Doctors on the Home Front: How Do We Deal with Our Private Practices During the COVID-19 Crisis

The rules of the game have changed.

 

Actually, the rules of the entire system have changed!  An invisible force is turning the world upside down and the set of rules we used to live by no longer apply.

As many other small business owners are doing, doctors in private practice are struggling to get their bearings and answer the question posed by a practice administrator, a creditor, or, more likely, a spouse who is worried about the kids’ college funds: “What the hell are you going to do?”

In essence, COVID-19 is a BAD BUG that wreaks havoc in our lungs causing severe interstitial fibrosis, respiratory failure, and sometimes death. Clearly the “virulence” of COVID-19 is greater and has a predilection for adults over 60 years of age with chronic medical conditions such as Diabetes, COPD, or Cardiovascular disease.  However, despite global estimates claiming that 80 % of folks have milder infections, the number of severe cases in the 25-55 age group is increasing at an alarming rate.

The message here for medical practice owners, our families, our staff, and our patients is that this is to be taken seriously. “Shelter in Place” orders in many states and closures of non-essential businesses are enacted to try to slow down or stop direct transmission of the virus between asymptomatic carriers.   Experts predict, however, that without universal testing, we have no way to know what the actual rate of infection in the US population is.  They suspect it is much higher than currently estimated and that, most likely, the virus has been traveling through our communities since last year! Consequently, experts recommend we maintain a six-foot separation from everyone outside of our domestic unit.

Thus, physician small business owners, must decide if their medical practices are “essential” and then take action to uphold their societal obligation to either provide care or limit or shut down their practices.  The financial consequences of both can be devastating for our businesses.

Recently, I polled 10-15 friends in private practices, mostly primary care, and was pleased that opinions and values were, by and large, aligned. Most of those contacted, felt that we doctors have a moral and professional obligation to remain open, albeit in a limited way, to serve our patients and allay their fears.

Additionally, most had informed their staff that if they were immune-compromised, cared for elderly parents in their home, or were simply uncomfortable being in the office, they could “Shelter in Place” without negative repercussions.  Their jobs would still be there when they returned.

Notwithstanding, only those with PTO (personal time off) would be paid. Fortunately, it appears that the federal government is making provisions for employees of small businesses to receive 8 weeks of pay if “materially affected by the COVID-19 pandemic,” though the details are still murky.

Additionally, most physician private practices are considering SBA (Small Business Administration) loans provided under the Economic Disaster Relief bill. The sage advice of an Atlanta based SBA lending firm, “get your application finalized and in the queue ASAP” (SBA Disaster Customer Service   at 1-800-659-2955 or the link https://disasterloan.sba.gov/ela/Information/PaperForms  )

During the current crisis every clinic and physician owner has important obligations to his/her patients and the staff members providing their care. We take an oath to “Do No Harm” which we now must balance with “Pay the Rent.” I, personally, have chosen to inform my patients and staff of current “Shelter in Place” recommendations, extended through April 30th.  I have also informed them that we remain open to take their calls and provide telemedicine consultations, answer everyone’s questions, and allay their fears.  In the meantime, I am choosing to spend quality time with my children and watch the spectacular springtime blossom around me as I hope for a better future for us all.

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