The reality of being a medical practice owner is that we are small business owners and very vulnerable to the impact of COVID. Having previously worked in the telemedicine industry and because I am a psychiatrist, I initially felt that I was in a good position to adapt to this crisis – and this has been overall true, but the reality is it hasn’t been so easy in other ways. I was able to transition to a full telemedicine practice rather quickly and seamlessly; I am fortunate that I have been able to work to some degree while some of my colleagues have not.
On the business side, I have had a significant decline in my overall revenue because patients were, especially for the months of March through May, seeking less health care overall, didn’t have sufficient privacy for telehealth sessions, or even simply preferred to wait for in-person visits to become available. As you know, New York was hit particularly hard, so this has been a prolonged situation of waiting until the coast is clear. Despite decreased revenues, operating costs remain at their pre-COVID levels – I am carrying the expense of my office rent and utilities, malpractice insurance, and other insurances, for example, accountant, biller, receptionist, and none of those expenses will be decreasing anytime soon if ever. I am the only clinician in my practice, but I would like to be able to rehire and re-expand my practice again but am facing some challenges in hiring due to poor cash flow.
Telemedicine has come a long way in a short time. There are some really great things about working in telehealth and telemedicine. Lucky for me, my discipline, psychiatry, is probably one of the most poised to transition to telemedicine.
I started to work in telemedicine a few years ago at a time that now feels like the stone ages because prior to this current crisis, telemedicine services were not accessible to most patients, primarily because of challenges with getting the insurance industry to support its wider use. The regulatory and system-level barriers to care were reduced when the COVID crisis hit, and the state and federal governments, DEA, and the insurance industry all activated to open things up so that people could safely access the care they needed from their homes. The ability to use video conferencing has finally helped more diverse patients to seek treatment, people who might never have previously because of seemingly simple barriers including commute times, inability to get adequate time from work, need for confidentiality (such as not letting their boss or coworkers know they are going for appointments). Unfortunately, while technology has opened some doors, it’s not the case for everyone – some people don’t have adequate technology or internet access, don’t have privacy, feel stigma for getting help, or even don’t know where to start to get help if they need it or know what kind of help to ask for. It seems to me that minorities, underserved and marginalized people are still not sufficiently seeking mental health care.
As a working parent, I was having trouble balancing family needs and professional needs. Luckily my husband and I have been able to share in managing everything at home, and it’s an almost round-the-clock operation, which is exhausting at times. We both just try to take on whatever we can and have learned to let a lot of things go.
1. It’s a luxury for sure, but I order all my groceries online. Actually, I order everything I possibly can online, there just isn’t time to go to a store, and many stores still have lines.
2. Get help where needed and make some decisions about where you can cut corners in terms of how you spend time on things you don’t necessarily have to do yourself. I am proud to be able to support people with small businesses like my housekeeper.
3. Stay connected and get support. This doesn’t just mean mental health treatment but also keeping up our relationships. COVID has been isolating for so many of us. It has been a tremendous help to be actively in touch with colleagues both within my field as well as across disciplines. I have had amazing support from colleagues such as other women physicians I am in touch with through the American Medical Women’s Association (AMWA), other psychiatry colleagues I know both locally and through the American Psychiatric Association.
4. Lower your standards. Once you think they are already lower, considering lowering them yet some more. At the beginning of all of this, I was doing a lot of meal planning, trying to follow a diet, and trying to get all the major food groups in. Well, you can guess what went out of the window! The scarcity of some fresh foods really forced me to let go of my plans.
5. Technology has brought some opportunities. I know of a lot of people who are taking online courses, learning other languages, watching great TV shows and concerts because our reliance on the internet has exploded. I say lean into that if it’s an option.
6. Mental health is important. Yes, I am biased, or maybe I’m preaching to the choir even. Physician mental health is under-recognized as a concern, and we at AMWA are working to bring attention to this. Putting aside my own reaction to all the changes that COVID has brought, I saw my children decline tremendously during the earlier months of the quarantine before we were better adjusted to it. They missed their friends, teachers, and the playground so much. We have brought in a friend’s teenage daughter for playtime with them, and they love having an older kid to admire and play with; it’s the highlight of their day, breaks up the monotony for them, gives them the exercise they need.
7. Limit how much news I watch. I’ve seen the benefit of turning on a silly comedy and just tuning the world out from time to time.
Sharon M. Batista is a psychiatrist.
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