Opinion

Doctors’ offices are in danger of going under

The COVID-19 pandemic increases costs and decreases revenues for doctors. The state should help.

Physician practices in New York are struggling during the COVID-19 crisis.

Physician practices in New York are struggling during the COVID-19 crisis. XiXinXing/Shutterstock

Every night at 7 p.m., New Yorkers cheer for the health care workers on the front line of the COVID-19 pandemic, fighting to save lives. We rightly laud their contributions. But we should also know that in addition to putting immense strain on our hospital system, the pandemic is preventing thousands of New Yorkers from getting the health care they need. And without help from the state and federal governments, many physician practices in New York will not be able to survive.

I work at a physician-owneddermatology practice in Elmhurst, Queens, one of the neighborhoods with thehighest rates of coronavirus in New York City. Before that I was faculty at NYU and Cornell for six years. I met my current boss, Dr. Hyun Soo Lee, when I was a resident at NYU and he was an attending physician at Bellevue.

Our practice is a few blocks from Elmhurst Hospital Center, one of the hospitalsmost overwhelmed by COVID-19 cases. Our patients are from Colombia, Mexico, Ecuador, Peru, the Dominican Republic, Puerto Rico, Korea, China, Bangladesh, India, Pakistan and Nepal. Our doctors and staff reflect this diversity. Most of us speak several languages, and organize our complex schedule to take care of uninsured and underinsured patients, arrange for patients to have providers who speak their language and support our local restaurants and businesses. I spend about 80% of my day speaking Spanish.

Medicaid patients comprise about 70% of our practice – what is called “an unfavorable payer mix” in health care finance terms. In human terms, these are cab drivers, medical assistants, pharmacy workers, delivery people, students, grocery store workers. In other words, they are often frontline workers. Many physicians in private practice cannot afford to take Medicaid, and academic centers most often do so only in their crowded resident clinics. This is because reimbursements are much lower than commercial health insurance, and the costs of operating a medical practice in New York are very high because of rents for commercial buildings.

Dr. Lee also has practices in the Flushing neighborhood in Queens, the town of Englewood, New Jersey and the Bronx. His bustling offices succeed because we service areas with a physician shortage and we have a very high volume of patients. This is made possible because our practice is efficient and well staffed – with four doctors, we employ approximately 110 people across all four offices, including mid-level medical professionals such as physicians’ assistants and a nurse practitioner. This means that we have a very large staff available to answer phone calls, fill out prior authorizations, act as scribes for providers and answer non-clinical messages. When I worked in Manhattan, on an average day I could see 25-30 patients – usually with about three hours of paperwork. On a busy day in Elmhurst with so much support, I can see on average 50 patients, since my charting and paperwork is minimal.

Over the last month, our patient numbers have dropped significantly. Like many other physicians’ practices, we have had to close our offices. Located in the epicenter of the epicenter, as our Elmhurst zip code has been called, I and several of our staff members have had COVID19, had to isolate, closed offices for our own and patient safety, and we have moved all of our patients for the time being to telemedicine. 

A survey by the Medical Society of the State of New York reported that 80% of physicians’ practices respondinghad a reduction of more than 50% in the volume of patients since the pandemic. Many of these practices were not assisted by the federal small business loans Congress created in the third COVID-19 relief bill, known as the CARES Act. On a Facebook page for dermatologists, a recent post informally asked New York doctors if they had received PPP loans after applying for them. Of the 25 who commented, only 10 had and only 2 reported having received checks. A more general member survey indicated that most practices receiving loans applied through smaller, local banks.

Even though our practice is suffering, our patients still show up. I now see my patients from isolation in my home, while they are in isolation too. We introduce each other to our pets and families, we talk on Facetime and other platforms. Many of them have been sick. None of them live alone. 

One young woman from Bangladesh told me that both of her parents had been in a hospital’s intensive care unit with COVID-19.

Another young man has Morbihan disease, a condition that causes severe disfiguring facial swelling. He would benefit at this point from a medication that needs lab monitoring, but I worry about the safety of sending him for labs right now in Elmhurst. He lives with older, more vulnerable, people.

 

A one-month old baby I saw on Friday had an extensive oozing rash with bumps of pus along his neck.

Many of my psoriasis and eczema patients are having extensive flares, possibly exacerbated by stress and indoor heating, are covered from head to toe in thick scales, and can’t sleep. Many of them are on medications that suppress their immune systems. Being immunocompromised is a risk factor for more severe cases of COVID-19, including death, so we now have long complicated conversations about the possible risks of these medications. We make plans to either stop their medications, switch to others thought to be safer, or continue them, based on our patients’ ages, other health issues, and the severity of their disease.

A patient with sarcoidosis, an autoimmune disease that can affect the skin and other organ systems such as the liver, lungs, and heart, heart, can’t get her prescription filled for hydroxychloroquine. The drug keeps her from being covered in thick red itchy bumps but is now in short supply in some pharmacies because of its experimental use as a treatment for COVID-19. My staff and I have spent a lot of time tracking down a pharmacy that can provide her with this medication.

Even with our office closed, Dr. Lee has met patients in his Flushing office to drain abscesses and keep them out of urgent care and the emergency room. Our patients need us.

When medical offices start to reopen, to limit the risk of spreading the coronavirus among patients and staff, the volume of patients will need to be low. Our regularly packed waiting room will be almost empty as we prioritize urgent patients for inpatient visits and schedule with more time between appointments to allow for cleaning and to minimize crowding. Expensive and scarce personal protective equipment such as masks will be needed. For practices like ours in New York that rely on a high volume of patients, the decreased revenue and increased time and expense associated with PPE and cleaning will be devastating.

Physicians’ practices are going to need support for a long time to be able to continue serving our patients.

What needs to happen to keep practices like ours open for New Yorkers who rely on us? Physicians’ offices, in addition to hospitals, must be supported by the state budget. Federal stimulus packages have not picked up the slack for local New York physicians’ practices. As federal small business loans are not reaching New York physicians adequately, small business loans prioritizing physicians’ practices must also be made available at the city and state level.

In addition, now is not the time to be cutting Medicaid funding, as the state budget proposes. Neighborhood doctors’ offices serve our frontline workers and in so doing, all of New York.

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.