Rumblings of the COVID-19 crisis started gently in January but it seemed like a problem on the other side of the globe. I thought it would be like other recent viruses such as H1N1 swine flu, Middle East Respiratory Syndrome (MERS-CoV) and Ebola virus disease. I just figured COVID-19 was another virus we would hear about but it would not directly affect us.
As February rolled in, the situation slightly escalated with emerging concerns about the COVID-19 virus coming stateside. In March, we finally realized that this would be an issue affecting the whole country and the whole world. I live in Illinois. On March 20, we received a shelter-in-place order. We had about 20 percent of our practice schedules cancel that following Monday. Cancellations continued out of fear and concern.
Upon receiving the shelter-in-place order, I met with my executive staff. Right away, we started getting a game plan together. We consolidated clinic hours in hard hit locations. As soon as telemedicine rules changed, we began researching and implemented these measures within two days. We jumped on webinars about the changing environment. I took the newfound free time to adapt to the changing health-care landscape. I felt that we stayed ahead of the curve so my practice could stay alive.
I now needed to consider what patients were going through. For many patients, leaving the house was a stressful experience. I sat down and began thinking, “What can I do to make patients more comfortable?” We instituted a mask-wearing policy prior to it becoming the norm. Our practice implemented temperature checks and screening questions. We increased our office cleaning efforts and educated patients on our cleaning policies. We put patients directly in treatment rooms instead of having them sit in the lobby. Our staff spaced out appointments whenever possible. The goal was to calm the anxiety around going out in public.
Managing Staff Concerns Amid A Public Health Crisis
While I was trying to figure out how my practice would adapt to COVID-19, I realized that my staff had concerns and even fears about their finances and their future. While we all worry about our staff, it may not have been the first thing to cross your mind. Across many industries, companies slashed and furloughed other employees' jobs. My staff saw us cutting hours and feared for their jobs. While we did have to cut hours, we tried to find more for the staff to do so they would not lose hours in the long run.
When patient volumes increased and things stabilized, we ran into other problems. There were added benefits to being unemployed to the point where some employees may have been making more money on unemployment than they would have actively working for us. Some employees acted out on purpose in hopes of getting fired, thinking it would be more profitable. True character came out. It made it easy for me to get rid of staff I was on the fence about. I originally tried to keep staff because of the requirements of the paycheck protection program (PPP) but I found some staff worked directly against me.
Morale changed too. My employees had friends who could work at home, a benefit I could not give to all of my employees. I felt a sense of resentment from some staff that we still had to work while their friends may be working from home or sitting at home collecting unemployment. We did what we could to keep morale up while facing these extenuating circumstances.
As I write this, I am writing now looking for at least a dozen employees. I posted on job websites, on my website and have talked to everyone I know. We are getting resumés but no-shows to interviews are common. The eagerness to return to work may not be there. Look around. There are “Help Wanted” signs up all over the place.
Navigating Financial Challenges In Uncertain Times
I think all of us were and may still be, scared. How long was this going to last? How long would patients stay at home? Would I have to lay off staff? The fear of all of these relates to finances, mainly cash flow and reserves.
The U.S. Department of Health and Human Services (HHS) grant money and the payback protection program were very welcomed, but the question is “could you have made it through this without these programs?” This made me really look at my cash reserves. What was my fixed overhead versus my variable overhead? I had to carefully see what cuts I could make without upsetting the balance of my organization.
What I found most surprising was my relationship with the bank that we have been with for 25 years. It is literally right across the street from our original office. When the government programs came out, how did your bank respond? Did your bank reach out with information and help you through the process? My bank did not. I had to find the resources through webinars, webpages and emails. It was not until I reached out to another bank that I found the guidance I needed. I felt hurt and betrayed by a bank that I thought was looking out for me.
I found myself with extra time on my hands. Initially, this time was frantically spent searching for answers to all the new problems. How do I protect my patients and staff from this virus? How long would this pandemic last? Would patients still come into the office? Can I keep my other doctors busy? What changes should I make to the office? What government programs were available and how do I qualify for them? These were just a few of the onslaught of questions and concerns that plagued us all.
Once I tackled many of these questions, I again found myself sitting at my desk with an abundance of time, that one thing I always felt I was lacking. This was new to me. I sat quietly for a minute. I knew that I would probably never again have this opportunity to tackle that “to-do” list that never seems to get addressed. Now there was no excuse. I sat at my desk reorganizing and prioritizing my list. I was not going to squander this time.
I really reflected on my practice’s past and future. Instead of sitting in my office feeling sorry for myself, I took a proactive approach. I used this time to look at my company organization and structure. We sat down to tighten up protocols. I spent time re-educating doctors. I revamped our protocols for patient care. I met with key staff to hear their concerns. We revised documents and our company handbook. We looked at our staff training and how we can be more efficient during the day. I interviewed new doctors and evaluated new opportunities for my business.
Exploring The Influence Of The Media On Patients
What surprised me the most about the situation was how the media affected the pandemic. Each day seemed more tragic than the next, making us feel hopeless and helpless as to what happened. Living in Illinois, I found a close parallel with how the evening news portrays the weather. In the winter, the meteorologists will sensationalize the impending next day’s snowstorm. Seemingly minutes later, patients will call to cancel.
As the pandemic coverage and concern grew, patients became more concerned, especially when shelter-in-place orders emerged. Cancellations topped 50 patients in one day for our practice. In the middle of the pandemic, the media focused on protests and the coverage of COVID-19 was put on the back burner. Patients became less concerned and office visits increased. As protests started to decrease in size and frequency, COVID-19 is back in the news. It really made me understand the influence of the media.
Family Time And The New Normal
I know some people reading this may find this weird but I really like working. I love seeing patients. I enjoy surgery. I find it exciting to plan my practice’s next move. I find training new doctors at my practice rewarding. I even find it exciting to read about the medical industry and how it is moving forward.
That said, I also love spending time with my family. At times, there is a sharp crossroads between family and work. COVID-19 forced me to spend much needed time with my family. There was no more traveling for conferences. Nighttime educational events stopped as soon as the restaurants closed. Late night clinic hours became consolidated. With the operating rooms limited, the elective cases did not drag into the evening hours. I was home at dinner time most nights, sometimes earlier. It was refreshing and grounded me in the renewed realization of the importance of family time.
As things open up and patient volumes are getting closer to normal, the question becomes: how do we proceed? Look at what COVID-19 has taught you. Start thinking about these things now. Do we take new risks? Do we need to be more conservative? Will there be another wave and, if so, how bad will it be? Will you be financially sound if there is another wave of this virus? Make sure you are able to adapt if health care rapidly changes again. Your clinical situation may not be the same six months from now. Take the time to learn these lessons now so if the next crisis is worse, you will be prepared.
Dr. McEneaney is a Diplomate of the American Board of Foot and Ankle Surgery, President of the Illinois Podiatric Medical Association and Co-Director of the Northwest Illinois Foot and Ankle Foundation Fellowship. He is a Fellow of the American College of Foot and Ankle Surgeons and is the owner and CEO of Northern Illinois Foot and Ankle Specialists.