May 29, 2020, 01:35 pm Michael Devitt – For the past several weeks, the AAFP National Research Network, in partnership with the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, has been surveying AAFP NRN members and, more recently, AAFP members to understand how the COVID-19 pandemic has affected family physicians and their practices and to help guide the Academy in its ongoing advocacy efforts.
The Graham Center recently posted final reports from the first six weeks of surveys, which provide a glimpse into the pandemic's effects. The results show that in just a short time, the outbreak has already dramatically reshaped the professional and financial outlook of many FPs -- information the Academy will use to support and fight for family medicine now and in the years to come.
"This pandemic will have a lasting effect on the specialty," said Elisabeth Callen, Ph.D., GStat, a senior data scientist with the AAFP NRN. "We need to know what is happening now so we can help, as we can, with short- and long-term impacts. Our results will inform AAFP's continued efforts to address needs brought on by the pandemic."
"The survey is showing a clear financial impact to many practices nationwide," added Yalda Jabbarpour, M.D., medical director at the Robert Graham Center. "These stories need to be heard by policymakers. Given the importance of primary care to the health of the community, policy changes need to be made to support these practices."
According to Ann Wade, a research engagement specialist with the AAFP NRN, the weekly survey typically consists of the same set of core questions so that researchers can not only document what FPs are experiencing now, but also follow and measure trends over time.
The first survey went to AAFP NRN members on March 27, two weeks after the United States declared a national emergency in response to the pandemic. It closed March 30.
Beginning with the second survey, fielded April 3-6, the number of questions was expanded to collect information on treatments FPs used for patients with confirmed or suspected COVID-19. Additional highly topical questions have also been included periodically.
Slightly more than 92% of all respondents who have taken the survey at least once said they specialize in family medicine. About 55% of respondents reported working in a primary care-only setting, while about 13% belonged to a multispecialty group.
More than three-quarters of respondents reported treating patients with suspected COVID-19 or who displayed symptoms associated with the disease. The most common treatments provided week-to-week included
When survey respondents were first asked about treatment options, more than 6% reported providing chloroquine or hydroxychloroquine. That number increased to 10% the following week but had dwindled to zero by the end of April.
Each week, about one-half of respondents have reported extensive declines in patient volume, which has severely impacted practice revenue and hindered clinicians' ability to pay operating costs and other expenses. Some respondents reported scheduling fewer appointments to address chronic conditions, as well as reductions in acute care appointments resulting from shelter-in-place recommendations.
Many respondents have reported embracing telehealth. On average, more than 30% of respondents said they either already offered or planned to offer remote care. However, remote care visits did not make up for the lack of in-person visits, resulting in decreased revenue.
In addition, numerous respondents have reported using various strategies, either alone or in combination, to offset declining revenues. Some clinicians chose to forego their own salaries or bonuses; others reduced staff hours, transferred staff to areas with increased demand, and/or implemented layoffs or furloughs. But even after implementing salary cuts, reduced hours and other staffing changes, a substantial proportion of survey respondents said their practices were experiencing severe financial stress.
"I am disheartened that so many practices report so much financial strain," Jabbarpour told AAFP News. "It just highlights the fact that chronic underinvestment in primary care and a fee-for-service payment structure lead to a health care system that starts to crumble when any stress is put on it."
Perhaps most significantly, some practices reported that they might not be able to withstand the long-term financial effects of the pandemic. In the April 17-20 survey, participants were asked how long they would be able to continue providing care under the current circumstances. Of those who responded, more than 59% said they could continue operating for more than six months. However, more than 22% reported that they would only be able to provide care for two months or less.
Jabbarpour, who also is a practicing family physician at MedStar Health in Washington, D.C., described the effects the pandemic has had on her personally and professionally.
"I work for a large multispecialty health system," she said. "We were fortunate in that we had the resources to switch to video-enabled telehealth almost immediately. Nonetheless, our patient volume did drop in the initial months of the pandemic, and as a result, we had to furlough and redeploy some of our staff. Recently, though, we have seen a large spike in visits. Some are related to COVID, some are related to catching up on chronic condition and preventive visits, (but) most are related to the mental health effects of the pandemic.
"Personally, the pandemic has just caused a lot of worry," Jabbarpour continued. "I worry that many of my patients are too afraid to call us with complaints that may snowball into larger issues. I also worry that I am not catching diseases via telehealth that I would in person. I worry about our patients and staff as we do return to in-person visits; how will we keep everyone safe? And, of course, as a parent of school-aged children, my biggest worry is how do I continue to work and serve the community if schools stay closed and we have no safe child care options?"
Callen told AAFP News that the current projected end date for sending surveys is six months after the end of the pandemic.
"We will continue to ask questions about telehealth, sustainability, impacts, mental health and reopening," Callen said. "We plan to ask questions around policies, patient panels and other topics as the need arises."
Surveys are distributed each Friday morning and close at 11:59 p.m. PT the following Monday. According to Wade, the survey typically takes less than five minutes to complete.
AAFP members who wish to participate are invited to provide their email address to begin receiving the survey link each Friday morning.