue to serve their communities, including a broad scope of services and care for underserved people. However, the COVID pandemic caused significant stress. With an increase in clinicians leaving clinical practice, we anticipate worsening access to primary care.