The COVID-19 pandemic has proven widespread, global effects which span further than just the immense death rates from country to country. As the infection and mortality numbers continue to increase, clinicians worldwide must still evaluate, diagnose, and treat patients for all medical issues whether those issues are related to COVID-19 or not. Along with its many unknowns, this virus has brought significant challenges to the healthcare system and the practice of medicine worldwide. COVID-19 has also created new, complex realities for practitioners of every specialty that have never been navigated to date. Due to this, South Beach Symposium conducted a survey of clinicians to assess the true impact of COVID-19 on their practices, if and how they have continued to see patients at this time, as well as the sources they rely upon to keep themselves updated regarding COVID-19.
Overall, 50 clinicians responded to the survey, and the specialty spread was representative of those that mainly manage patients with dermatologic conditions, including dermatology (75%), primary care (8%), cosmetic/aesthetic dermatology (7%), pediatric dermatology (4.5%), other (3.5%), and plastic surgery (2%). Most of the respondents surveyed were physicians (over 91%), with 4.44% being allied healthcare practitioners (RN, ARNP, PA), and 4.44% being both office administrators/managers and other office staff.
Close to 50% of the clinicians surveyed practice medical dermatology primarily, 17% practice mainly aesthetic dermatology, and 22% of clinicians who practice a combination of both aesthetic and medical dermatology.
Impacts on Patient Care
As widely reported, most respondents claim to have had patient care highly impacted by COVID-19. Due to the fact that COVID-19 has generated fear and anxiety among patients and caregivers, many patients are worried about their safety in clinics and, therefore, are reluctant to visit their physicians due to fear of contracting the virus. Medical offices are very attentive to this outbreak and actively taking steps to safely manage and protect patients as well as clinical staff. To that end, we asked our participants the extent to which their practices have been impacted. When asked specifically to choose which hardships or challenges they had experienced due to COVID-19, an immense majority, over 93%, indicated a reduction in patient visits. Close to half of respondents (43%) reported the challenge of furloughing/laying off staff (43%) being a challenge, 34.8% reported that they or a member of their staff had to self-quarantine, 24% reported being unable to apply for the SBA loan, with 15% reporting that they or a member of their staff had tested positive for the virus.
With regards to the reduction of patient care due to Covid-19, approximately half (46%) of respondents claim to be seeing 0-20% of the patient base that they saw prior to COVID-19. Following that, 37% are only seeing emergency or urgent cases during this time. Only 8.7% claim to be seeing 50-80% of their patients, and 8.7% are seeing 20-50% of their patients.
Regarding the methods in which the respondents are treating patients, 83% stated they are utilizing telehealth to see their patients, 11% have not utilized the technology, and 6% are thinking about incorporating telehealth.
The telehealth platforms most used among respondents include:
- me / Doximity
- EMA/Modernizing Medicine
- “skype or whatever patient has”
- google duo
- Practice Suite
- mychart video visit or telephone visit
Most respondents’ answers varied about which platforms their practices utilized, but an interesting observation is that the two most commonly used above (by 48% of respondents) selected Zoom and Facetime, which are not platforms specific to telehealth. This could mean that most practices responding to this survey were not previously set up or ready for telehealth prior to this pandemic.
When given the following four options, 52% of respondents claimed they are utilizing telemedicine, 37% are still seeing patients in their offices (with limitations/safety measures), 7% are utilizing phone conferences to treat patients, and 4% are sending patients elsewhere or to the Emergency Room for treatment.
We asked how respondents specifically are treating patients who cannot have interruptions in their treatment plans (i.e. skin cancer, squamous cell, melanoma, flare ups), and the majority (72%) are seeing these types of patients in the office and performing minor surgery in the office with appropriate precautions. The rest (28%) have been utilizing telemedicine or phone conferences for these patients.
Impacts on Prescribing
In dermatologic medicine, as with other specialties, many patients are placed on long term care plans with continuous prescriptions. With regard to prescription habits being affected by the COVID-19 pandemic, 71% reported no change to their prescription habits, 16% admitted to prescribing alternative prescriptions in the interim, 9% stated they are working with their pharmacist on prescribing and 4% claimed to prescribe oral medications vs. injections during this time.
Impacts on Staff/Practice Management
When asked about staff and managing employees, 52% stated they have not had to furlough staff, followed by a close 44% who have had to either furlough or lay off staff members. The rest, a small 4%, stated they have not furloughed staff yet but are planning to soon. Of the staff that have been retained, 51% have continued to pay their staff full time, 31% have decreased the pay structure for most or all of their staff, 13% reported “other” and 5% have asked staff to take paid vacation.
Interestingly, when asked whether their practices have been able to take advantage of SBA Loan offerings, 37% of respondents stated (as widely reported by media outlets) that they had tried but could not get their applications through. The rest of the respondents were split almost equally with 32% stating they had taken advantage, and 30% stating they had not.
The grand majority (72%) reported that their practice has been severely impacted, 20% reported significant impact, and only 8% reported to be moderately impacted.
When respondents were asked whether COVID-19 has changed the scope of their practice (i.e. if respondents have had to assist clinically with Covid-19 efforts in any way), the great majority (85%) indicated that it had not changed their scope of practice while 15% stated it had.
The general public has been exposed to numerous news reports, articles and a flood of information during this pandemic. Analyses on a constant basis have caused for ambiguity and uncertainty among both clinicians and their patients. Finding sources of credible and evidence-based information is becoming increasingly difficult. When respondents were asked what their primary source of information about COVID-19 has been up until this point, over 54% stated Medical News Media, close to 20% selected regular news, 8% selected webinars, 6.5% selected peer-reviewed publications, 6.5% selected institution updates, and over 4% selected “other” which they specifically outlined as expert podcasts and speaking with their colleagues.
In moving forward, respondents were asked what education or information would be most beneficial or of most value at this time, and the great majority (41%) selected ‘how to utilize telehealth’, while 24% shared they would like to learn more about SBA Loan Application services. This was followed by 20% of respondents looking for Med/Legal Advice on human resource issues and 15% selecting “other”.
The specific responses shared by those respondents that selected “other” included:
- how to expedite loans
- how to restart a practice after being ‘shut down’
- reworking office efficiencies with telehealth
- how to return to clinical practice ASAP
- safety in the office during the pandemic
- all of the above
Respondents were asked how they prefer to learn about what their colleagues are doing right now to get through this pandemic, and 63% of respondents shared that they would rather learn via an interactive webinar with questions and answers, while 37% preferred a podcast.
Long Term Effects
We asked respondents if they believe there will be long term effects of this pandemic on dermatology practice/aesthetic medicine in the future, and the majority (85%) of respondents indicated that there will be long term effects. Only 15% did not believe there would be long-term effects. We went on to ask our respondents to specify what they determined those long-term effects may be, and respondents shared the following:
- Decreased volume of patients due to social distancing measures
- The growth of telehealth
- Loss of income as patients lose jobs
- A distrust of our government
- Severe reduction in dermatologic physicians in solo and small group practices due to practice shut down and early retirements
- Pent up demand for dermatologic services
- Social distancing protocols being put in place (i.e. no handshaking)
- Less lax behavior by practices
- Fewer people (family members/friends) accompanying patients to appointments
In summary, the results of our survey suggest that COVID-19 has had tremendous impacts on the practice of dermatologic medicine and that these challenges have created long term effects which will continue to be a factor in the future. One of the largest opportunities for education and growth indicated in the survey’s responses is in the utilization of telehealth.
*Source: COVID-19 Survey by South Beach Symposium, Administered April, 2020; Results compiled in this article “The Impact of COVID-19 on the Dermatologic Healthcare Community” by Laura Landera, J.D.