Routine appointments for health care came to a halt in March, when Mainers hunkered down at home as the state braced for a possible surge of the coronavirus. The sudden drop in patients hit independent physicians especially hard, who saw steep declines in revenue. Now as the state reopens, some of these doctors say they are starting to emerge, but their future is still tenuous.
In mid-March, Dr. Cortney Linville was preparing for an open house. She had just moved her primary care practice, Wiscasset Family Medicine, from two old homes into a new, renovated space down the street. But just days before she planned to officially welcome patients into her new office, the first case of COVID-19 was identified in Maine, and everything changed.
"We lost between 40 and 50 percent of our business in March and April."
Linville had to make adjustments that were good for public health, but terrible for business.
"We were trying to not let anybody come in who had any symptoms at all, no fever, cough, sore throat. And, that's some of the bread and butter of primary care, is seeing people who are sick."
Her practice transitioned to telemedicine, which helped. But Linville says the reimbursement can be significantly less than an office visit, depending on the type of insurance. And appointments were still down overall.
"We had people who didn't want to bother us, so they wouldn't call or they wouldn't come in or didn't know it was an option."
Within the first two weeks, Linville let go of one-third of her staff. She eventually got a loan from the Paycheck Protection Program, and was able to hire back four employees. But the loan only covers eight weeks of payroll, and she is not clear what will happen when that funding dries up. Patient visits have been ticking up in May, but Linnvile does not receive reimbursements immediately for the medical care she provides. That means the effects of the lost business from March and April will hit sometime this summer.
"Then we'll have to figure out if we can continue to pay a staff this size based on the visits we had in March and April,” Linville says. “And obviously, we're doing everything we can to try to save money and squirrel it away. But there's no guarantee that those March and April numbers will be enough to hold us through, let's say August and September and beyond."
Linville’s 50 percent drop in business was a lot, but other providers saw even steeper declines.
"Oh, 90 percent. I mean it really dropped."
Dr. Karen Bossie specializes in obstetrics and gynecology at Waterville Women's Care. Once the state shut down, she says the practice cancelled almost all gynecology appointments. A Paycheck Protection Program loan helped them avoid letting go of any staff. It was a scary time that Bossie says is just now starting to shift. The practice is back up to about 60 percent of normal volume.
"It's still a scary time, even now as far as, just the future is so unknown right now. Are things going to get back to normal, are we going to get back to where we were in January or last year?”
Dan Morin of the Maine Medical Association says there are roughly four to 500 independent physicians in Maine who serve tens of thousands of patients, and the business impact of the coronavirus has been severe.
"They don't have a lot of operating reserves. The strains of the COVID crisis are less acute for physicians who work large systems. Those physicians have lots more resources to respond to the crisis."
Dr. Michael Clark, a family practice physician at Lifespan Family Healthcare in Newcastle, says once the coronavirus hit Maine, he thought the worst.
"I know myself and other colleagues I spoke with really wondered if this was it, if this was kind of the final nail in the coffin for small town primary care."
Clark's practice went from a patient load of a few dozen per day to just a handful almost overnight. He had to furlough two staff members and put others on a reduced schedule. As his practice scrambled to figure out a way to stay viable, they quickly embraced telemedicine. Within a month, he says, they replaced up to half of their patient volume with virtual visits. Now, that's risen to about 85 percent.
"Telehealth was the key for us because it gave us a sufficiently robust patient visit, you know, to really connect with patients and do the work that we need. We were really surprised by how much you can do through telemedicine."
Clark says he wasn't able to provide telemedicine before because of federal regulatory burdens. But those have been temporarily lifted during the pandemic, and he hopes the changes will become permanent. It's a tool, coupled with some federal loans, that have kept his practice stable. And he sees telemedicine as a key component of primary care’s success for the long-term.
"My fingers are crossed, but I really think we can do this, we can make it through this into a viable future."
It could be something good that comes out of this crisis, Clark says. More options to provide care that helps patients and independent physicians.
This story is part of our series “Deep Dive: Coronavirus.”