COVID-19 put strain on private practices to book patients for routine care
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I am in a nine physician private practice in Providence, RI, with an academic affiliation to Brown University and the Lifespan hospital system. We have never seen it so busy and I’ve been in practice since 1997. I think it’s three things coming together in a perfect storm.
One is that many patients delayed care from the COVID-19 pandemic starting in March 2020. Those patients who had delayed care, whether it was for routine care or for symptoms, are all now seeking attention. So, there’s more than a year’s worth of patients who had delayed who are now coming in. Two, we are now seeing a lot more GI conditions that the pandemic and stress in general have increased the frequency of (such as irritable bowel syndrome or alcohol related liver disease) or severity of the symptoms. Thus, more patients with existing conditions and more patients with new diagnoses or symptoms are seeking care.
Similar Strain Across the United States
Finally, the final big change that happened in the past year in GI is that the age for colon cancer screening was dropped from 50 to 45 years old. So, we have an onslaught of people who qualify to be screened for colon cancer and we’re already booking out pretty far. Now, everyone in our area is booking out at least 8 to 12 weeks in advance. We are doing our best trying to triage so that we can get people with more urgent issues in appropriately.
In talking to my colleagues across the country, they are reporting similar issues both at academic centers and in private practices. Frequently, when patients or family friends need to see a GI physician elsewhere, they will contact me for a recommendation. Recently in helping a friend’s son in Northern California who needed to see an IBD specialist, I was shocked at how long he had to wait before he could be seen.
Some physicians may have retired early as a result of the pandemic, but I don’t know of any GI practices that closed because of the pandemic. I think private practices were challenged — perhaps small practices couldn’t weather the stresses of COVID-19. However, I am not aware of any published data documenting that possibility. Most private practices (small and large) managed to get PPP (Payment Protection Program) loans and PPE (Personal Protective Equipment) and managed to get through it. We applied for the loans and got them. That helped sustain us and pay employees when we weren’t able to see patients in person (we were able to pivot rapidly to telehealth) and had diminished volume/income with all elective endoscopic procedures on hold for several weeks. We had a significant decrease in income during that time and for several weeks, the partners in our group took no salary so that we could continue to pay our employees.
Challenges to Continue in 2022
Everyone, all my partners in our practice, other private practices and the full-time academic groups in our region, is booked out, and I don’t see that changing in 2022. So, we’re doing things to try to make things more efficient. We’re trying to hire more doctors, hire advanced practice providers and utilize a combination of in person and telehealth visits to help us improve access — but there’s only so many hours in the day.
This is a challenge for all of us, whether we’re in private practice or in academic centers. For our hybrid situation, we need to make sure that we’re triaging patients and getting the patients who need more urgent care in to see us while still teaching and training the next generation of doctors. Obviously now with COVID-19 surging, it’s putting a strain on the practices, local hospitals and even the tertiary centers. There are a lot of places that are restricting elective cases. So that backlog is unfortunately going to get worse until we get further out from this pandemic.
- For more information:
- Samir A. Shah, MD, FACG, is clinical professor of medicine at Brown University’s Alpert Medical School.
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