Changing times

What practicing medicine could look like after COVID-19

The pandemic is leading to seismic shifts in all industries—but in health care in particular. Experts weigh in on the changes we may see on the other side.

As Jeff Dunn, DO, MBA, watched the novel coronavirus disease (COVID-19) pandemic spread, the physician entrepreneur knew it was time to pick up his stethoscope and return to clinical practice.

“I told my wife, “I have to go help these people,’” says Dr. Dunn.

Dr. Dunn left clinical practice in 2015 to start Redivus Health, a health care technology company. Now, he plans to return to the front lines of patient care.

Unfortunately, Dr. Dunn’s good intentions have run headlong into a wall of bureaucracy.

Dr. Dunn was able to renew his Missouri and Kansas medical licenses quickly. But progress stalled when it came to hospital privileging. He has been waiting for 60 days to get approval to practice anywhere, and has been told the process can take up to four months.

“I would’ve loved to help out in a hot zone where the need is high, but haven’t been able to help to date, which is sad,” he says.

Dr. Dunn hopes the medical profession learns from the pandemic and makes important changes—chief among them the need to reduce or eliminate red tape. He’s optimistic that it will happen at least to some degree. “Innovation is sped up in a pandemic like this,” he says.

Below, three physician experts predict three major ways the practice of medicine may change in a post-COVID world.

Telemedicine may become more commonplace

One of the biggest transformations already is apparent—the sudden, widespread embrace of telemedicine.

About 48% of physicians now are treating patients via telehealth, compared to just 18% in 2018, according to a survey released on April 21 by Merritt Hawkins and The Physicians Foundation.

Prior to the arrival of COVID-19, many doctors were reluctant to use telemedicine because it was not always financially feasible, says Michael Brown, DO.

“Reimbursement was horrible,” says Dr. Brown, who recently led an AOA/AIOA webinar on practicing telemedicine during COVID-19. “A lot of insurance companies did not consider telemedicine to be real medicine.”

In addition, red tape was strangling telemedicine. For example, doctors were required to use often-expensive and cumbersome telemedicine software that complied with HIPAA rules.

All that began to change when the Centers for Medicare & Medicaid Services announced it would reimburse telemedicine at the standard rates used for in-person care.

“Most of the major (insurance) carriers then followed suit,” says Dr. Brown, who practices family medicine with Meritas Health in Smithville, Missouri.

In another bow to the realities surrounding COVID-19, the U.S. Department of Health and Human Services said it would not penalize doctors for using software that was not HIPAA-compliant.

That opened the door to serving patients via popular videoconferencing services such as FaceTime, Skype and Facebook Messenger.

These changes helped create a watershed moment that has removed many of the roadblocks that prevented physicians from jumping into telemedicine. “All this red tape just went away overnight,” Dr. Brown says.

Physicians now can see more patients than before and treat them remotely, reducing the spread of the virus, he says.

Although the relaxation of telemedicine rules is supposed to be temporary, Dr. Brown believes they will remain in place once the COVID-19 threat finally subsides.

“I follow a lot of national experts on this, and I haven’t heard a single one who thinks this will go away,” he says.

Pay structures may change

Physician payment arrangements also might change, says Seger S. Morris, DO, MBA.

The pandemic likely will cause more employers to turn to productivity incentives when crafting compensation packages for the physicians they hire, says Dr. Morris, who is president of the Mississippi Osteopathic Medical Association.

Currently, the pay of many employed physicians is based on a combination of salary and productivity, according to a review of 2016 data from the AMA Physician Benchmark Survey. Pay structures vary by specialty—12-40% of employed physicians reported being paid by salary alone, depending on specialty, and 8-33% reported being paid by productivity alone, depending on specialty.

In a productivity-based model, doctors often are paid a percentage of either billings or collections, or their pay is based on resource-based relative value scale units (RVUs) that correspond to specific procedures or types of patient visits.

Paying a physician on a straight salary basis—with little or no productivity incentive—is risky for the employer, who bears the responsibility of ensuring there is a steady volume of patients for the physician to treat, Dr. Morris says.

The pandemic is highlighting such risks, as patient flows have dried up in some practices. “Right now, the employers with these arrangements are suffering a significant financial setback,” Dr. Morris says.

Dr. Morris—who is the division chief of Mississippi Internal Medicine Programs and internal medicine program director at Baptist Memorial Hospital-North Mississippi in Oxford—adds that a more pronounced shift toward productivity incentives is particularly likely in some specialties focused on elective treatments.

“In a number of physician specialties right now, we are seeing productivity volumes cut in half or worse,” he says.

Dr. Morris also believes the pandemic may cause more private-practice physicians to think about giving up their individual practice in favor of embracing “the perceived financial security” of being an employee. “Many private-practice physicians are really struggling right now,” he says.

More physicians may turn to nonclinical work

Finally, the coronavirus pandemic might cause many physicians to re-evaluate whether clinical medicine is right for them, says Heather Fork, MD.

“In a number of ways, COVID has magnified their disillusionment with the health care system,” says Dr. Fork, a Master Certified Coach and founder of Doctor’s Crossing, which offers career coaching services to physicians around the country.

Many physicians felt burned out even before the pandemic arrived. They were “disheartened by the administrative demands and loss of autonomy,” Dr. Fork says.

As the virus has spread, it has opened new areas of frustration for physicians. “They often have not had adequate PPE, they are being told to work ‘or else’ and are having their pay cut when CEOs are being fully compensated,” Dr. Fork says.

What would a mass exodus mean for the physicians who are still working in clinical roles? For one, the physician shortage would be exacerbated. Dr. Fork notes that pre-COVID-19, a shortfall of between 40,000 and 122,000 physicians was expected over the next decade, according to a 2019 report by the Association of American Medical Colleges.

Physicians leaving the workforce en masse would put more stress on the remaining physicians, Dr. Fork says.

“It may be harder for them to negotiate working part-time work or more flexible schedules,” Dr. Fork says.

However, Dr. Fork is hopeful that the exodus from clinical work can be avoided through efforts to give physicians more of a voice in their work and to treat them with more respect.

“I hope it is a wake-up call to the health care system that physicians are invaluable,” she says.

Related reading:

How to do telemedicine in the time of COVID-19

DO starts a COVID-19 support hotline for physicians

2 comments

  1. This will change how we practice, but not in a good way. Telemedicine does allow some care; however without a physical exam one can not assess many diseases. ie. To look at a diabetics feet can not be done well on line. The bean counters will see this technology as another way to increase efficiency at the cost of quality. Yes, the number of older physicians who will leave practice will add a strain to the system. The expanded scopes of practice will try to fill some of those gaps, again I have quality concerns as overworked physicians will not have the time for adequate oversight. Lastly in a state of emergency hospitals should have an emergency credentialing process. The face that we have willing providers and the type of delay mentioned means that medical staff organization needs education with Joint Commission standards.

  2. Definitely will see major shifts in how medicine is practiced and there will be pressure from the public too for more affordable health plans (many already have lost insurance due to it being paid by their employers).

    When a fully licensed physician cannot practice medicine during a pandemic (offering to go anywhere needed and with existing licenses and no malpractice) and “red tape” blocks them from being able to serve, that is a big problem. There is a shortage of able-bodied physicians out there as this virus takes its toll. The volunteer positions even for non-medical jobs, contact tracing, etc., also are backlogged. So, a large portion of able-bodied physicians are sitting idle when they could be available to relieve those already suffering from PTSD, burnout and even the virus itself.

    There needs to be a better way of tapping into experienced physicians being able to be placed where needed. Right now, it seems that medical students, new interns and residents are in he trenches and the aforementioned doctors are sitting idle. Experience has a lot of merit. Even the ads for requests for help are mostly posted for ER, respiratory, critical care and lots of requests for nurses and PA’s.

    Physicians should not have to be delivering meals to the elderly, shopping for their neighbors, sewing face masks, when they have the medical training to do more and be of more use. This is unfortunate, and shows how inadequate our emergency response/deployment has been.

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