Early in 2020, it was as if a COVID-19 atomic bomb had been dropped. There was disbelief, panic, and confusion in the medical environment. Almost immediately there was a sudden surge of patients seeking medical assistance from emergency rooms for the treatment of COVID-19. Primary care practices were silent with the majority of patients too afraid to seek care from their primary care physicians and bound by stay-at-home orders. As a result, practices furloughed or laid off key personnel and temporarily or permanently closed offices. Primary care physicians were daunted by the task of developing a plan to survive and see patients without spreading the highly contagious virus. Surgical specialties were grounded. Executive orders by the State of California mandated that surgeries and intensive procedures could proceed only if delay was deemed to cause significant impact on health.
According to the Medical Group Management Association, COVID-19 had a financial effect on 97 percent of the 724 practices it surveyed. All medical practices have been affected by at least 50 percent.
As terrible as the pandemic has been, with its sweeping devastation to medical practices, COVID-19 has prompted physicians to develop new systems and procedures to treat patients. As a result, physicians have turned their shrinking practices into busy offices providing vital services to patients.
Who would have known that doctors would utilize telemedicine on such a wide scale? Telemedicine has been an available method of maintaining a patient/physician relationship since the late 1950s. It has been utilized most often by psychiatrists; however, because of the pandemic, most specialties have found value in the platform. Routine primary care visits, pre- and post-surgical visits, even physical therapy sessions have proven to be effective forms of treatment using telemedicine.
Many physician offices, especially pediatric practices, have set up alternate ways of checking in office appointments. An appointment is established. The patient reports to the office parking lot, at which time a call is made to the office for “check-in.” The office acknowledges the arrival and instructs the patient to wait in the car. When the office is ready, the patient is called on a cell phone with instructions to enter a designated “in-only” door. Upon entering, the patient is escorted directly to a sanitized exam room. When the visit is completed, the patient leaves by a door that is designated “out-only.” Efficient and safe.
Some physicians have clothed themselves in personal protective equipment with shields, masks, and gloves to administer vaccines to children who are in their cars in the parking lot. Others have taken to visiting patients in their homes.
Physicians Expand Their Scope of Practice
Anesthesiologists have been invited to assist in COVID-19 intensive care units as a result of their regular tasking of intubating patients who need to go on ventilators. They have found a way to continuously use their training while assisting in a vital situation.
General medicine, family medicine, and internal medicine specialties have been called into emergency rooms for help managing the triage process in hospitals that have been inundated with overflow due to COVID-19. Those that are willing to take the risk of infection have gladly accepted the opportunity to continue to practice. Other physicians have pointed out that partnerships with the military during a situation such as this pandemic can provide additional opportunities to practice that may not otherwise be available.
Physicians and healthcare professionals have proven the theory of adaptability and resilience by becoming better than they were before the pandemic. Due to the unbelievable circumstances of COVID-19, many have recreated the manner in which they treat patients by expanding their scope of practice and integrating new ways to extend care while remaining connected to their patients.
Gwen Spence is Assistant Vice President, Membership Services for CAP. Questions or comments related to this article should be directed to gspence@CAPphysicians.com.