<?xml version='1.0' encoding='UTF-8'?><xml><records><record><source-app name="HighWire" version="7.x">Drupal-HighWire</source-app><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Britz, Jacqueline B.</style></author><author><style face="normal" font="default" size="100%">Huffstetler, Alison N.</style></author><author><style face="normal" font="default" size="100%">Brooks, E. Marshall</style></author><author><style face="normal" font="default" size="100%">Richards, Alicia</style></author><author><style face="normal" font="default" size="100%">Sabo, Roy T.</style></author><author><style face="normal" font="default" size="100%">Webel, Ben K.</style></author><author><style face="normal" font="default" size="100%">McCray, Neil</style></author><author><style face="normal" font="default" size="100%">Krist, Alex H.</style></author></authors><secondary-authors></secondary-authors></contributors><titles><title><style face="normal" font="default" size="100%">Increased Organizational Stress in Primary Care: Understanding the Impact of the COVID-19 Pandemic, Medicaid Expansion, and Practice Ownership</style></title><secondary-title><style face="normal" font="default" size="100%">The Journal of the American Board of Family
                Medicine</style></secondary-title></titles><dates><year><style  face="normal" font="default" size="100%">2023</style></year><pub-dates><date><style  face="normal" font="default" size="100%">2023-12-13 08:02:59</style></date></pub-dates></dates><elocation-id><style  face="normal" font="default" size="100%">jabfm.2023.230145R2</style></elocation-id><doi><style  face="normal" font="default" size="100%">10.3122/jabfm.2023.230145R2</style></doi><volume><style face="normal" font="default" size="100%"></style></volume><issue><style face="normal" font="default" size="100%"></style></issue><abstract><style  face="normal" font="default" size="100%">Background: Primary care is the foundation of health care, 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 6 times and nonresponders 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 2296 primary care practices (23% response rate) completed the survey, with broad representation across geography, ownership, and payer mix. Compared with 2018, in 2022 there were increases in practices owned by health systems (25% vs 43%, P &lt; .0001) and average percent of patients with Medicaid per practice (12% vs 22%, P &lt; .0001). The percent of practices reporting any major stressor increased from 34% to 53% (P &lt; .0001). The main increased stress was losing a clinician, with 13% of practices in 2018 versus 42% in 2022 reporting losing a clinician (P &lt; .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-19 pandemic caused significant stress. With an increase in clinicians leaving clinical practice, we anticipate worsening access to primary care.</style></abstract></record></records></xml>