Letters from Dr. Jonas
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Dear Friend,

COVID has had a large impact on many primary care physicians' financial, personal, and mental health, but these problems began well before the pandemic. Depression, anxiety, financial distress, substance abuse, and suicidality have been high in primary care for years.

Over 50 percent of all annual medical visits are with primary care providers; but this health discipline gets less than seven percent of total healthcare expenditures and 0.2 percent of the National Institutes of Health funds. The lack of financial reimbursement and research compounds the difficulty of balancing the health needs of whole persons and the personal distress of physicians.

To implement current requirements for good health maintenance, it would take an unrealistic 20 hours a day. Mentally, physically, and financially this takes a toll on primary care physicians and now COVID has inflamed these problems.

Growing Body of Research
Data from the Green Center's ongoing survey of roughly 450 practitioners found several alarming changes during this pandemic resulting in further trauma to primary care.

These include:

  • Sixty-three percent of respondents say stress is at an all-time high; 48 percent say burnout is at an all-time high.
  • Forty-five percent say the pandemic has harmed their psychological well-being; 36 percent say it has affected their physical health; 33 percent say it adversely impacted their families.
  • Nineteen percent say their clinics are critically understaffed.
  • Forty-four percent report face-to-face patient volume is 30-50 percent lower than pre-pandemic levels, threatening their practices' financial viability.
  • Twenty percent are uncertain about their practices' financial viability beyond the next four weeks; 20 percent have skipped or deferred their salaries at some point.

Resiliency is important at this time, but it isn't easy to bounce back, grow, thrive, and learn from the trauma physicians are experiencing.

Positive Steps Forward
The first step moving forward to help physicians is to acknowledge the realities of over-stress and burnout. That needs to come from the top—from the nation's healthcare leaders. Discussing their struggles can remove the stigma associated with distressed physicians that are unable to cope with the current situation.

Even before COVID, the American Academy of Family Physicians had been proactively providing "physician wellness" as a key theme of its annual conference and it developed a series of online "Physician Health First" learning modules.

I have also been working on a set of self-assessment and self-help tools to assist doctors recognize and mitigate their own stress and trauma. These tools are based on my HOPE Note program to implement holistic medicine typically made for patient care but also useful for physician wellbeing. Part of the takeaway is that self-care is important for both patients and doctors.

Financial Improvements
Many primary care leaders (including myself) believe primary care's future depends on a widespread shift from fee-for-service (FFS) billing toward global payment plans that provide capitated monthly per-patient payments covering a whole-person’s health – mind, body and spirit. Oak Street Health and Iora Health are examples of how this can be done effectively.

During our current healthcare landscape, it is vital that physicians take care of their mental and physical health while working to improve how their practice can be profitable. Learn more about these topics in Holistic Primary Care.

Be well,
Dr. Wayne Jonas

P.S. We’ve recently launched the full set of four courses as part of the new Integrative Approaches to Chronic Pain course. Explore this course and keep an eye out for more information.

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