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Pandemic forces primary care doctors to adapt, and patients take notice

Dr. Nisha Thakrar, a pediatrician and chief medical officer at South Boston Community Health Center, examines 19 month-old Francis Kieve.Jessica Rinaldi/Globe Staff

During the early days of the pandemic, Dr. Clovene Campbell and her colleagues made a decision. Their North Shore pediatric office would remain open, and they would find a way to keep taking care of patients, despite the risks and uncertainties brought on by COVID.

When being indoors felt unsafe, they brought medical equipment outside and treated patients under a tent. They quickly ramped up video visits and called all of their patients to reassure them that the office was open and providers were there to help.

“If we weren’t flexible, we had to become flexible. Otherwise we would have had to close,” said Campbell, medical director at Pediatric Associates of Greater Salem and Beverly. “All of those things we did during the pandemic went a long way to cement the relationship with the community, because they knew they weren’t abandoned.”


The pandemic has forced primary care doctors’ offices to become nimble to meet the needs of patients. And patients have noticed.

Results from a statewide survey, released Thursday, of 38,000 patients with private insurance suggest that despite the many disruptions of the COVID era, primary care offices actually improved how they communicated with patients and coordinated care last year, compared with 2019, before the pandemic.

Patients reported that their doctors spent more time with them, listened more carefully, and had better knowledge of their medical needs. And they credited staff at their primary care offices for being more courteous and more helpful.

Barbra Rabson, president of Massachusetts Health Quality Partners, a nonprofit that conducts the annual survey, said the increase in satisfaction was remarkable for a year when the pandemic disrupted lives and hampered access to health care.

“These practices knew they’re the front lines, and they’ve got to be there for their patients,” she said. “They kept their doors open, they welcomed people, and they took really good care of them.”


To be sure, primary care offices, like all parts of health care, continue to face significant challenges even as COVID cases decline in the state. Staffing shortages have made response times slower, sometimes forcing patients to wait months for appointments. Patients who responded to the survey said it was harder to schedule medical appointments in 2021, compared with 2019.

Many patients returning to primary care appointments now are sicker than before, after their chronic illnesses went uncontrolled for periods of the pandemic, and their care requires more resources.

And for health care providers, the pandemic has only worsened their exhaustion and burnout, a crisis that pre-dates COVID.

Some smaller primary care offices didn’t survive. Those that stayed open learned to adapt, said Dr. Russell Phillips, director of the Center for Primary Care at Harvard Medical School.

“Primary care practices have demonstrated the capacity to innovate in the face of challenge,” said Phillips, a primary care doctor at Beth Israel Deaconess Medical Center.

Some practices set up special clinics for patients with respiratory symptoms, to keep healthy people safe from exposure to COVID. Many offices started testing symptomatic patients for COVID and established clinics to vaccinate their patients.

They fielded flurries of questions from patients worried about COVID — and every other kind of health issue.

State and federal regulators approved emergency rules during the pandemic that allowed health care providers to be paid the same amount for for phone and video calls as for in-person visits. This helped providers to rapidly expand remote care. And, a federal loan program in 2020 helped many practices maintain staff and keep offices open.


Like other practices, Outer Cape Health Services ramped up telehealth appointments during the pandemic, talking to patients by phone when video wasn’t available, and added screening and social distancing rules for patients who needed to come to the office. Outer Cape providers also kept patients informed with e-mail updates about how to stay safe from COVID.

Dr. Andrew Jorgensen, chief medical officer at the Provincetown-based practice, said the pandemic has led people to realize the importance of health care.

“Most individuals, at least in Massachusetts, have better relationships with their health care clinicians,” he said. “They value what we do.”

Leaders at South Boston Community Health Center made the decision not to furlough their staff in 2020, even as other clinics and hospitals temporarily laid off thousands. This engendered loyalty and commitment from workers, which likely helped them provide better service to patients, said Dr. Nisha Thakrar, chief medical officer at the clinic.

To keep up with preventive care during the COVID crisis, the health center called its highest-risk patients and invited them in for blood pressure checks, immunizations, and screenings.

To help monitor the growth of newborn babies, they distributed digital scales to parents and tracked the infants’ weights remotely.

And they extended appointment times to at least 30 minutes so they could address as many issues as possible for each patient.


Thakrar told her staff: “When the patient’s there, do absolutely everything you can so they don’t have to come back.”

The challenge now as we emerge from the worst of the pandemic, Thakrar said, is to find ways to maintain the improvements in patient care and “not just go back to business as usual.”

Campbell, from the North Shore practice, said primary care offices must continue adjust to every twist and turn of the pandemic.

“What this pandemic has forced us to do is realize that you don’t have to practice in one specific way,” she said. “There are actually ways to give good care that may not be 100 percent — but it’s better than zero.”

Priyanka Dayal McCluskey can be reached at Follow her on Twitter @priyanka_dayal.