Cormay Caine misses a full day of work and drives more than 130 miles round trip to take five of her children to their pediatrician. The Sartell, Minnesota, clinic where their doctor used to work closed in August.
Caine is one of several parents who followed Dr. to her new location on the outskirts of Minneapolis, an hour and a half away. Many couldn鈥檛 get appointments for months with swamped nearby doctors.
鈥淚 was kind of devastated that she was leaving because I don鈥檛 like switching providers, and my kids were used to her. She鈥檚 just an awesome doctor,鈥 said Caine, a postal worker who recently piled the kids into her car for back-to-back appointments. 鈥淚 just wish she didn鈥檛 have to go that far away.鈥
So does Decker, who had hoped to settle in the Sartell area. She recently bought her four-bedroom 鈥渄ream home鈥 there.
The HealthPartners Central Minnesota Clinic where Decker worked is part of a wave of COVID-related closures starting to wash across America, reducing access to care in areas already short on primary care doctors.
Although no one tracks medical closures, recent research suggests they number in the thousands. A by the estimated that 8% of all physician practices nationally 鈥 around 16,000 鈥 have closed under the stress of the pandemic. That survey didn鈥檛 break them down by type, but another from the Virginia-based r and the found in late September that 7% of primary care practices were unsure they could stay open past December without financial assistance.
And many more teeter on the economic brink, experts say.
鈥淭he last few years have been difficult for primary care practices, especially independent ones,鈥 said Dr. , co-director of the Center for Health Economics and Policy at Washington University in St. Louis. 鈥淧utting on top of that COVID, that鈥檚 in many cases the proverbial straw. These practices are not operating with huge margins. They鈥檙e just getting by.鈥
When offices close, experts said, the biggest losers are patients, who may skip preventive care or regular appointments that help keep chronic diseases such as diabetes under control.
鈥淭his is especially poignant in the rural areas. There aren鈥檛 any good choices. What happens is people end up getting care in the emergency room,鈥 said Dr. , head of the family and community medicine department at the University of Missouri and a practicing physician in Columbia. 鈥淚f anything, what this pandemic has done is put a big spotlight on what was already a big crack in our health care system.鈥
that 82 million Americans live in primary care 鈥渉ealth professional shortage areas,鈥 and the nation needed more than 15,000 more primary care practitioners even before the pandemic began.
Once the coronavirus struck, some practices buckled when patients stayed away in droves for fear of catching it, said Dr. , president of the Physicians Foundation, a nonprofit grant-making and research organization. Its survey, based on 3,513 responses from emails to half a million doctors, found that 4 in 10 practices saw patient volumes drop by more than a quarter.
On the West Coast, a released in October by the California Medical Association found that one-quarter of practices in that state saw revenues drop by at least half. One respondent wrote: 鈥淲e are closing next month.鈥
Decker鈥檚 experience at HealthPartners is typical. Before the pandemic, she saw about 18 patients a day. That quickly dropped to six or eight, 鈥渋f that,鈥 she said. 鈥淭here were no well checks, which is the bread-and-butter of pediatrics.鈥
In an emailed statement, officials at HealthPartners, which has more than 50 primary care clinics around the Twin Cities and western Wisconsin, said closing the one in Sartell 鈥渨as not an easy decision,鈥 but the pandemic caused an immediate, significant drop in revenue. While continuing to provide dental care in Sartell, northwest of Minneapolis, the company encouraged employees to apply for open positions elsewhere in the organization. Decker got one of them. Officials also posted for patients on where more than 20 clinicians were moving.
The pandemic鈥檚 financial ripples rocked practices of all sizes, said LeFevre, the Missouri doctor. Before the pandemic, he said, the 10 clinics in his group saw a total of 3,500 patients a week. COVID-19 temporarily cut that number in half.
鈥淲e had fiscal reserves to weather the storm. Small practices don鈥檛 often have that. But it鈥檚 not like we went unscathed,鈥 he said. 鈥淎ll staff had a one-week furlough without pay. All providers took a 10% pay cut for three months.鈥
Federal figures show earn an average of $184,400 a year, and $201,400, making primary care doctors among the lowest-paid physicians.
As revenues dropped in medical practices, overhead costs stayed the same. And practices faced new costs such as personal protective equipment, which grew more expensive as demand exceeded supply, especially for small practices without the bulk buying power of large ones.
Doctors also lost money in other ways, said , co-director of the research group. For example, she said, pediatricians paid for vaccines upfront, 鈥渢hen when no one came in, they expired.鈥
Some doctors took out loans or applied for Provider Relief Fund money under the federal CARES Act. Dr. , who practices in Modesto, California, said his group of more than 300 physicians received $8.7 million in relief in the early days of the pandemic.
鈥淲e were about ready to go under,鈥 he said. 鈥淭hat came in the nick of time.鈥
While the group鈥檚 patient loads have largely bounced back, it still had to permanently close three of 11 clinics.
鈥淲e鈥檝e got to keep practice doors open so that we don鈥檛 lose access, especially now that people need it most,鈥 said Dr. Ada Stewart, president of the .
Caine, the Minnesota mom, said her own health care has suffered because she also saw providers at the now-closed Sartell clinic. While searching for new ones, she鈥檚 had to seek treatment in urgent care offices and the emergency room.
鈥淚鈥檓 fortunate because I鈥檓 able to make it. I鈥檓 able to improvise. But what about the families that don鈥檛 have transportation?鈥 she said. 鈥淥lder people and the more sickly people really need these services, and they鈥檝e been stripped away.鈥
