Just like 9/11 changed the world as we know it so will COVID-19. COVID-19 will have lasting and profound effects on the practice of medicine beyond the issues of preparing for and managing pandemics. This article represents our opinions on the ways COVID-19 will change medicine once the pandemic is OVER and life returns to a new normal.
Post-COVID-19 will have the following impact:
- Decrease in in-office patient visits.
- Increased use of Telehealth or Telemedicine.
- Tendency towards less medical care and lower quality care.
- Expansion of scope of practices for other health professionals.
Decreased in-office patient visits
In 2005 I was practicing in Dallas, Texas. In August of that year Katrina hit the state of Louisiana and in particular the city of New Orleans. Overnight 5,944 doctors were out of work (one reason why doctors should have more than one state medical license). Would could have predicted that? But, not just doctors. Nearly everyone was out of work.
In the immediate aftermath of Katrina, two-thirds of the population fled New Orleans with many moving to Texas. Now, 15 years later the population of New Orleans is only one-half of what it was pre-Katrina.
We will see the same thing in medicine with in-office patient visits following the COVID-19 pandemic. Three weeks ago in our office our patient volume was 30% of usual as a result of the COVID-19 pandemic. Nowhere near enough to pay our overhead. Two weeks ago our volume was 40% of usual, and last week it was 50% of usual. Most of these visits were done via Telehealth as well.
When the pandemic first broke, we figured at least those of us in medicine will be busy, and that is certainly true for those doctors, nurses, respiratory technicians, and many others on the front lines of managing this pandemic.
But, everyone else in medicine is not so busy, at least in seeing patients in the office. Procedures and elective surgeries have been put on hold. In our office we have been busy in other ways. We are managing patients as best we can through phone calls and video visits. But, in-office visits have dropped significantly.
In our office, we are not seeing any patients with fever or respiratory symptoms. We are not seeing patients for routine follow up visits though some of those are being “seen” through Telehealth options – patient refills and monitoring of these like blood pressure or anxiety or depression (which have increases as a result of the pandemic).
The only patients being seen in our office are patients who have problems that require a hands-on exam plus or minus some type of testing to diagnose their problem, and whose problem can be managed in the office setting rather than exposing them to potential COVID-19 patients by referring them to urgent care or emergency rooms which are already overcrowded.
Which begs the question, “were many in-office visits really that necessary prior to the outbreak of the COVID-19 pandemic?”
Like Katrina, the number of in-office patient visits have dropped. They will gradually increase over time, but like Katrina the patient population for in-office visits will never return to its pre-pandemic levels for the reasons stated below.
Telehealth or Telemedicine Visits
Some of this decline will be offset by an increase in Telehealth or telemedicine visits. Such visits are fine for simple problems and for monitoring of single problems like blood pressure and adjusting doses for patients on medication for anxiety and depression. But, such visits are challenging when patients have a multitude of problems or complex issues.
The younger patients like this option and many will insist on Telehealth visits long after the COVID-19 pandemic is over and will gravitate to physicians who routinely provide this options. Many older patients struggle with using telemedicine options, however, but even many of them like it when they can get the technology to work
Less medical care and less quality care
The numbers or data we are most interested in seeing are this. Once you pull or tease out all the numbers related to COVID-19, what is the morbidity and mortality for all the non-COVID-19 individuals that have been managed with few doctor visits and through the use of Telehealth and telemedicine options?
We suspect that we will not see a significant rise in morbidity and mortality relative to the decline in cost and visits for non-COVID-19 patients during the pandemic.
In other words, we may conclude that we were providing more care than was necessary prior to the pandemic. This will lead to a decrease in “routine office visits” moving forward. Instead, of seeing diabetic patients every three months to monitor their HgA1C, maybe we will see them only every six months.
In addition, higher quality care has been slowly taking a back seat to quick, convenient, and less costly care for the past several years. Much of this is being pushed by large employers and insurance companies. Nearly all such entities encourage patients to use telemedicine/telehealth options before seeing a doctor in person, mainly to lower costs.
The trick is figuring out what can safely be managed by televisits and what cannot, and that will be an ongoing process. While good care, and in many cases, good enough care, can be given through televisits, it is not the same quality that can be given in a face to face visits with a hands-on exam.
Expansion of Scope of Practice for other Health Care Professionals
It’s been said that you should never let a crisis go to waste. We believe in the wake of this pandemic that other health care professionals like chiropractors, physician assistants, nurse practitioners, and physical therapists, among others, will seize on this pandemic in an attempt to have their scope of practices increased. And, in some cases they will likely succeed. This will be done in an attempt to provide less costly care and bridge any gap for any physician shortages.
That’s how see we it.