COVID-19 Resource Center

COVID-19 Resource Center

Disclosures: Greiner reports no relevant financial disclosures.
August 07, 2020
3 min read

Stress remains high among primary care practices amid COVID-19 pandemic

Disclosures: Greiner reports no relevant financial disclosures.
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Primary care practices are still experiencing significant strain amid the COVID-19 pandemic, according to recent results from the COVID-19 Primary Care Survey.

“Stress levels remain very high even through we’re 5 months in, and in some areas of the country there’s been lessening of the virus,” Ann Greiner, president and CEO of the Primary Care Collaborative, told Healio Primary Care. “It is unfortunate and concerning primary care practices are not on firmer footing as the country anticipates there may well be a second wave of the pandemic.”

Stress to primary care practices July 2020
Reference: Primary Care Collaborative. Primary care & COVID-19: Week 17 survey.

The survey, which was conducted by the Larry A. Green Center and the Primary Care Collaborative, included responses from 523 primary care clinicians from 47 states and Guam.

The survey revealed that 55% of clinicians have a stress level of four or five out of a possible five. Among the clinicians, 33% reported that their stress at the time of the survey was worse than it was in the first month of the COVID-19 pandemic, and 43% reported that the strain to their practice was the same but they adjusted to it or that it was improving.

In addition to stress to practices, respondents reported increased stress among patients, with 80% reporting that their patients had a heavier mental health burden than what they typically see.

Photo of Ann Greiner August 2020
Ann Greiner

Of the participating clinicians, 51% reported that in the previous 4 weeks they had observed an uptick in suspected cases of COVID-19. Greiner said that “there’s no doubt” that if cases continue to rise, stress to practices would worsen because practices are still financially vulnerable and patients may not get needed care.

She added that patients pulled back from in-person visits during the COVID-19 pandemic, with some relying more on telehealth and others putting off care that is necessary to manage their chronic conditions or mental health.

Greiner said that “high rates of mental anguish on the part of their patients, concerns about deteriorating health of their patients stress about their own financial vulnerabilities — it all adds up to quite a perfect storm.”

“Many have been waiting for a lifeboat from the federal government or health plans that just hasn’t come,” she said.

The survey further showed that 26% of respondents described a physically and emotionally damaging work environment, with clinicians reporting exposure to serious illness, lacking PPE or being required to wear it at all times, and having to physically distance from patients and colleagues while witnessing COVID-19-related emotional difficulties and stress.

According to Greiner, one way clinicians, particularly those in independent practices, can address stress is by turning to their professional society for help acquiring needed supplies or changes in policies to better support primary care practices.

For example, Greiner said the ACP has partnered with a PPE supplier — Project N95 — to help provide PPE to internal medicine physicians. The organization plans to offer PPE more broadly to other specialties and types of clinicians, she said.

The Primary Care Collaborative recognized health plans that have taken measures to help practices remain in business during the COVID-19 pandemic in their Health Plan Honor Roll.

“This is such a dire emergency, and many health plans are in a good financial position,” Greiner said. “They should be doing what they can to use that position to support practices that are financially vulnerable.”

Recent additions to the list include Blue Cross Blue Shield of North Carolina, which offered financial support for small and independently owned practices that commit to joining the health plan’s value-based program.

Another plan, Blue Shield of California, announced that it would be providing $200 million in support to hospitals and providers.

“Let’s make sure that primary care practices are strong and viable so that if we do encounter a second wave of the virus when the weather gets cold, they’re there to help keep patients healthy and safe, administering the flu vaccine and taking care of their preventative and chronic care needs, which is a guard against getting really sick, including with the COVID-19 virus,” Greiner said.


Primary Care Collaborative. Primary care & COVID-19: Week 17 survey.

Primary Care Collaborative. Quick COVID-19 primary care survey. Accessed August 4, 2020.

ACP. American College of Physicians and Project N95 Partner to Provide PPE for Frontline Internists. Accessed August 5, 2020.