Report from the Frontlines of US Primary Care on the Impact of Recent Federal Policy Changes

Primary care clinicians are a bellwether for the state of health care and health in the United States. With the Trump Administration moving at breakneck speed to implement sweeping changes in health care and other policies, primary care clinicians are positioned to serve as valuable informants about the effects of federal policy changes on patients and practices. One month after President Trump’s inauguration, we administered a rapid response survey to a diverse national sample of primary care clinicians, with 355 responding from 42 states and across a range of practice settings — the latest in a series of primary care tracking surveys conducted by the Larry A. Green Center for the Advancement of Primary Health Care for the Public Good (Table 1).

Table 1: Survey Sample Characteristics

The survey finds primary care clinicians (75% physicians, 19% nurse practitioners, and 6% other professionals) report a range of early effects from recent federal policy changes (Figure 1). Given the volume of executive orders and shifts in policy that could affect population health, respondents were not asked about specific policies but for their overall assessments. Questions used wording such as “Over the past month, have you noticed changes in your patients’ concerns or health that you attribute to the activities of the new Administration” and “What effects do you anticipate federal policy having on the following types of care?”

Invitations to take the survey were shared with clinicians who previously agreed to receive such invitations following their participation in a monthly Green Center survey of frontline clinicians during the pandemic. In addition to the participant characteristics shared in Table 1, clinicians located in five states were responsible for 48% of responses: Virginia (19%), Rhode Island (11%), California (6%), Colorado (6%), and New York (5%). While it is impossible to know if respondents from a “democratic” state identify themselves as a Democrat, based on the 2024 Presidential election, 70% of responses originated in states that Kamala Harris won.

In this article, we draw on the insights from frontline clinicians to highlight early warning signals of how current rapid policy changes are disrupting the nation’s health care services and affecting patients. We then offer several recommendations to mitigate harmful outcomes.

Optimism Overshadowed by Pessimism About Effects on Clinical Practice

A distinct minority of respondents report favorable impact of recent policy changes on their patients and practices (see Figure 1). Eight percent report feeling “more optimistic about our practice fulfilling our mission.” In open-ended comments, these clinicians characterize policy changes as relieving pressures to reduce racial health disparities or provide gender-affirming care, for example, that they believe are constraining or misdirecting their practice. A similarly small proportion of respondents report they no longer feel pressured “to support DEI policies” or “vaccinations that are of negligible benefit to population health.” One clinician said, “I am optimistic that the new administration will eliminate Obamacare which has ruined health care. All it did was create a second Medicaid.” Another, who agreed that “the new Administration has elevated the role of primary care in addressing chronic conditions,” wrote “It remains to be seen, but the new HHS secretary is reportedly very supportive of preventive health and does not seem to be beholden to the pharma and insurance industries.”

Figure 1: Over the past month, has your practice experienced any of the following as a result of the transition [in Presidential Administration]?

_{Source: author’s analysis}

In contrast, two-thirds of respondents agree that “the new Administration has impaired our ability to improve the health of our patients and communities” and a majority report that “my ability to practice medicine is under attack.” Open-ended comments describe a federal policy climate in which cuts to Medicaid and Medicare are expected and the federal stance on vaccines is unclear. One clinician said, “I have deep concerns about the current and future state of primary care practice. I am highly motivated to do the best I can for people … but the current uncertainty and potential deep cuts to Medicaid, potential for not extending telehealth, and sense of lack of value and collaboration to support primary care feels overwhelming and distressing. [It’s] like the pandemic all over again.”

A majority of clinicians endorse feeling “increased anxiety about the security of our practice.” Many (43%) report they have developed plans to respond if Immigration and Customs Enforcement (ICE) agents enter their practice. About 40% report that they “lost access to data resources that support clinical care” such as Centers for Disease Control and Prevention (CDC) guidelines. The survey was conducted during extended downtime of CDC websites, which have now been restored with some modified content such as the replacement of “pregnant people” with “pregnant women.” News articles highlight a continuing concern that information and data are still missing. The modifications were noted by several respondents, with one clinician stating, “I always used the CDC as a resource but now worry the information there will be inaccurate, incomplete, or politically biased.”

Perception that Patients Are Affected

The survey findings suggest that changes in federal policy have already started to affect patient health. The majority of clinicians noted an increase in patients’ mental health symptoms in the past month, including increased reports of anxiety (72%), depression (46%), “increased visits related to stress” (47%), and difficulty with sleep (42%). While it is hard to draw a direct line from policy changes to these reported concerns, 57% of clinicians note that patients in the last month shared they “fear losing access to the care I need.” In a comment echoed by dozens, one clinician reported, “Everyone, patients and staff alike, are petrified. Patients are worried they will lose access to routine cancer screenings, vaccines, and contraception. They’re worried they’ll lose access to social programs that keep them alive.”

Differential Impact on Different Primary Care Services

Respondents were asked about the potential effects of recent policy changes on specific types of care. The types of care listed were chosen either for their significance to the Administration’s Make America Healthy Again (MAHA) initiative or because they were the subject of recent news stories.

Figure 2: Primary care clinician ratings of potential policy effects on types of care

_{Source: author’s analysis}

More than two-thirds of clinicians perceived harmful effects for the types of health services that federal policies have aimed to curtail or eliminate: gender affirming care, reproductive care, and care for immigrant populations. One clinician stated “a large proportion of our community is made up of immigrants. Children born here are terrified of losing their parents. [Immigrant patients] are avoiding getting care for fear of ICE raids. Much of the US-grown produce is from here; we will lose maybe half of the fieldworkers … harvesting will grind to a halt … what’s left will be exorbitantly expensive, affecting health all over the US.”

A relatively small proportion of respondents see beneficial effects for the types of lifestyle, prevention, and chronic disease services prioritized by the Making America Healthy Again (MAHA) Commission led by HHS Secretary Robert F. Kennedy, Jr., though many offered qualifying comments, such as, “I do appreciate the increased focus on lifestyle choices but the reimbursement has to be there to make it feasible.”

Funding cuts to federal grant programs, while not mentioned in the survey, were raised in a meaningful number of comments. Many primary care settings, particularly those who care for vulnerable populations, are supported in their mission through federal grants and rely on direct or indirect government funding for their sustainability. Noted a clinician working in a free and charitable clinic, “If the halt on federal grants goes through, we will lose 10% of our budget. My transgendered patients are suffering. My recently immigrated patients are suffering. I am suffering from anxiety and depression.”

Others expressed concern about the impact of curtailed research on population health. Said one clinician, “I am extremely distressed about the huge disruption of funding for medical research that will have a devastating impact on the NIH’s mission to enhance health, lengthen life, and reduce illness and disability.”

Professionalism and Well-Being at Risk

Two-thirds of clinicians agree “the medical profession has been compromised by the new Administration.” Many perceive current policy directions as fundamentally at odds with their professional values. In addition to quantitative findings shared above (Figure 1), such as feeling their ability to practice medicine is “under attack” or “impaired,” several clinicians volunteered comments, such as this one, drawing a clear line between policy changes and the potential professional norms affected, “The president wants to censor health knowledge and politicians are controlling how we are allowed to practice, banning evidence based medicine in many cases and forcing us to fear prosecution for care for patients in the right way.”

Primary care clinicians have among the highest rates of moral injury and workforce attrition among all health professionals. It is therefore telling that nearly 60% of respondents agree that their “level of mental exhaustion is high” while just 35% agree that their “practice is thriving.” One clinician said, “burnout levels are high, and yet we have so many patients that we are scheduling new care visits 6-9 months out. So, in a sense we are thriving but, in another sense, we are not.” Despite these findings, the survey also reveals notable hope among the 57% of clinicians who report they “usually leave work satisfied I was able to provide my patient the care they needed.”

Implications for Policy and Practice

Although prior research using data on campaign contributions has found that primary care physician party affiliation tends to lean Democratic, our pulse check suggests widespread concern among primary care clinicians about adverse effects of new federal policies. While some respondents note positive effects, most do not and report new strains on a care delivery system already under duress. Some priorities of MAHA, such as prevention and managing chronic disease, align with primary care, and yet their resonance with clinicians surveyed seems vastly overshadowed by perceived threats to patient welfare and their ability to serve patients’ needs.

As with any survey, these findings may be subject to response bias, and findings from a national sample of primary care clinicians may not be generalizable across all clinicians in this or other health care sectors. Invitations to take the survey on which these findings are based were sent to those who had responded to repeated surveys conducted by the Green Center during the Covid-19 pandemic. Participation was voluntary and anonymous.

While this may not be a representative sample of primary care, the overall demographics of our participants are fairly aligned with the overall characteristics of primary care nationally, as seen in recent national chartbooks and scorecards. Because our respondents include a higher proportion of those practicing in community health centers than the general primary care population, our findings are more likely to represent those for whom federal policy is immediately salient. Nonetheless, these results send a strong warning signal from the frontlines for how the current federal policy upheaval is disrupting the nation’s health care services. Primary care plays a foundational role in our health care system, often serving as the first point of contact and the only point of integrated and personalized care for millions of Americans. Tumult in primary care destabilizes the entire system.

Recommendations

1. Securing US population health is paramount. Respondents clearly identify mental/behavioral health care, reproductive, and gender-affirming care as both valued and threatened by the current policy shifts. Respondents also show heightened concern for populations made increasingly vulnerable by policy changes.

The success of comprehensive care rests in the humanity of care delivery that is responsive to people’s lives as they are lived. Federal health policy is far ranging, covering everything from insurance to licensing to marketplace regulations for the country’s fourth largest industry. The introduction of rapid change to this platform, without time for appropriate planning, increases the probability for negative health outcomes, for patients and clinicians. Along with slowing the implementation of policy changes to allow for appropriate planning and evaluation, securing the nation’s health must include securing access to health care and the safety of health settings. This means minimizing intrusions into the doctor-patient relationship, including ICE raids in health care facilities. It means protecting access by maintaining funding levels for Medicare and Medicaid and payment models that continue to support telehealth.

2. Maintain professionalism through self-determination and data-driven decisions. Given that two-thirds of respondents said that their profession has been compromised by new federal policies, the administration should reverse directives that run counter to evidence-based practice and instead allow medical boards to adjudicate whether care is consistent with professional standards.  

About 40% of respondents report that they “lost access to data resources that support clinical care” such as CDC guidelines. These prohibitions on gathering, studying, and reporting health data presents a clear and present danger to the nation’s health. To support the progress of science and health care, it is vital to restore the integrity and independence of national health datasets.

Likewise banning terms such as diversity, equity, and inclusion, and initiatives and research that support these concepts, diminishes both the ability of health care professions to advance health and the progress of science.

To ensure clinician self-determination and enable responsible policy planning and implementation, frontline clinicians should be in deliberations by the MAHA Commission and related entities. In addition, professional organizations have a critical role to play in forcefully articulating how public policies enhance or endanger patient care, professionalism, and the health of the public. These organizations should not hold back on taking positions because of unrealistic expectations of achieving unanimity of opinion among their members or fear of potential political retaliation.  

3. Monitoring systems are needed to continuously assess the real time effect of rapid policy change on patients and primary care practices, based on frontline data. The survey itself highlights the value of information collected from clinicians in such a monitoring system. Policy evaluations must incorporate outcomes as directly experienced by the public and as witnessed by the professionals who care for them. Primary care is a particularly fragile sector in US health care and should be prioritized for surveillance, as recommended in the call of the National Academies of Sciences, Engineering, and Medicine for a national primary care scorecard. Foundations and professional societies have a key role to play as potential sponsors of clinician tracking surveys.

Securing Primary Care for All

This survey captures an early snapshot of clinician perspectives during a time of rapid policy transitions affecting healthcare delivery across states and primary care settings. Primary care has been chronically under-resourced for decades, despite its significant role in improving population health and patient experience at reduced cost. As federal health policies continue to evolve, tracking their effect on the capacity and response of US healthcare will be essential. The strength of primary care has always rested on its whole person, relational approach and its ability to adapt to local contexts. Supporting this adaptability while preserving its core values remains the critical challenge created by the current period of policy change and uncertainty. Ensuring the health benefits of primary care for the nation requires both ongoing assessment of the impact of policy changes at the frontlines of health care and the will of our national leaders to act to secure primary care for all.