Amanda Pitz chose to visit her primary care office this week because she was having trouble breathing during her fitness workouts.
She needed another inhaler for her asthma and wanted to feel better about the steps she was taking to protect her health during the coronavirus pandemic.
“It was literally quick and simple,” said Pitz, 28, of Eden, a patient at Highgate Medical Group in Amherst for the last three years.
Pitz and patients like her have been a rarity in medical practices across the country since mid-March, when most states suspended typical life to prevent hospitals from becoming overrun with those who contracted Covid-19.
New York State on Tuesday began to ease its pause order for Western New York in a four-phase process expected to take several weeks – if benchmarks including the number of Covid-19 hospitalizations and deaths continue to fall.
In that case, health care providers in the region have a new message for patients who in recent weeks have been encouraged to avoid hospitals and medical offices.
Please come back.
Health care providers have readjusted to the new coronavirus landscape as most people sheltered in place. They started or accelerated medical appointments online or by phone. They steered more patients with questions or concerns to their website patient portals. They also established new protocols for patients they believe should be seen in person.
“The pandemic has changed the way we practice medicine,” said Dr. Fuad Sheriff, an internist with Amherst Medical Associates.
A dearth of patients caused financial hardships for hospitals and specialists, punishing many primary care providers most.
It also took a physical toll on millions of Americans forced to put off surgeries or too afraid to seek medical help unrelated to coronavirus infections.
“People right now should not be ignoring their symptoms and should be seeking health care the way they normally would,” said Dr. Vijay Iyer, chief of cardiovascular medicine at the University at Buffalo Jacobs School of Medicine & Biomedical Sciences.
Surgeons during the last two months have had to perform more complicated procedures for burst appendixes, agonizing tendonitis and heart problems that could have been addressed more easily if patients sought help sooner, Iyer said.
Specialists last week started to reschedule more than 4,000 non-emergency surgeries postponed in the region as part of the pause in typical life.
Those with chronic health conditions, or those overdue for well visits, also are encouraged to reach out to their primary care provider during the next several weeks.
If not, they likely will reach out to you. The latest phase of federal legislation designed to help businesses soldier through part of the pandemic has equipped most practices with eight weeks of salary for staff.
Highgate Medical is among practices that this week used its money to call back furloughed workers and remake the way it manages patients.
It has handled three-quarters of its smaller caseload by computer or phone during the last eight weeks. Its providers hope that will become a 50-50 split by July and that 75% of patients will resume office visits before Labor Day, said Dr. David Pawlowski, medical director for the practice.
Triage nurses will continue to handle calls to Highgate and work with patients to decide whether to schedule an appointment by phone, online or in person.
New office protocol
Office visits allow for more thorough examinations, which lead to better treatment plans, Pawlowski said.
Visits at Highgate follow new guidelines recommended by the federal Centers for Disease Control and Prevention.
“Patients are not going to see a lot of people,” Pawlowski said. “That’s the goal. We want to keep our staff and patients healthy.”
That’s what happened for Pitz on Wednesday afternoon.
She drove into an almost empty lot outside the Northwoods Medical Center, which includes offices for several health businesses.
“Parking is usually tricky,” she said.
The Highgate Medical office was locked when she arrived at the front entrance. The receptionist let her in and asked if she had a cough, trouble breathing or other symptoms of Covid-19. The she took her temperature.
Both wore surgical masks.
Pitz arrived in a waiting room with one other patient. (Many practices will call or text those who prefer to wait in the parking lot.)
She checked in at a kiosk that had been redesigned to take more information, then paid her copay. Two minutes later, she was taken to an examination room to see physician assistant Stephanie Guize.
Her vital signs were taken before Guize, wearing a mask and gloves, listened to Pitz’s heart and lungs through a stethoscope.
Pitz left about 15 minutes later – through a different door than where she arrived – with prescriptions for a new inhaler and medication for a chronic thyroid condition.
She said she felt safe and comfortable throughout.
“I would recommend an office visit right now,” she said. “I think your health is vital, and you should see the doctor when you need to.”
Many practices will choose to visit with patients by phone or a confidential online meeting platform if the case involves a respiratory infection. Others will see those patients at different times and/or in specially designated rooms.
All rooms will be thoroughly cleaned and disinfected after each visit.
The Medical Society of the State of New York reported last week that its most recent survey of physicians showed nearly four of five saw a reduction of more than 50% in the volume of patients visiting their practices.
Nearly three in four experienced a greater than 50% drop in practice revenue.
More than a quarter had to lay off or furlough more than half of their staff, and 40% had to lay off or furlough at least a quarter of their employees.
Highgate Medical Group has two offices in Amherst and serves 30,000 patients. The practice went from seeing up to 1,500 patients a week before the coronavirus pause to about 50 the week it started.
“We had to furlough 40% of our reception staff and nursing staff the first week,” Pawlowski said. “We kept one provider and one nurse in the office with a secretary. We took computers home, learned a telephone system and innovated everything to get on a video platform very quickly. We’ve been running on that since.”
Sheriff and the other three partners at Amherst Medical Associates took pay cuts, furloughed at least 70% of its 33 workers and cut hours for others.
“The phone calls initially were all related to the Covid-19 crisis and the fear among patients,” he said. “Now almost everybody who calls wants to do a Covid-19 antibody test.”
Changes in pediatrics
Medical Health Associates of WNY, a pediatric practice, suffered fewer financial hardships but also had to adjust its business model.
Like other primary care practices, its leader echoed the importance of preserving and protecting overall health and wellness, regardless of the pandemic.
That includes encouraging parents to keep up with well visits and vaccination schedules for themselves and their children, as well as understanding that pediatricians also will continue to be there for illnesses and emergency care.
Practice providers experienced a precipitous drop in patient volume, especially with sick visits, after the pandemic struck the region, said Dr. Colleen Mattimore, president of Medical Health Associates.
“As the days went on, and people were in quarantine, kids were out of school and not seeing other kids, so disease transmission also went down," she said. "That’s sustained.”
Mattimore is among 50 providers, including 35 physicians, who nearly three years ago combined eight free-standing practices across Erie County under the same corporate management while keeping individual practice names and identities. The combined staff of 250 serves 48,000 patients.
Patient volume fell 60% at first, Mattimore said. Some families have since embraced telehealth and using the online patient portal to send photos of rashes, cuts and swelling that become more common with better weather. Still, many families continue to wait out the pandemic.
During the last full week of April two years ago at WNY Pediatrics in Orchard Park, where Mattimore is among 10 providers, the practice handled 277 well visits and 344 sick visits.
The same week this year, it handled 180 well visits and 82 sick visits.
Decline in patient demand led to furloughs of up to 30% of staff in some of the related practices, she said.
The American Academy of Pediatrics gradually changed recommendations during the last two months for well visits and immunizations. It started with kids 2 years old and under and now includes all young patients. That boosted the number of office visits this month.
Pediatric providers measure development and give vaccinations, physical exams and other screenings, Mattimore said, “so telemedicine doesn’t lend itself as easily.”
Visits since the pandemic look and feel different at WNY Pediatrics.
The days of waiting rooms filled with sniffling, coughing and feverish kids, their siblings and parents are over, at least for the foreseeable future.
Walk-in clinics are canceled, the new CDC office guidelines followed.
Toys and books once shared freely throughout the day by dozens of children are gone.
“We want people to feel like they can safely bring their kids in for their well visits, especially if they need vaccinations,” Mattimore said. “We’ve staggered visits and redesigned waiting rooms.”
The office licensed mental health counselor and other staff are available to support teens who understandably can use more perspective on missed milestones and distancing from friends.
“This is not going to last forever” is a common piece of advice.