How to successfully practice medicine in person again

What would the COVID-19 pandemic death toll have been had the government done nothing to curb the spread of the coronavirus? It’s impossible to say with certainty, though epidemiologists estimate that 90% of US COVID-19 deaths could have been avoided if the nation began social distancing just 2 weeks sooner.

While stay-at-home restrictions have been largely effective, health systems and clinics across the country have been hit hard financially. The American Hospital Association found that healthcare facilities will likely lose more than $161 billion in revenues from March through June due to reductions in care, such as canceled elective surgeries. The American Academy of Family Physicians estimated that as many as 60,000 primary care practices would shutter or rein in their operations. And telemedicine blasted into the stratosphere, with patient adoption up from 11% to 46%, and healthcare providers virtually treating as many as 175 times the number of telemedicine patients as in the past.

All that’s to say, physicians have good reason to be eager to return to the clinic.

But steep challenges remain for independent and employed physicians alike. Doctors must take new steps to restore patient trust, rebuild patient volume, and keep everyone safe when the doors open again. MDLinx scoured guidance from governmental and professional organizations and interviewed consultants who authored a new practice recovery kit to get key insights on how physicians can return to practicing medicine in person—and patients can receive much-needed care—while reducing fear and uncertainty. Here’s what we found.

Is your community ready for in-person medicine?

Before traditional care can resume, state and local governments must give the green light. The American Medical Association has published a guide to reopening that sheds light on each state’s executive order and what it means for healthcare, including current stay-at-home guidelines and dates for resuming elective procedures. Meanwhile, the California Medical Association has advised physicians to consult their local public health departments to better understand state and county regulations.

Of course, physicians who work for themselves or large employers should continue to monitor COVID-19 trends in their areas, says Robin Roberts, co-founder of Chirpy Bird Health IT Consulting and co-author of the practice recovery kit. To that end, doctors should understand the local availability of testing and the direction in which the number of COVID-19 cases is trending, she says.

The key question to answer: Given your state’s progress in reopening, is it appropriate to resume non-emergent care?

How to prepare for patients’ return

Whether physicians run a practice or work for someone else, they must ensure their clinics are ready to safely accept patients in the COVID-19 era. “This is now more than ever a time for physician leaders to step up and lead,” Roberts told MDLinx. “The only way that you can recover and reopen successfully is to really step up, unify your team, and address the clinical operational process needs of your entire team.”

That starts with training and infection prevention and control. Healthcare organizations need an “established plan for thorough cleaning and disinfection prior to using spaces,” with new protocols governing everything from how physicians and other colleagues work and what they wear to which kinds of disinfectants to use, according to the practice recovery kit.

Adequate supplies of personal protective equipment (PPE), from masks to gloves, are critical to every successful return to medicine, Roberts notes. If a physician doesn’t have access to PPE, then delay reopening or raise the issue with a supervisor.

Although physicians might be quick to fill their schedules, some cases may warrant staggered scheduling in which patients come to the clinic at different times, possibly without guests, to lower the odds of in-person contact and coronavirus exposure, according to the AMA. If possible, implement separate waiting areas for well and sick patients.

Don’t be too quick to abandon telemedicine, adds Joy Rios, Chirpy Bird co-founder and co-author of the practice recovery kit. “If the practice understands their own individual goals and what they want to accomplish through reopening, potentially with two tracks of both in person and via telehealth, make sure that everybody within the practice is aware and trained on how to do both safely,” she says.

For instance, primary care physicians might choose to perform COVID-19 screening through telemedicine to keep potentially infected patients from spreading the virus, while dermatologists might opt to buy new equipment to perform skin checks virtually.

Patients might be hesitant, but physicians can help

Despite the efforts of large institutions and independent practices to sanitize clinics, patients are likely to be wary of stepping foot in the doctor’s office. “You have to put in the work to assess that,” Roberts says. “The patient’s willingness to come back in and feel confident and safe in doing so is still the most important.”

She advises clients to start by sending digital surveys to patients. Then, after determining their appetite for traditional care, physicians and healthcare organizations can craft appropriate messaging to reach patients via email, social media, portals, and other appropriate channels.

Patient communication might be more challenging than any other aspect of practice recovery in the coronavirus pandemic. Successful physicians will spotlight the work their office has undertaken to create a safe and clean environment. They will be clear about when, where, and how they plan to practice medicine. And they will inform patients of what is and isn’t appropriate. The chief goal is to rebuild trust.

“Right now, it’s hard to know what to expect in anything,” notes Rios, who, along with Roberts, hosts a renowned industry podcast named HIT Like a Girl. “So, the more normalcy, standards, structure, and routine that we can create, everybody will be thankful and grateful for that level of communication.” 

What’s at stake in the return to in-person visits

Rios and Roberts work with some physician practices that have yet to return to in-person medicine, but others have scaled up to between 30% and 70% of their typical patient volume. Among the greatest challenges is the clash between the desire to revamp scheduling—and thus revenues—and new demands ushered in by COVID-19. Physicians who are readjusting well to the “new normal” took planning seriously and spent time to train themselves and their colleagues, the consultants say.

“You sure as heck don’t want to be the guy who’s not prepared, who hasn’t done the work, who’s just hoping nobody gets sick,” Roberts adds. “It’s about taking good care of one another. And that is what physicians do best: take care of their patients.”

MDLinx has no financial interest in Chirpy Bird or its products.