Department of Family Medicine, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Public Health Rep. 2022 Jan-Feb;137(1):149-162. doi: 10.1177/00333549211054083. Epub 2021 Oct 25.
The impact of the COVID-19 pandemic has been particularly harsh for low-income and racial and ethnic minority communities. It is not known how the pandemic has affected clinicians who provide care to these communities through safety-net practices, including clinicians participating in the National Health Service Corps (NHSC).
In late 2020, we surveyed clinicians who were serving in the NHSC as of July 1, 2020, in 20 states. Clinicians reported on work and job changes and their current well-being, among other measures. Analyses adjusted for differences in subgroup response rates and clustering of clinicians within practices.
Of 4263 surveyed clinicians, 1890 (44.3%) responded. Work for most NHSC clinicians was affected by the pandemic, including 64.5% whose office visit numbers fell by half and 62.5% for whom most visits occurred virtually. Fewer experienced changes in their jobs; for example, only 14.9% had been furloughed. Three-quarters (76.6%) of these NHSC clinicians scored in at-risk levels for their well-being. Compared with primary care and behavioral health clinicians, dental clinicians much more often had been furloughed and had their practices close temporarily.
The pandemic has disrupted the work, jobs, and mental health of NHSC clinicians in ways similar to its reported effects on outpatient clinicians generally. Because clinicians' mental health worsens after a pandemic, which leads to patient disengagement and job turnover, national programs and policies should help safety-net practices build cultures that support and give greater priority to clinicians' work, job, and mental health needs now and before the next pandemic.
COVID-19 大流行对低收入人群以及少数族裔社区造成了尤为严重的影响。目前尚不清楚这场大流行对通过安全网实践（包括参与国家卫生服务团（NHSC）的临床医生）为这些社区提供护理的临床医生有何影响。
2020 年末，我们对截至 2020 年 7 月 1 日在 20 个州服务的 NHSC 临床医生进行了调查。临床医生报告了工作和工作变动情况以及当前的幸福感等情况。分析对亚组应答率的差异和实践内临床医生的聚类进行了调整。
在接受调查的 4263 名临床医生中，有 1890 名（44.3％）做出了回应。大流行对大多数 NHSC 临床医生的工作产生了影响，包括 64.5％的临床医生的门诊就诊人数减少了一半，而 62.5％的临床医生的大部分就诊是虚拟的。工作变动的人数较少；例如，只有 14.9％的人被停职。其中 76.6％的这些 NHSC 临床医生的幸福感处于风险水平。与初级保健和行为健康临床医生相比，牙科临床医生更经常被停职，其诊所暂时关闭。
大流行以与报告的一般门诊临床医生类似的方式扰乱了 NHSC 临床医生的工作、工作和心理健康。由于临床医生的心理健康在大流行后恶化，导致患者脱离和工作流失，因此国家计划和政策应帮助安全网实践建立文化，现在和下次大流行之前，更加重视临床医生的工作、工作和心理健康需求。
