Physicians are feeling left out of the Covid-19 vaccination effort as the Biden administration moves to provide shots in retail pharmacies, while doing nothing to boost vaccine opportunities at doctors’ offices and medical practices.
Beginning Feb. 11, the White House will launch a national program that will eventually allow 40,000 retail pharmacies to provide Covid-19 vaccines. The effort will target stores that can reach patients who have, thus far, been underrepresented in the vaccine effort and who are more likely to get severely ill from Covid-19.
Physicians and other clinicians eligible to provide the vaccines say they could use a similar program to steer more vaccines their way. A survey in late January by the Medical Group Management Association found 71% of medical practices were unable to get the vaccine. It jumped to 85% for independent practices not affiliated with a hospital or health system.
“And those that did get some, only got enough for 1% or less of their patients,” said
Eager to Fight ‘Vaccine Hesitancy’
The vaccine’s high demand and low supply is frustrating doctors who say they could leverage their patient relationships to vaccinate more of the very people who have been prioritized for the shots at pharmacies—seniors with underlying health conditions, and Blacks, Hispanics and immigrant groups whose take-up rates have lagged amid continued vaccine hesitancy.
“We’re not trying to point fingers. We’re just trying to say this is a huge missed opportunity,” Gilberg said. “To me, it’s crazy when we’re saying ‘we need to bring nurses and physicians out of retirement in order to deliver these shots,’ and we have actual nurses and physicians who are currently working, who can proactively identify patients and also deliver the shots.”
The White House press office didn’t respond to a request for comment on whether doctors’ offices and medical practices should or would be targeted for more vaccine doses.
Early in the process, medical practices and doctors’ offices seemed like the “place to go” for Covid-19 vaccinations, since more than half of influenza shots are administered through the medical care system rather than at vaccination clinics and pharmacies, said Dr. Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officials.
But that “judicious approach” has been largely scrapped with regards to Covid-19, said Plescia, whose association members largely decide where vaccines are distributed in each state. Instead, speed and volume have become the most important factors due to the emergence of three troubling Covid-19 variants that are much more transmissible.
‘Just About Speed’
“So if it’s just about speed. If it’s just about ‘vaccinate as many people as you possibly can,’ then I don’t know how much we’re going to utilize medical care practices because the most effective way” to provide the most shots is through mass vaccination sites, Plescia said. And only a few places, like hospitals, stadiums and convention halls can accommodate those events.
And because these vaccination sites tend “to not be very equitable or strategic in targeting priority groups,” Plescia said, “I don’t think state health officials believe that’s the best guiding approach.”
Gilberg agreed: “Medical practices have lists of patients. They have existing relationships. They can help with those patients that have questions, who don’t trust the vaccine, who are hesitant to get the vaccine,” he said.
Because they work closely with state officials and can reach large swaths of the population, state health departments, hospitals and health systems have been prioritized for vaccine distribution, said Shawn Martin, executive vice president and chief executive officer for the American Academy of Family Physicians. But beyond that, the distribution channels break down.
In Kansas and Minnesota, doctors’ offices have a process to request vaccines from local health departments, Martin said. But those states are outliers.
“In many states, the distribution isn’t getting beyond the hospitals or health systems,” Martin said. “It’s kind of a flippant statement, but I think a lot of people have really overthought this. Instead of just, kind of using the systems that are in front of them, they’re trying to create new ones. Sometimes, just the old tried and true is your best way to start.”
Martin said 54% of all vaccines are administered in a primary care practice.
“That doesn’t mean that pharmacies or mass vaccination sites don’t have an important role to play here. It’s just that we don’t see it as an ‘either, or’ situation,” Martin said. “We kind of see it as an ‘all of us’ situation. And our goal right now is to continue to work with the administration to broaden the availability of sites where you can be vaccinated. And make sure that, sometime in the very near future, that that includes community-based primary care practices.”
Plescia said as more people are inoculated, and the potential threat from Covid-19 variants subsides—and more vaccines become available—doctors and medical practices will be called upon to vaccinate those hard-to-reach patients.
In a statement, Susan R. Bailey, president of the American Medical Association, seemed to agree. “Physician practices will be an integral part of the vaccine administration process,” she said. “Once enough supplies are available, we encourage the federal government to ensure physician practices have an adequate supply of COVID-19 vaccines to vaccinate their patients.”
In the meantime, Martin said AAFP will continue writing letters, talking to thought leaders and encouraging the Biden administration and governors to not forget about doctors.
“It’s the most interesting of advocacy objectives because we’re all after the same thing,” Martin said. “We’re just trying to help them do it better.”