Digging their way out of the disruption of COVID-19 pandemic, small medical practices are struggling with a wide range of challenges to their ability to successfully reopen their practices.

Shrinking patient volume and challenges accessing personal protective equipment (PPE) are combining to make rebuilding practices more difficult than ever, says a new survey by Denver-based Kupersmit Research.

Kupersmit polled practices in Arkansas, Alabama, Colorado, Connecticut, Georgia and Maryland in May and June on behalf of the AMA in partnership with state medical societies/associations. Respondents were generally from small office-based practices, except for Colorado where larger practices were polled.

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The surveys are otherwise generally representative of their respective medical societies by specialty, geography and physician age, according to company president Benjamin Kupersmit. Most reported similar business concerns.

For example, the survey revealed in-person visits have fallen dramatically, and most practices project that patient visits will remain at depressed levels for the foreseeable future. A typical state reported a drop of more than 35% in practices that had 46 in-person patient visits or more per week before COVID-19. Projections for the coming weeks show some increase, but not a return to pre-COVID-19 levels.

Learn more with the AMA about CARES Act loans and other financial assistance available to physician practices.

Physicians are also very concerned about the financial viability of their practices. About 75% are “extremely” or “very” concerned about practice viability in most states.  About one-third have seen a decline in revenue ranging from 26% to 50%, with about one-fourth reporting declines ranging from 51% to 75%.

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Federal funding is a critical backstop for practices as they reopen, Kupersmit said.

About three-quarters of respondents said they applied for CARES Act or Paycheck Protection Act financial assistance and most—85% to 95%—got some help. However, Kupersmit said while some practices reported general satisfaction with administrative process, feedback from some respondents indicated that the process was more cumbersome than they had hoped.

Those who were dissatisfied point to administrative hurdles with the application or with their bank.

If the need to reapply for more aid arises, respondents said they needed a more efficient process.

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The survey also points toward a series of broader concerns, including stress and long hours, concerns about the health of their families, poor access to general information about COVID-19 and its spread, and access to patients whose symptoms have not yet emerged.

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About half of respondents said they experienced personal stress and anxiety. Except for Colorado and Connecticut, about two-thirds of respondents in other states were concerned about patients or staff in their offices becoming infected, and about half were concerned about infecting their family members.

Learn how the AMA has been working with state and national medical specialty societies to ensure patient access to care and increase protections for physicians during the COVID-19 pandemic. 

Telehealth did not replace the volume of in-person visits that were lost during lockdowns, and most physicians continue to see at least some patients via telehealth with practices reporting about one to 20 telehealth visits each week, the survey says.

Kupersmit said the survey results indicate that telehealth may have changed the medical delivery process permanently, and most practices will continue to use audio and video means of connecting with patients but there are still barriers to widespread use.  About half of respondents cited a lack of patients’ connectivity and lack of experience with technology as ongoing barriers.

About 30% to 40% of respondents also expressed concern about insurance payment levels in their respective states.

Find out how to maintain momentum on telehealth after the COVID-19 crisis ends.

The AMA’s telehealth quick guide supports physicians and practices in expediting the implementation of telemedicine, so care can continue to be provided to those who need it most. 

Stay current on the AMA’s COVID-19 advocacy efforts and track the pandemic with the AMA's COVID-19 resource center, which offers resources from JAMA Network™, the Centers for Disease Control and Prevention, and the World Health Organization. 

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