How much has your volume changed due to COVID-19

[InvestingDoc]

Just curious how much your practice has been affected by COVID. Most doctors I talk to are down about 50% or more with patient volumes.

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[gutonc]

I'm in oncology so we're still going strong. Volume decrease is mostly due to BS heme consults being pushed out 3-never months and the complete shutdown of screening mammos and colos.

My institution is talking about a slow startup of elective surgeries and screening procedures/imaging over the next 6-8 weeks so I suspect if you ask me in 3 months the answer will be Up 26-50% compared to now.

 

[InvestingDoc]

I'm in oncology so we're still going strong. Volume decrease is mostly due to BS heme consults being pushed out 3-never months and the complete shutdown of screening mammos and colos.

My institution is talking about a slow startup of elective surgeries and screening procedures/imaging over the next 6-8 weeks so I suspect if you ask me in 3 months the answer will be Up 26-50% compared to now.

Glad to hear that business is still good.

Where I am at it seems that most practices are down at least 50% for visits. Some of my friends who own free standing ER's tell me that it is totally dead and they may have to close down completely. Some of the primary care practices have already had layoffs, many specialist are simply not open and doing telemed only a few hours a day.

Things have picked up for me in the past week but at our lowest we were down 60% on visits.

 

[RheumDoc112]

We've taken a pretty big hit. Rheumatology clinic with 5 providers. Office visits down about 50%. Adoption of telemed hasn't been easy for many of our patients (to put it mildly). Infusions are also significantly down.
Not feeling very optimistic at the moment.

 

[Modstopizdy]

I guess the biggest concern is how much of all of these changes are permanent? Medicine is a profession that is on a definite downslope, and any shocks to the system such as COVID are likely to only accelerate the trends working against us. I think it's possible office visits will be permanently reduced going forward and the pandemic will massively accelerate the already preexisting trend towards telemedicine, which reimburses a lot less.

Lots of private practices will also shut down and get swallowed up by Big Players that have access to the trillions in Fed money being funneled to corporations. "Emergency" relaxation of scope of practice rules will also almost certainly be made permanent, as all the major players (corporate medicine, government, and nursing lobby) are in favor of it and COVID provides a perfect excuse. And to be honest, it's not likely COVID itself is going to go away anytime soon, so whatever slim picking are left for physicians going forward are going to be acquired at much greater personal health risk than before. It's going to be grim.

 

[InvestingDoc]

I guess the biggest concern is how much of all of these changes are permanent? Medicine is a profession that is on a definite downslope, and any shocks to the system such as COVID are likely to only accelerate the trends working against us. I think it's possible office visits will be permanently reduced going forward and the pandemic will massively accelerate the already preexisting trend towards telemedicine, which reimburses a lot less.

Lots of private practices will also shut down and get swallowed up by Big Players that have access to the trillions in Fed money being funneled to corporations. "Emergency" relaxation of scope of practice rules will also almost certainly be made permanent, as all the major players (corporate medicine, government, and nursing lobby) are in favor of it and COVID provides a perfect excuse. And to be honest, it's not likely COVID itself is going to go away anytime soon, so whatever slim picking are left for physicians going forward are going to be acquired at much greater personal health risk than before. It's going to be grim.

Telemedicine in my experience has felt like "good enough" medicine. Not for everything, but some things. Don't get me wrong, telemed is better than nothing, and for some things can work well. However, for many things it just feels like its just good enough for a visit that in my opinion is not good medicine.

Patients also don't want to pay their copays because they see an ad on facebook where they could have seen another telemed doctor for $25 and are asking why they have to pay me $40 (or whatever their copay is). We have run into a ton of these issues where perceived value is definitely not as high as in office visits.

Patients also seem to want antibiotics or some medication for every visit. If I tell them its just a virus, they still ask for an antibiotic "just in case."

I've had patients open telemed visits while driving, not wearing a shirt. I just don't like the way some of the visits go over.

I'm very happy that we are getting paid now for telemed and it is for sure here to stay in some fashion but I think regular office visits will make a come back once people are no longer afraid to go to the doctors office.

For those clinics with tons of overhead, they are going to get decimated or gobbled up by a large group.

Maybe this will lead to more micro practices? With the ease of telemed, why join a big group if you can start one from home, get paid, and only pay doxy $35 a month for their software?

 

[bronx43]

I don't see why larger groups would buy smaller groups in this kind of situation, as administrative costs tend to go up with respect to the size of the group. The only reason health care entities have been expanding in the past two decades has everything to do with consolidating and increasing negotiating power, instead of promiting actual efficiency and cost saving measures.

I agree with Medicinedoc ... COVID is likely the nail in the coffin for the privatized health care system that is currently in place.

I don't see the economy recovering to pre-covid levels any time soon, and there will be massive employment. The government will likely push out a public option in the next 12 months, which will then dominate the entire market. From there, reimbursement rates from the public option will drop, and as HC systems go under, they will be acquired by the government a la NHS in UK.

 

[bronx43]

We've taken a pretty big hit. Rheumatology clinic with 5 providers. Office visits down about 50%. Adoption of telemed hasn't been easy for many of our patients (to put it mildly). Infusions are also significantly down.
Not feeling very optimistic at the moment.

PP rheum is a dead man walking. It was already mortally wounded before COVID, and now it's on its last legs. If you have an opp to go to academia or VA, do it.

 

[throwaway1000000]

Has any of the stimulus bill reached the primary care clinics?

 

[InvestingDoc]

Besides one payment a few weeks ago from medicare, I have not received any money otherwise. Applied for PPP day one it came out and it ran out of money before I got approved.

 

[IMGASMD]

Besides one payment a few weeks ago from medicare, I have not received any money otherwise. Applied for PPP day one it came out and it ran out of money before I got approved.

That blows. I hope you saved enough to get through. Some places around me are thinking to start elective OR cases within the next two weeks. So at least some of that “new normal” is coming.

 

[chessknt]

You guys are starting to sound like anesthesia from the 90s

 

[bronx43]

You guys are starting to sound like anesthesia from the 90s

Different times. Different problem.

 

[TraderDoc]

Fortunately as a hospitalist, because we're frontline providers for COVID-19, administration actually told us our salaries are protected because of that, but our quarterly bonuses have been wiped and moonlighting opportunities gone to zero. Overall we have seen decrease in patient volume down about 25% compared to pre-COVID. We've also initiated a hiring freeze. I feel horrible for residents who are about to graduate and will be seeking jobs as I'm sure many practices and hospitals have put on similar hiring freezes due to significant decrease in patient volume among all specialties.

As unemployment continues to rise, many will lose their jobs permanently and I'm certain people will continue to be hesitant to seek care whether it is PCP/specialist visits or ER/UC visits as they will be fearful of COVID and the possible financial toll these visits can take. Elective visits will start to rise in volume as economy begins to ramp up but I think it will continue to be far less than Pre-COVID levels for the foreseeable future IMO. But overall just extremely grateful to still be employed. These are extremely tough times in medicine, both in terms of economics of healthcare and personal health risks by providers.

 

[RheumDoc112]

PP rheum is a dead man walking. It was already mortally wounded before COVID, and now it's on its last legs. If you have an opp to go to academia or VA, do it.

Not private practice, hospital-owned group. All of the providers are salaried. As much as I enjoy the VA and academic centers (some of them at least), I don't have a whole lot of desire to see my base pay drop to 150k. Plus or minus an insignificant amount.
It could certainly be worse, but not a whole lot of options at the moment.

 

[bronx43]

Not private practice, hospital-owned group. All of the providers are salaried. As much as I enjoy the VA and academic centers (some of them at least), I don't have a whole lot of desire to see my base pay drop to 150k. Plus or minus an insignificant amount.
It could certainly be worse, but not a whole lot of options at the moment.

Salaried? Or RVU based productivity. I haven't seen many hospital employed positions offer straight up salary. Most offered me productivity after first 2 years. I also expect that hospitals will drastically cut comp/RVU when re-negotiation comes.

 

[RheumDoc112]

Salaried? Or RVU based productivity. I haven't seen many hospital employed positions offer straight up salary. Most offered me productivity after first 2 years. I also expect that hospitals will drastically cut comp/RVU when re-negotiation comes.

Straight 100% salaried with not a single mention of RVUs in my contract (well aware how rare this is).


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[medstudent2IM]

Fortunately as a hospitalist, because we're frontline providers for COVID-19, administration actually told us our salaries are protected because of that, but our quarterly bonuses have been wiped and moonlighting opportunities gone to zero. Overall we have seen decrease in patient volume down about 25% compared to pre-COVID. We've also initiated a hiring freeze. I feel horrible for residents who are about to graduate and will be seeking jobs as I'm sure many practices and hospitals have put on similar hiring freezes due to significant decrease in patient volume among all specialties.

As unemployment continues to rise, many will lose their jobs permanently and I'm certain people will continue to be hesitant to seek care whether it is PCP/specialist visits or ER/UC visits as they will be fearful of COVID and the possible financial toll these visits can take. Elective visits will start to rise in volume as economy begins to ramp up but I think it will continue to be far less than Pre-COVID levels for the foreseeable future IMO. But overall just extremely grateful to still be employed. These are extremely tough times in medicine, both in terms of economics of healthcare and personal health risks by providers.

I will second this. I graduated last year and started hospitalist job last summer. Our hospital census is running at between 25-50% of normal levels (closer to 50%). Salary is guaranteed. We have PTO in addition to scheduled time off in our contracts and we are essentially being asked to utilize some of that right now in conjunction with reduced census. Moonlighting opportunities are gone at the moment within our hospital system. 401k matching is reduced. Right now though, I also feel fortunate to have a job. We really need the surgeons to be able to operate again in order to get census back to where it was sitting pre-COVID.

 

[Laradd]

It seems to depend on where you currently are in the hospital. Overall volume is down but if your one of the providers on a "COVID" floor you'll be plenty busy (at least at our hospital)