During the depths of the COVID-19 shutdown in early spring, many physicians with private practices struggled both financially and emotionally. And they may not be out of the woods yet.
In March, many physicians responded to the calls from their professional associations to close their offices or limit the number of patients they saw. A survey of 500 physicians, nurse practitioners, and physician assistants found that by late March, almost 9 in 10 were limiting patient visits to their offices.
Dr. Alieta Eck, who runs an internal medicine practice in Piscataway, New Jersey, was one physician who did not close down her practice.
“We noticed a lot of our colleagues were closing their practices,” she said. “We didn’t. We figured when people are sick, that’s when they need us.”
Still, Eck did see a decline in office visits.
“About one-quarter to one-third of visits became telemedicine visits, as people were afraid to come to our office,” she said.
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The fear that patients had of visiting the doctor for fear of contracting the virus in a waiting room took a toll. Total doctor visits declined 37% from early March to late June, according to the Commonwealth Fund. At the worst point in late March, visits declined by 58%. While traffic to doctor’s offices began to recover in early April, it still hadn’t fully recovered by late June, when visits were still down 11%.
The decline in visits also had a financial impact. An analysis in Health Affairs found that primary care physicians would lose an average of $67,774 in income due to the pandemic.
Dr. Kelly Green, an ophthalmologist in Marble Falls, Texas, shut her practice down on March 20 and reopened on May 4. She wouldn’t specify an exact amount that her practice lost but said that “it was in the hundreds of thousands.”
She received loans from the Paycheck Protection Act and Small Business Administration to help keep her practice open.
“I know that some people think that doctors are highly paid, but patients should care because if private practice doctors don’t make it, then you could lose your doctor,” she added.
The Health Affairs article noted that physicians could reduce their losses to about $25,000 if they furloughed staff and reduced benefits. But that leads to another set of problems.
“There are 18 people who work at my practice,” said Green. “Some of them are single moms, some of them take care of aging parents. And some of them don’t have a safety net or a family nearby.” She worked closely with her staff to get them unemployment benefits and provided financial assistance to those staff who did not receive them.
A recent Primary Care Collaborative survey found that 70% reported high levels of strain on their practices, and almost 4 in 10 agreed with the statement that “burnout in my practice is at an all-time high.”
At times, the stress was overwhelming for Green.
“Every day, you wake up, and you want to go to work and have it be normal, and you can’t,” she said. “And you just want to see your staff and see your patients … You don’t know how it is going to go. You wonder, are my patients going to get sick and die?”
Green recounted one patient who lost part of her vision who she couldn’t see because of the pandemic. However, she said that didn’t seem to occur much during the shutdown.
Eck saw lots of difficult cases at the Zarephath Health Center, a free clinic she runs in New Jersey.
“We just saw the saddest cases, people who were just destitute,” she said. “They lost their jobs, they lost their insurance, a lot of people lost everything, and that was hard to see. Depression [among these patients] was rampant.”
As the virus surges again in parts of the United States, the possibility that physician practices would have to close again looms. In July, Texas has had over 8,100 new cases of COVID-19 daily. In response, Gov. Greg Abbott, a Republican, ordered hospitals in 100 counties to stop nonessential procedures unless they can meet certain COVID preparedness standards.
“The governor is closing up a lot of things, but the governor never told me to close up. It was my professional society [of ophthalmologists],” said Green. “We now have an approach to maintain a safe atmosphere for the patients if we stay open, which I hope we do.”
In all, primary care offices could lose up to $15 billion due to the spring shutdown, according to the Health Affairs study. While the study did not estimate the effect of a summer virus surge, it did account for the possibility of one in the fall. In that case, total losses could exceed $19 billion.
