Increased Organizational Stress in Primary Care: Understanding the Impact of the COVID-19 Pandemic, Medicaid Expansion, and Practice Ownership

• DOI: 10.3122/jabfm.2023.230145r2
• Publication Date: 2024-01-11T16:40:17Z
• Authors: Jacqueline B. Britz; Alison N. Huffste...; E. Marshall Brooks; Alicia Richards; Roy T. Sabo; Ben K. Webel; Neil McCray; Alex H. Krist
• Keywords: Stressor; Equity; Pandemic; Scope of Practice

<h3>Background:</h3> Primary care is the foundation of health care, resulting in longer lives and improved equity. was frontline COVID-19 pandemic public response essential for access to care. Yet primary faces substantial structural systemic challenges. As part a longitudinal analysis track capacity we surveyed every practice Virginia 2018 again 2022. <h3>Methods:</h3> Surveys were emailed or mailed up 6 times nonresponders received phone call. Questions assessed organizational characteristics, scope capacity, stress prior year. From respondents, 39 clinicians, nurses, staff, administrators, managers interviewed. <h3>Results:</h3> 526 out 2296 practices (23% rate) completed survey, with broad representation across geography, ownership, payer mix. Compared 2018, 2022 there increases owned by systems (25% vs 43%, <i>P &lt; .0001</i>) average percent patients Medicaid per (12% 22%, .0001</i>). The reporting any major stressor increased from 34% 53% (<i>P main losing clinician, 13% versus 42% clinician <h3>Conclusions:</h3> are resilient continue serve their communities, including services underserved people. However, caused significant stress. With an increase clinicians leaving clinical practice, anticipate worsening