Private practices:
Many people who work in private doctors’ offices, including physicians, are being furloughed.
As the coronavirus crisis surges, many private medical practices in the Bay Area have seen a steep drop in patients and revenue that could force them to go out of business, leaving their workers — physicians, nurses, assistants and staffers — unemployed and patients in the lurch.
The term private practice may conjure images of the lone family doctor who runs his or her own office with a nurse and an assistant, but it covers everything from practices with a handful of physicians and staff to those with hundreds of doctors and staff members. They include specialists and surgeons as well as primary care doctors. The slowdown is also affecting dentists and optometrists and ophthalmologists.
“Anyone who isn’t in the hospital has pretty much shut down to all but emergency conditions,” said Andrew Tomlinson, a San Francisco ear, nose and throat doctor who serves as a delegate to the San Francisco Marin Medical Society.
“Patients stand to be stranded,” he added.
While it may seem counterintuitive during a medical crisis, many people who work in private doctors’ offices, including physicians, are being furloughed as a result of declining business. Many patients are staying home and canceling routine or nonurgent medical appointments during the shelter in place — often at their doctor’s direction.
Most elective surgeries have been canceled and many practices have stopped nonessential appointments, including checkups of patients with chronic conditions. Some offices have drastically reduced hours or even closed.
This has led to the same financial challenges many small businesses are facing.
“We’re like a restaurant that’s now only doing takeout,” said Brian Grady, a San Francisco urologist and medical society president. “We still have rent to pay, employees to pay, but fewer patients and less revenue.”
He suggested that “a few dozen” of the society’s 2,000 members across two counties will likely close their doors. That number, of course, could be greater.
“It’s probably more than you would think,” said Dustin Corcoran, CEO for the California Medical Association,. “It’s not just small practices. We are hearing of practices with as many as 250 doctors that are suffering as well. These are sophisticated operations.”
In the East Bay, Joe Greaves, executive director of the AlamedaContra Costa Medical Association, said that business in most outpatient practices “plummeted to about 30% of normal,” and several urgent care centers have either closed or consolidated. At Michael Schrader’s internal medicine practice in San Francisco, they’ve only seen about 10 patients, all in need of urgent treatment, in the past three weeks, he said.
ManKit Leung, an ear, nose and throat doctor in San Francisco’s Chinatown, said he worries that many practices will close, particularly in underserved communities. “That’s my fear,” he said. His practice, San Francisco ENT Medical Group, should stay afloat, though it may require the use of Small Business Administration loans and some lines of credit, he said. The number of patients it’s seeing is about 10% of normal.
“We’re furloughing staff, writing letters asking for rent relief, trying every way we can to avoid paying bills,” Leung said. “The physicians are forgoing salaries and pay while we’re trying to keep paying our staff.”
Closed medical practices could have immediate and longterm effects after the coronavirus crisis ebbs. After stayathome orders are lifted, practices expect to be hit by what some are calling “a second surge” — a flood of patients who’ve deferred regular medical appointments or put off treatment for lessserious injuries.
“Are all those practices going to be there when we need them when we get past the COVID surge?” Corcoran asked.
Shuttered practices could also force many patients to seek new doctors, which would present issues of patient familiarity and treatment continuity.
“It’s not just older people; it’s anyone with chronic medical problems,” Corcoran said. “If you’re healthy and you just need an annual checkup, anyone will do. But if you have a chronic condition, like diabetes or a heart condition, it takes a while to figure it all out with your doctor. It’s not easy to transfer that knowledge between doctors.”
Telemedicine — video appointments via smartphone or computer — could help practices keep serving patients during the crisis, doctors say. But many practices lack the equipment or the expertise, and telemedicine visits often pay less than office visits. Doctors’ groups are scrambling to help smaller practices to set up telemedicine, Greaves said, and Schrader said the number of practices that go under may depend on “whether we can adapt to a new model by using telemedicine if the pandemic lasts months.”
The Asian American Medical Group, a collection of 250 physicians in San Francisco and northern San Mateo County, was prepared for the shelterinplace orders with an approved telemedicine app. The app and FaceTime have allowed the group to keep seeing patients, many of whom are older and many of whom have underlying conditions like diabetes or heart disease.
“That way we maintain our contact with the patient, have a facetoface connection and can do a visual examination,” said Eric Leung, an ophthalmologist and the group’s chairman.
Physicians say they also need financial assistance, starting with breaks on rent and better reimbursements from Medicare, MediCal and health care plans. Stimulus legislation contained some aid to doctors, Corcoran said, and doctors are eligible for small business loans, but that might not be enough.
“That bill is going to come due for us as a society,” he said. “We’re going to need our physicians, our clinicians, ready to go the minute that we’re able to get back to business. We don’t need physicians and nurses and other medical personnel worrying about their financial future when we’re sending them to the front lines of a health crisis.”