America's looming primary-care crisis

For decades, health care was America’s indomitable industry. While employment in other sectors—retail, manufacturing, construction—rose and fell with the business cycle, clinics, hospitals, and medical practices steadily added jobs. But the pandemic has changed health care’s trajectory. Hospitals now find themselves in dire financial straits as they forgo revenue from elective procedures, and a surge in unemployment is shifting patients from private insurance plans to Medicaid, which is less remunerative for doctors. Some rural hospitals, whose financial footing was already tenuous, are facing the prospect of closure.

Among the most vulnerable parts of the nation’s health-care system are family-medicine, internal-medicine, pediatric, and obstetrics-and-gynecology clinics. With covid-19 precautions in place, in-person appointments have dropped precipitously. In May, a survey of primary-care doctors found that nearly a fifth had temporarily closed their practices, owing to the pandemic, and two in five had laid off or furloughed staff. Primary-care clinics are tasked with keeping people healthy, and decades of research have shown that the care they provide is associated with better outcomes and lower costs. As my colleague Dhruv Khullar has written, the health consequences of these clinics’ closures could be significant. Vaccination rates for children have already begun to fall; patients are missing screenings proven to save lives; prescriptions are going unfilled. Chronic conditions could worsen; life expectancies could drop.

Even before the pandemic, primary care was in crisis. Primary-care doctors were already among the most poorly compensated physicians in the country; for medical students burdened with debt, those smaller salaries lessened the specialty’s allure. Experts have long warned of a shortage of doctors providing foundational forms of outpatient care, especially in rural areas. Last year, the Kaiser Family Foundation estimated that more than fourteen thousand primary-care physicians were needed to eliminate existing shortages.

This is an aspect of the pandemic that I don't think has gotten enough coverage.

Along the same lines: Coronavirus may cause 3,500 deaths in England from four main cancers

Routine cancer screening was suspended during the lockdown, the authors said. So was the routine referral to hospital outpatient departments of people with symptoms that could be something else but also might possibly be cancer. Only those deemed to need emergency care by the GP or those who go to A&E are being picked up. Inevitably, those are people with more advanced cancers. If cancer is picked up at an earlier stage, successful treatment and survival are much more likely.

More or less the entire healthcare sector has shifted to covid response. This is undoubtedly the right thing to do, under the circumstances. But it also means we will have long-lasting effects of the pandemic in otherwise unrelated fields of healthcare for years and decades to come.