Reflections of rural primary care physicians on the impact of the COVID-19 pandemic: a qualitative study.

Background: Rural physicians tend to develop deep relationships with their patients and communities; however, few studies have evaluated the impact of the COVID-19 pandemic on relationships of physicians working in rural primary care clinics. We aimed to collect reflections of primary care physicians to understand their experiences during the pandemic and the impact on their relationships with patients, other physicians, clinic staff, and their communities.

Methods: Interviews with primary care physicians practicing in rural Wisconsin used open-ended questions about experiences during the pandemic and the impact of the pandemic on their work and relationships, coping and well-being, and resources of their rural clinics. Interviews were recorded, transcribed, and de-identified for thematic qualitative analysis.

Results: Twelve physicians were interviewed between October 3, 2022 and April 7, 2023. Experiences varied by the phase of the pandemic, especially changes in the work of physicians (e.g., working in the hospital), adapting to telemedicine, implementing mitigation strategies, and addressing vaccine hesitancy. These experiences impacted physicians' relationships with patients and their communities, especially when addressing vaccine hesitancy, mitigation strategies (e.g., masking), and misinformation. Some relationships were strengthened by shared experiences, such as clinic staff working together to meet challenges. Other relationships, however, were strained by social distancing and many physicians reported a loss of camaraderie with colleagues attributed to isolation and virtual meetings replacing in-person activities. Challenges for rural clinics included lack of resources (e.g., staff shortages), limited broadband access, and difficulties transferring patients to tertiary care centers.

Conclusions: Physicians working in rural primary care clinics described a myriad of experiences during the pandemic. Difficulties in addressing vaccine hesitancy and misinformation about the pandemic were consistently identified as negatively affecting relationships with patients and some staff. Fewer in-person interactions with colleagues negatively impacted relationships, although the ability to connect with others through virtual methods was viewed positively. Future work could address the loss of collegiality and increasing isolation among clinicians attributed to continued use of virtual tools and increased remote work.