Shrinking and disappearing doctors' offices could trigger public health crises as sick patients go untreated and children do not receive important vaccines.
It's not just doctors' offices in New York, the epicenter of the coronavirus epidemic in the U.S., that are experiencing financial hardship. Some 51% of primary-care providers are uncertain about their financial future over the next four weeks, and 42% have either laid off or furloughed staff, according to aby the nonprofit Primary Care Collaborative and Larry A.
Green Center. In addition, 13% predict closure within the next month. Dr. Conrad Flick said the independent clinic where he practices medicine in Raleigh, North Carolina, saw a sudden 70% drop in patient volume from one week to another in late March as people grew fearful of going to the doctor and sheltered in place. His clinic, Family Medical Associates of Raleigh, is a small practice with five physicians and five nurses on staff. "We're a small business and our profit margin is 3% or 4%," Flick said. "It does not take a lot of business sense to know when the volume of patients is down 70%, you're in trouble." Even with fewer patients, Family Medical Associates had to rapidly adapt to protect its staff and the people who were still coming in. They converted part of the building that had been used as a weight loss clinic into a dedicated area for examining patients who were displaying Covid-19 symptoms. The clinic also installed plexiglass screens in the check-in and check-out areas. But as demand for testing soared, the practice decided it was safer to see potential coronavirus patients in their cars in the parking lot. The staff's personal protective equipment — N95 masks and gowns, in particular — started to run low. And in a matter of days, the practice's inventory of nasal swab tests from LabCorp was on the verge of running out. They decided to reserve what was left to test staff members in case they show symptoms. Dr. Conrad Flick and nurse practitioner Ryan Johnson at Family Medical Associates in Raleigh, North Carolina. Independent primary-care clinics have been hit hard by the pandemic.A handful of Flick's patients have tested positive for the coronavirus, and two were so sick they had to stay in the hospital for several days for monitoring, he said. Fortunately, they did not need to be placed on ventilators. The practice is now referring most patients with symptoms to larger testing centers affiliated with hospitals. In difficult financial straits, Family Medical Associates has sought to compensate for the drop in office visits by rapidly transitioning to telemedicine, but patient volume is still down overall by more than 25%. Flick and two physicians who own the practice took 45% pay cuts while the practice's other two doctors took 25% pay cuts. The mortgage has been delayed three months, and the practice came close to laying off a third of staff until it got a small business loan through the second round of the Paycheck Protection Program. Flick said the loan would only buy Family Medical Associates about six weeks of solvency if patient volume drops to its worst low of the crisis again. Many physicians are concerned about a second coronavirus outbreak in the fall or winter, renewed stay-at-home orders and further financial pressure. Unlike Guillen's practice in the Bronx, Flick has more Medicare patients and received about $31,000 from the federal government's relief fund. That, too, is helping his practice ride out the crisis as they search for ways to adapt to an uncertain post-pandemic reality. For now, the practice is tracking how patient volume and revenue are shifting. "We are going to dramatically change our business model," Flick said, "because I don't think number of patients we used to see will come through our doors soon."
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