By JULIE APPLEBY <a href="https://www.kcur.org/news/2021-01-14/private-practice-doctors-patients-wonder-when-its-their-turn-for-the-covid-19-vaccine">Kaiser Health News</a>Dr. Andrew Carroll — a family doctor in Chandler, Arizona — wants to 
help his patients get immunized against covid, so he paid more than 
$4,000 to buy an ultra-low-temperature freezer from eBay needed to store
 the Pfizer vaccine.But he’s not sure he’ll get a chance to use 
it, given health officials have so far not said when private doctor’s 
offices will get vaccine.“I’m really angry,” said Carroll.Not
 only are doctors having trouble getting vaccine for patients, but many 
of the community-based physicians and medical staff that aren’t employed
 by hospitals or health systems also report mixed results in getting 
inoculated. Some have had their shots, yet others are still waiting, 
even though health workers providing direct care to patients are in the 
Centers for Disease Control and Prevention’s top-priority group.Many
 of these doctors say they don’t know when — or if — they will get doses
 for their patients, which will soon become a bigger issue as states 
attempt to vaccinate more people.“The reason that’s important is 
patients trust their doctors when it comes to the vaccine,” said 
Carroll, who has complained on social media that his county hasn’t yet 
released plans on how primary care doctors will be brought into the 
loop.Collectively, physicians in the county could vaccinate 
thousands of patients a day, he said, and might draw some who would 
otherwise be hesitant if they had to go to a large hospital, a 
fairground or another central site.His concern comes as, 
nationally, the rollout of the vaccine is off to a slower start than 
expected, lagging far behind the initial goal of giving 20 million doses
 before the new year.But Dr. Jen Brull, a family practice doctor 
in Plainville, Kansas, said her rural area has made good progress on the
 first phase of vaccinations, crediting close working relationships 
formed well before the pandemic.This fall, before any doses 
became available, the local hospital, the health department and 
physician offices coordinated a sign-up list for medical workers who 
wanted the vaccine. So, when their county, with a population of 5,000, 
got its first 70 doses, they were ready to go. Another 80 doses came a 
week later.“We’ll be able to vaccinate almost all the health care-associated folks who wanted it in the county” Brull said recently<h2>Gaps in the Rollout</h2>But that’s not the case everywhere.Dr.
 Jason Goldman, an internist in Coral Springs, Florida, said he was able
 to get vaccinated at a local hospital that received the bulk of 
vaccines in his county and oversaw distribution.In the weeks since, however, he said several of his front-line staff members still “don’t have access to the vaccine.”Additionally,
 “a tremendous number” of patients are calling his office because 
Florida has relaxed distribution guidelines to include anyone over age 
65, Goldman said, asking when they can get the vaccine. He’s applied to 
officials about distributing the vaccines through his practice but has 
heard nothing back.Patients “are frustrated that they do not have
 clear answers and that I am not being given clear answers to provide 
them,” he said. “We have no choice but to direct them to the health 
department and some of the hospital systems.”Another troubling 
point for Goldman, who served as a liaison between the American College 
of Physicians and the expert panel drawing up the CDC distribution 
guidelines, is the tremendous variation in how those recommendations are
 being implemented in the states.The CDC <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations-process.html" target="_blank">recommends</a>
 several phases, with front-line health care workers and nursing home 
residents and staff in the initial group. Then, in the second part of 
that phase, come people over 75 and non-health care front-line workers, 
which could include first responders, teachers and other designated 
essential workers.States have the flexibility to design their own
 rollout schedule and priority groups. Florida, for example, is offering
 doses to anyone 65 and up. In some counties, older folks were told 
vaccines were available on a first-come, first-served basis, a move that
 has resulted in long lines.“To say right now, 65-plus, when you 
haven’t even appropriately vaccinated all the health care workers, is 
negating the phasing,” said Goldman. “There needs to be a national 
standard. We have those guidelines. We need to come up with some 
oversight.”On Thursday, the American Hospital Association echoed 
that concern in a letter to Health and Human Services Secretary Alex 
Azar. Hospitals — along with health departments and large pharmacy 
chains — are doing the bulk of the vaccinations.Calling for additional coordination by federal officials, the <a href="https://www.aha.org/system/files/media/file/2021/01/aha-hhs-leadership-actions-needed-expedite-administration-covid-19-vaccines-lettetr-1-7-20.pdf" target="_blank">letter</a>
 outlined what it would take to reach the goal of vaccinating 75% of 
Americans by the end of May: 1.8 million vaccinations every day. Noting 
there are 64 different rollout plans from states, cities and other 
jurisdictions, the letter asked whether HHS has “assessed whether these 
plans, taken as a whole, are capable of achieving this level of 
vaccination?”<h2>Making It Work</h2>Lack of direct national 
support or strategy means each county is essentially on its own, with 
success or failure affected by available resources and the experience of
 local officials. Most state and local health departments are 
underfunded and are under intense pressure because of the surging 
pandemic.Still, the success of vaccination efforts depends on planning, preparation and clear communication.In
 Lorain County, Ohio, population 310,000, local officials started 
practicing in October, said Mark Adams, deputy health commissioner. They
 set up mass vaccination clinics for influenza to study what would be 
needed for a covid vaccination effort. How many staff? What would the 
traffic flow be like? Could patients be kept 6 feet apart?“That 
gave us an idea of what is good, what is bad and what needs to change,” 
said Adams, who has had previous experience coordinating mass 
vaccination efforts at a county level.So, when the county got its
 first shipment of 500 doses Dec. 21, Adams had his plan ready. He 
called the fire chiefs to invite all emergency medical technicians and 
affiliated personnel to an ad hoc vaccination center set up at a large 
entertainment venue staffed by his health department. Upon arrival, 
people were greeted at the door and directed to spaced-apart “lanes” 
where they would get their shots, then to a monitoring area where they 
could wait for 15 minutes to make sure they didn’t have a reaction.Right
 after Christmas, another 400 doses arrived — and the makeshift clinic 
opened again. This time, doses went to community-based physicians, 
dentists and other hands-on medical practitioners, 600 of whom had 
previously signed up. (Hospital workers and nursing home staff and 
residents are getting their vaccinations through their own 
institutions.)As they move into the next phase — recipients 
include residents over 80, people with developmental disorders and 
school staff — the challenges will grow, he said. The county plans a 
multipronged approach to notify people when it’s their turn, including 
use of a website, the local media, churches, other organizations and 
word-of-mouth.Adams shares the concerns of medical providers 
nationwide: He gets only two days’ notice of how many doses he’s going 
to receive and, at the current pace of 400 or 500 doses a week, it’s 
going to take a while before most residents in the county have a chance 
to get a shot, including the estimated 33,000 people 65 and older.With
 10 nurses, his clinic can inject about 1,200 people a day. But many 
other health professionals have volunteered to administer the shots if 
he gets more doses.“If I were to run three clinics, five days a 
week, I could do 15,000 vaccinations a week,” Adams said. “With all the 
volunteers, I could do almost six clinics, or 30,000 a week.”Still,
 for those in the last public group, those age 18 and up without 
underlying medical conditions, “it could be summer,” Adams said.<a href="http://www.kaiserhealthnews.org/" target="_blank">Kaiser Health News</a>&nbsp;is a national health policy news service. It is an editorially independent program of the <a href="http://www.kff.org/" target="_blank">Henry J. Kaiser Family Foundation</a> which is not affiliated with Kaiser Permanente.

Private practice docs, patients wonder when it’s their turn for vaccine