President Trump has compared the fight against COVID-19 to a war against a silent enemy. The soldiers on the front lines are the doctors, nurses, technicians, and others who are fighting it in hospitals across the United States.
These brave people deserve the long-overdue adulation being heaped on them. The untold story, however, is of the hundreds of thousands of doctors facing not only the health risks of caring for patients with undiagnosed COVID-19, but also ruinous financial calamity and professional catastrophe, self-inflicted by government.
Take, for example, the largest urology practice in the Southeast, where I serve as managing partner. We employ more than 400 people, including physicians and advanced practice providers. When the Wuhan virus pandemic hit the United States, we were at first asked, and later ordered, to stop performing elective surgery, which accounts for more than 50 percent of our revenue.
We also were told to restrict patient office visits to those with urgent or emergency problems. The rationale for these mandates included possible spread of disease, lack of personal protective equipment (PPE), and scarcity of resources such as hospital beds for the flood of expected COVID-19 victims. We complied with these restrictions because the health and safety of our patients and employees was our paramount consideration.
The Health Care Effects of COVID-19 Are Far-Reaching
Like many practices, we struggled with how best to care for our tens of thousands of patients within these restrictions. Telemedicine was being touted as the best way to see one’s doctor, but an overnight, full-scale transition to telemedicine is far more challenging than simply willing it to happen. Fortunately, the Trump administration eliminated much of the red tape that had needlessly complicated the delivery of telemedicine. Technological problems, however — especially those experienced by elderly patients — continue to make the transformation challenging.
Our partners gave up their paychecks to honor our vow to keep our employees on at full salary. We had made this difficult decision even before Trump signed the Paycheck Protection Program. The PPP money we eventually received has helped, but the immediate and long-term danger to our practice and to thousands of others still threatens to devastate us, our patients, and the American health care system.
The “elective” surgeries we can no longer perform are not “optional.” They are important surgeries that need to be done. “Elective” only implies a surgery can be timed conveniently for the patient. Examples include a biopsy for cancer, or an operation on a diseased organ. Delaying these procedures risks the long-term health of patients.
We expect many of these patients to disappear from our practice, becoming what we call “lost to follow-up.” This means that despite our attempts to get them back into our office, contacting them becomes impossible for any number of reasons. Many of them will resurface later — when their problem is more serious or even irreparable.
Meanwhile, patients with less serious problems have stopped coming in to see us, thereby putting themselves in grave danger of future harm. They have been frightened to the point of believing the risk of COVID-19 exceeds the danger of not treating new or chronic medical problems.
We’re determined to keep our practice open, but smaller practices will be unable to withstand this financial blow. Those that were forced to shut down may never reopen. Some practitioners will have no choice but to sell to hospitals, which already employ 65 percent of the physicians in the country. Hospital stakeholders stand to get even weightier, collecting medical practices at bargain basement rates. Other practices will disappear as many older physicians lose interest in forging ahead. This will be a gut punch to a system already struggling to ensure access to care.
The most serious problem looming for doctors and the medical system will come from predatory lawyers quietly collecting possible clients who have been “injured” by doctors during this pandemic. Leave it to this group to look to profit from the misery this crisis has inflicted upon us all.
Lawmakers Must Right These Wrongs
Now our health-care system is poised to implode, not because of novel coronavirus but because of self-inflicted injury by our federal and state governments. Many patients need care, and not just those with COVID-19. To ensure our system can recover, federal and state governments should implement a few basic provisions.
First, the federal government should indemnify doctors against frivolous lawsuits that result from this pandemic.
Second, the federal government should make available interest-free loans to doctors who feel they cannot reopen offices because of financial hardship inflicted by COVID-19-related mandates. This is important to prevent wholesale migration of small practices to hospitals.
Third, the federal government should seize this once-in-a-century opportunity to decimate the bureaucracy impeding innovation in medicine. Cutting red tape will stimulate a wave of doctor-led creativity, which is now constrained by onerous laws, such as Stark laws, which restrict collaboration.
Fourth, the reprieves that have allowed telemedicine to expand during this pandemic should be made permanent. Doctors need to continue to be paid for these services just as they would for office visits, and be allowed to deliver these services across state lines.
Finally, the playing field in health care needs to be leveled, giving more control to doctors and less to hospitals. State lawmakers should repeal certificate-of-need laws, which prevent competition and the opening of new facilities in certain areas. We were underprepared for this pandemic in part because of hospital consolidation. More resources, not fewer, would provide helpful redundancy and protection against the next pandemic.
Doctors on the front lines of the COVID-19 fight really are heroes, but don’t forget about the tens of thousands of “backline doctors” who are equally at risk, physically and financially. They are the ones caring now for the millions of patients whose medical problems were straining our health-care system before coronavirus, and who will be here long after our country defeats this pandemic — unless federal and state governments leave these doctors exposed, uncompensated, and shackled.