To help Californians and state policymakers understand evolving demands on the state’s health care system during the COVID-19 pandemic, CHCF is working with survey firms on two fronts. CHCF and global survey firm Ipsos are assessing residents’ desire for COVID-19 testing and their access to health care services. CHCF and Truth on Call, a physician market-research firm, are surveying different types of health care providers about availability of testing, personal protective equipment, and their experience in California’s health care delivery system. Download the charts and data for your own presentations and analyses.

May 15, 2020 — One-third of primary care physicians in California are worried their practices and clinics will be forced to close because of the financial consequences of the COVID-19 pandemic, according to a statewide survey from CHCF and Truth on Call. Many physicians say their practices have furloughed or laid off staff or reduced physician pay while dramatically increasing phone and video visits with patients.

The survey was conducted last weekend among 350 primary care physicians in California.

The poll found that 83% of the primary care doctors surveyed say the patients and health care workers at their practice or clinic can get tested for COVID-19 if they need it. Doctors at large practices, defined as 51 or more physicians, report the greatest access, with 93% saying testing is available for those who need it. Sixty-eight percent of doctors at small practices (five or fewer physicians) say testing is available.

The survey found that 17% of primary care physicians say they don’t have enough COVID-19 tests to meet current needs. Among doctors in small practices, 32% do not have sufficient testing available.

Physicians were asked whether they are getting their patients’ COVID-19 test results in a timely manner. They ranked their responses on a numerical scale from 1 to 5, with 1 being “not timely” and 5 being “very timely.” Sixty percent of doctors rate the timeliness of results as 4 or 5, suggesting that they are getting results quickly, while 23% give a timeliness rating of 3. Sixteen percent of respondents rate it at 1 or 2, the lowest scores.

Among physicians in small practices, 32% report the lowest levels of timeliness.

Physicians in safety-net groups or clinics, defined as having at least 30% Medi-Cal or uninsured patients, are less likely to report timely testing, with 54% giving a 4 or a 5 compared to 62% of physicians outside the safety net reporting these ratings.

Sixty-nine percent of surveyed doctors report that their practice has adequate access to personal protective equipment (PPE). Differences by practice size are stark: 57% of physicians in small practices report adequate access versus 82% of physicians in large practices.

By comparison, 89% of critical care doctors in hospitals said they had adequate PPE in the CHCF / Truth on Call survey earlier this month.

Primary care physicians in the safety net are slightly more likely than other physicians to report adequate access, 74% compared to 68%.

Many primary care doctors are worried about the survival of their clinic or practice. Thirty-seven percent of survey respondents say they are “very” or “somewhat” worried their practice or clinic “will be forced to permanently close because of the financial consequences of COVID-19.” Respondents in small practices are significantly more worried, with 56% saying they are “very” or “somewhat” worried their practice will close. This concern is shared by 25% of large-practice physicians.

When asked what operational strategies their clinic or practice has considered in the past month, 33% of doctors say their clinic or practice has considered closing temporarily. There is essentially no difference in responses of safety-net and non-safety-net doctors.

Nine percent of respondents report their clinic or practice has considered merging with another clinic or practice in the past month.

Many practices have taken steps to reduce staffing or pay in the past month. Among surveyed physicians, 37% say their clinic/practice has furloughed or laid off staff, and 18% say they have reduced staff pay. Twenty-seven percent of respondents say clinics/practices have reduced physician pay. All these responses are somewhat lower for physicians in safety-net practices/clinics and somewhat higher for those working outside the safety net. Physicians in small practices are more likely to say their clinic/practice have taken these steps than their counterparts at larger practices.

Surveyed physicians report a dramatic increase in their phone or video appointments — often referred to as “telehealth” — since shelter-in-place restrictions were enacted in March. Nearly two-thirds (63%) of primary care physicians say weekly telehealth visit volume at their clinic/practice has increased 50% or more since the stay-at-home orders began. Physicians at large practices report the greatest increase, with 76% saying telehealth volume is up at least 50%. Majorities of both safety-net and non-safety-net practices say their telehealth volume has increased by 50% or more.

Most respondents say they are confident that their clinic/practice has the “necessary non-financial support (e.g., billing, vendor, and/or workflow guidance)” to transition more of their patient visits to telehealth. Eighty-two percent of surveyed physicians are at least somewhat confident they have the needed support, with 49% “very confident” or “confident.” Physicians at small practices are somewhat less confident overall, with 69% saying they are at least “somewhat confident.”

Methods: This survey was conducted online using Truth on Call’s proprietary physician database. Responses were solicited over email, and methods were employed to ensure a representative sample of physicians treating at least 30% of patients who are on Medi-Cal or who are uninsured. The study consisted of 350 California physicians practicing internal medicine or family practice. Responses were collected between May 8 and May 13, 2020. Truth on Call is a division of Slingshot Insights.

Kristof Stremikis

Kristof Stremikis is director of CHCF’s Market Analysis and Insight team, which promotes greater transparency and accountability in California’s health care system. Read More

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