Patient volume in COVID-19 era

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FrustratedFamDoc

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Looks like I'm on tap to see 9 patients today. Typical Tuesday has me 23-25. Almost all of my routine 3/4 month follow ups have cancelled and my visits today were new patients or ER follow ups. Anyone else with similar experiences?

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Somewhat. I saw 10 yesterday, back up to 20 today. Lots of regular follow ups are canceling and just asking for refills (which I'm fine with) but getting lots more acute stuff that about balances out.
 
I saw around twenty/day the past two days, which is about average. We've had a few routine follow-ups cancel or reschedule, but it's been offset by URIs. So far, no proven COVID-19. It's coming, though. We're seeing most of the URIs in their cars in the parking lot (with PPE). All it would take is one proven case with staff exposure to shut us down and quarantine everyone for two weeks.

I'm looking into telemedicine as an option, as well.
 
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I saw around twenty/day the past two days, which is about average. We've had a few routine follow-ups cancel or reschedule, but it's been offset by URIs. So far, no proven COVID-19. It's coming, though. We're seeing most of the URIs in their cars in the parking lot (with PPE). All it would take is one proven case with staff exposure to shut us down and quarantine everyone for two weeks.

I'm looking into telemedicine as an option, as well.
Apparently 2 of our guys have been testing a telemedicine option that can be integrated into Epic for the last month or so, they have good things to say so are likely to ramp that up to all of us when this gets worse.
 
Apparently 2 of our guys have been testing a telemedicine option that can be integrated into Epic for the last month or so, they have good things to say so are likely to ramp that up to all of us when this gets worse.

The one we're using is integrated into our EHR, as well. It looks pretty cool so far. I was just added to our beta test group, so I haven't had a chance to use it with an actual patient yet.
 
Have had several local confirmed cases which is likely driving things here. Next few days will let me know more.
 
Starting yesterday we’ve cancelled all non essential appointments, been calling patients. Will likely see even more non-essential care done over the phone this week.
 
I've treated a few patients over the phone for things that I normally would've asked them to come in for. That's one reason I want to get the telemedicine thing going, so I don't leave money on the table. It will also help the next time I'm on call, which I'm expecting to be higher volume than usual.
 
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Volume in urgent care has dropped by half. Had a crazy few days last week where I was seeing 60-70 people by myself. The general public thinks we can just test for COVID like we do flu and the masses are angry. Nursing fielding angry calls all day. Admin is a total cluster. So glad today is my last day for a while.
 
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15 yesterday, 17 today. First confirmed case in my practice's county confirmed, in the town I practice. We had our first local death one county over. I expect the schedule to vacate.
 
We've had 6 confirmed cases in the county and one recently passed. I somehow managed to eek out 11 visits yesterday. Today is looking like single digits.
 
I’ve got 14 today, 12 yesterday. Have been averaging around 20-25.

My office partner is throwing a fit, she only saw 3 today (she works half day). Has one scheduled tomorrow.

Luckily I’m on salary guarantee still.

We know this lull will end soon enough though.
 
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I've had a cough for the last 6 days which only lasts in the morning for 20 minutes then would go away after I hacked up phlegm. I didn't think it was COVID-19 because it wasn't a dry cough - I honestly think it's actually just from being stuck inside with no fresh air. But, I wanted to go to my PCP for an unrelated problem because one little cough in the morning isn't concerning, but they "Screened me" over the phone and because I had a cough told me not to come in - Is anyone else following similar protocol?
 
Man, it feels like the creepy calm before the storm. Like half as many people coming in through the ED. First day I've ever had were we had NO outside transfers.

They have erected walls inside the ED, and a huge tent outside the ED. Conserving our PPE as best we can.

Crazy times.
 
I've had a cough for the last 6 days which only lasts in the morning for 20 minutes then would go away after I hacked up phlegm. I didn't think it was COVID-19 because it wasn't a dry cough - I honestly think it's actually just from being stuck inside with no fresh air. But, I wanted to go to my PCP for an unrelated problem because one little cough in the morning isn't concerning, but they "Screened me" over the phone and because I had a cough told me not to come in - Is anyone else following similar protocol?

Yep.
 
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I've had a cough for the last 6 days which only lasts in the morning for 20 minutes then would go away after I hacked up phlegm. I didn't think it was COVID-19 because it wasn't a dry cough - I honestly think it's actually just from being stuck inside with no fresh air. But, I wanted to go to my PCP for an unrelated problem because one little cough in the morning isn't concerning, but they "Screened me" over the phone and because I had a cough told me not to come in - Is anyone else following similar protocol?

Yes pretty much.
We have wide community spread here and I’m sure other cities will be soon to follow.
As of 2 weeks ago essentially no routine visits can come in and we’ve moved everything to phone and video visits.
We’re still open for urgent visits and for certain things like newborn visits, necessary prenatal care, etc.
If you call saying you have a cough, fever, etc we recommend the safest place for you to be is at home and to not come in if it doesn’t sound like you need to go to ED.
 
In urgent care we see 80-90/day split between two providers. I saw 8 yesterday, 17 total for both of us. Phone triage at the front door w calls taken by providers only- no coughs or fevers or worried-well allowed in. You try to pick out the pyelos and PNAs amongst the fevers/flu likes.
 
Almost 75% of resident schedule in our clinic is still there, but 2/3 are now telemed visits via phone. As for specialties and even the faculty clinic, its all way down. A relative's PP is down to 40% of usual patients. He's worried about staying viable.
 
Currently down to 10-15/day, so essentially <1/2 volume. Hope to replace some of that with telemedicine. I've done a few of those now. So far, so good. Hope we get paid for 'em.
 
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Currently down to 10-15/day, so essentially <1/2 volume. Hope to replace some of that with telemedicine. I've done a few of those now. So far, so good. Hope we get paid for 'em.
Is 10-15 a day enough to at least keep the lights on and pay staff?
 
A ray of sunshine poked through yesterday. 6 in the am, 10 in the afternoon. Literally had 4 UTIs (COVID babies 9 mos from now?) yesterday. About to see my 6th pt of the am today and it's only 9:30.

My feeling is that people are growing tired of the lockdown already and starting slowly resume normal life activities again. Hopefully, next month will be back to fairly normal volume.
 
13 patients all day yesterday. Most I’ve seen all week I think.

Now being told to expect a salary reduction (I’m on guarantee still). I’m fairly confident my contract would preclude that, but I’ll get my lawyer to advise me better on that.
 
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13 patients all day yesterday. Most I’ve seen all week I think.

Now being told to expect a salary reduction (I’m on guarantee still). I’m fairly confident my contract would preclude that, but I’ll get my lawyer to advise me better on that.
Don't you think it's fair to accept a salary reduction even if your contract precludes that? I would...
 
Don't you think it's fair to accept a salary reduction even if your contract precludes that? I would...

Nope, because my production is down purely for the good of the public. We’ve yet to have a confirmed case in my county, but we’re limiting office visits all the same to be be proactive. And our admin said publickly anyone doing their regular work load (even if from home) won’t get cut (I.e. them).

They make way more than I do, by siphoning their salary off of what I do. So it stands to reason that if my income goes down, theirs should too.

Plus, I’m still going to be 100% available to handle covid patients once things pick up here. I’m FM, but I’m also hospitalist for adults and peds, ER doc, gyn, hospice etc. And I’m currently available in office for any urgent needs per company protocol and requirements. It’s not like I’m taking a vacation here.
 
Meh. The partners in my group (including me) aren't getting paid at all until further notice. We'll be lucky if we can cover our overhead even with layoffs and staff salary reductions.
 
Meh. The partners in my group (including me) aren't getting paid at all until further notice. We'll be lucky if we can cover our overhead even with layoffs and staff salary reductions.
And as an employed doctor, I would have no problem taking a pay cut during this if, and only if, administration does as well.

As an aside, are y'all too big for all the SBA loans that are now available?
 
I am seeing 3-10 a day, before this I was seeing around 22 a day on average.

Our county will likely have >1,000 positives today, despite very limited ability to test.
 
Previously seeing 25+ a day now at about 15-18 a day via telemed.

Applied for PPP SBA loan,I am waiting to hear back. Wells fargo ran out of dedicated funds for this program after 24 hours of having application open. I used a smaller local bank.

Visits for all my friends who are in private practice are down 50% or more.

I had one day last week where for whatever reason I only had 6 on the schedule.
 
My schedule has been hit and miss. I usually am around 20 per day with MSK and procedures sprinkled in. This week I’ll be lucky to break 50 patients for the week (clinic is closed on Friday). Doing a fair amount of video and telephone visits with in person visits sprinkled it.
 
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