Small Practices At Risk

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Restaurants and retailers aren’t the only small businesses that have taken a severe financial blow from COVID-19. Physicians in small practices around the country have reported steep declines in revenue, drops so significant that some of them and their supporters have resorted to GoFundMe – ironically the platform best-known for helping patients pay their medical bills – to raise funds to help pay their overhead. Telemedicine has been of minimal financial help to small practices. Tenants have had evictions stayed and rents suspended (how the landlord then pays their bills I don’t know) but physicians still have to pay all their bills including, in some cases, tens or hundreds of thousands of dollars in malpractice premiums, especially here in NY where malpractice premiums are among the highest in the country.

A few weeks into the pandemic, the Medical Group Management Association found that COVID-19 had a negative financial effect on 97% of the nearly 800 practices it surveyed. In May, the Texas Medical Association found that 68% of practicing physicians had cut their work hours and 62% had their salaries reduced. Many practices had to furlough employees as practice volumes fell to 20 or 30% of normal. Patients, especially those at high risk from this virus, stayed away from doctors and hospitals in droves. Many patients had the mistaken impression that doctor’s offices were swamped with sick patients when in fact the opposite was true. Many physicians report that despite restrictions being lifted, their practice volumes have remained below prepandemic levels and are likely to stay there at least as long as social distancing is required.

Although people packed beaches and boardwalks after restrictions were lifted and Black Lives Matter demonstrators flooded city streets and parks, many people, often older and in poorer health, remained reluctant to visit physician offices. As Ateev Mehrotra, MD, a researcher at Harvard Medical School and hospitalist at Beth Israel Deaconess Hospital said, “As a country, we did a very good job of explaining that there was this sudden, horrible virus going around.” But that message had unintended consequences, he added. He said “We got people scared of going to the doctor’s office or the hospital. They would rather die at home than get exposed to the virus.” Unfortunately, that is what many people did as non-COVID-19-related deaths spiked across the country (a fact sadly lost in all the COVID media hype).

Experts predicted that the pandemic would accelerate the closure of many small practices, and that is exactly what has happened. With many of these practices, more than 40% of revenue goes directly to pay overhead expenses, so when volume and revenue drop precipitously, it is no longer possible to keep the doors open. That is what happened to me, causing me to opt for retirement rather than stick around losing money while waiting for a vaccine to improve the situation. Only a handful of doctors make huge amounts of money, for example cardiothoracic surgeons. Most make enough to live comfortably but are by no means wealthy. Most doctors I know entered the medical field to help humanity, not to become rich. Doctors no longer top the list of top income earners. Attorneys now top that list, and doctors are way down on that list. Anyone thinking of a medical career would be wise to consider that. As for me, I have no regrets.

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 By Peter Galvin, MD

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