Hospitals dominate headlines when it comes to caring for those sick with COVID-19.
But the pandemic has also put a spotlight on an oft-overlooked segment of medicine: primary care physicians, who are screening patients and giving the authorization needed for most COVID-19 tests, as well as continuing to treat unrelated illnesses and to perform routine care.
Despite an influx of new testing sites and increasing capacity in recent weeks, the lack of a primary care provider among a large portion of state residents remains a barrier to testing across the state, according to Dr. Michael Fine, Pawtucket public health liaison and Central Falls health policy adviser.
“Access to primary care is your access to a test,” said Fine.
R.I. Department of Health spokesman Joseph Wendelken said access should not be an issue because the CVS Health Corp.’s rapid test site and those operated by respiratory clinics do not require primary care authorization.
But Central Falls Mayor James A. Diossa said the lack of a relationship with a primary care provider has depressed testing rates among residents in his city, many of whom also don’t have the ability to get to the CVS test site in Lincoln.
Lifespan Urgent Care is offering doctor’s notes and overseeing test results for those without primary care doctors, according to Olivier Gherardi, the medical director.
A bigger concern than access to testing was the 75% drop in patient volume at the urgent care center – a result of anxiety over potential exposure and some people not knowing the center remains open, Gherardi said.
‘No one is more essential to public health and safety than our primary care doctors.’
NOAH BENEDICT, Rhode Island Primary Care Physicians Corp. CEO
Visits to South County Health Medical & Wellness Center in East Greenwich – which are now all virtual – have also fallen significantly, though calls from anxious patients continue to rise, according to Dr. Brian Kwetkowski.
Many inquiries have been from patients seeking a doctor’s note to get tested at many of the state-run testing sites. Some patients already diagnosed with the virus needed medical-leave paperwork completed, while others wanted to run their symptoms by a doctor, unsure if they had COVID-19. Some calls were from people without a doctor who wanted to become patients.
Kwetkowski’s office has stopped accepting new patients because of the difficulty of establishing a relationship via telehealth appointments, as well as cuts to staffing and hours amid a loss of revenue. Other practices have taken similar steps, exacerbating existing access issues.
While some people didn’t seek primary care treatment before the pandemic because of a lack of interest, others have had difficulty finding someone to take them, Fine said. Rhode Island has the most primary care physicians per capita of any state, according to a 2018 report by the United Health Foundation, yet it faces a significant doctor shortage that is predicted to grow over the next decade as practitioners retire.
Compounding the inaccessibility of primary care is a lack of a coordinated state system to match patients with providers, said Noah Benedict, CEO of Rhode Island Primary Care Physicians Corp.
Another factor is money. Primary care practitioners’ average salaries are a fraction of that of neurosurgeons and other more-lucrative specialties, according to Doximity’s 2019 physician compensation report.
Pediatric physicians make among the lowest average salaries, a hardship compounded by the fact that Rhode Island pediatricians have the second-lowest insurance reimbursement rate in the country, according to Dr. Dinusha Dietrich, of Smithfield Pediatrics Inc. And the drop in patient volume during the pandemic has put her small practice under great financial pressure. The practice has been forced to lay off one employee and cut hours for another four.
Kwetkowski’s office also laid off two medical assistants amid revenue declines, and he worried about the practice’s future, fearing that people’s anxiety about possible exposure would continue to dampen patient visits – and, in turn, revenue – after the pandemic threat fades.
One area of good news for primary care doctors is telemedicine. Many have quickly adapted to conducting more virtual visits, with the mandate from Gov. Gina M. Raimondo that insurance companies provide reimbursement equal to a typical office visit.
Whether this would continue after the pandemic remained unclear. Dr. Claire Levesque, chief medical officer for commercial products at Tufts Health Plan, said the company needed more information before making any decisions.
Telehealth could improve primary care access without a significant injection of new providers, according to Dr. Steven Lampert, president of Lifespan Physicians Group Inc.
“It’s conceivable that primary care doctors might be willing and able to carry a [patient load] larger than what was typical before the pandemic thanks to innovative practices [such as] telemedicine,” he said.
Above all, providers hope their role in the crisis will highlight their importance beyond the pandemic.
“This is a watershed moment for primary care,” Benedict said. “No one is more essential to public health and safety than our primary care doctors.”
Nancy Lavin is a PBN staff writer. Contact her at Lavin@PBN.com.
