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What Arizona Docs are Saying...In Their Own Words

By Miriam Anand, MD, Allergy Associates & Asthma Ltd, Adrienne Forstner-Barthell, MD, Arizona Advance Surgery, Pamela Frazier, MD, Pamela T Frazier MD, Brenda LaTowsky, MD, Clear Dermatology & Aesthetic Center, Ann Cheri Foxx-Leach, MD, Nocio Interventional Pain Management, Paul Lynch, MD, Arizona Pain Specialists, and Edward Patterson, MD, Panda Pediatrics and Adolescent Care

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From Print Issue - Summer 2020

The COVID-19 pandemic has severely affected Maricopa County physicians working in their own practices, medical groups, and hospitals. Read excerpts of what some Maricopa County Medical Society (MCMS) physicians are experiencing during these tough times.

 

 

We have had a 50-75% decrease in patients seen and cared for since the pandemic began. – Dr Forstner

 

Engaging with kids is challenging with mask and goggles or a face shield.  My usual distraction technique of making faces during a toddler’s exam doesn’t work well with a mask, so I resort to peak-a-boo or clapping hurrah to avoid crying.  Stickers on my face shield would be helpful.  For masked school age kids it is hard to see their facial reactions fully when evaluating for abdominal pain.  And, it is harder to read a teen’s facial reaction when asking sensitive questions.  In addition, the whole process can be challenging for parents when only one parent can be with the child or teen, although no siblings can be beneficial for the whole process.  I also avoid holding an infant or toddler because of the risk of COVID transmission which is just sad for anyone who works in pediatrics. – Dr Murphy

 

We had a slowdown, initially, interacting with patients, but now we are seeing patients face-to-face and through telemedicine. I am still operating on patients, but everyone gets pre-screened for COVID 2-3 days beforehand to ensure that they are not infected.  So the “new norm” is that we are all wearing masks when we speak, but I have still been engaged with my patients. – Dr Goldberg

 

 The quarantine for the COVID-19 pandemic greatly reduced our daily patient census despite our implementation of telehealth visits. The curtailing of elective procedures and increased time between patient visits to ensure little to no waiting room time also impacted our patient volume. We have updated our policies to reflect CDC guidelines to address the health and safety of our patients; and, we continue to update them as we learn more about the pandemic and the virus. – Dr Foxx

 

I am seeing fewer patients but the ones I'm examining seem to have a greater percentage of pathology than my usual mix of patients. – Dr Cooper

 

It shut down my referral sources, patient visits and elective surgery until the quarantine lifted. Many patients were reluctant to have elective surgery even after the quarantine ceased.  We still have patients who are afraid of a face-to-face visit (June, 2020).  My private Oculoplastic Surgery practice typically involves problems that may be identified visually.  This dovetails perfectly with the recent improvements in Telemedicine.  We were lucky to be early adopters of Telehealth visits that allowed ongoing evaluations of existing patients and offered new patients an opinion about their care needs in advance of a physical visit. Many patients were relieved to have a better understanding about their condition and comforted by offering temporary solutions to prevent their issues from progressing until they could be addressed by traditional measures.  I think that remote access to healthcare providers relieved an enormous amount of patient anxiety and helped to reduce the burden on an overwhelmed Urgent Care/ER system. – Dr Edelstein

 

For our small private otolaryngology practice, one of the most detrimental effects of the coronavirus pandemic has been its financial impact.  During the initial stages of the pandemic, the restrictions on elective surgery forced us to cancel or postpone most of our surgical cases, and we also limited office visits to enforce social distancing.  Our practice was operating at less than 50% of its usual volume from late March until the end of April.  This led to a significant loss of revenue.  Volume has improved since the stay at home order has been lifted, but the continued need for social distancing and increased sanitizing still limits patient flow, and it is unlikely that we will be able to make up for the loss of revenue in March and April. – Dr Agarwal

 

After 16 years with Kaiser Permanente, I took our life savings to relocate to Arizona and form a solo direct pay practice.  My plan was to open doors in early April.  Naturally, that didn't happen, and the challenges mounted.  Aside from the non-urgent shutdown and elective surgery ban, every aspect of practice formation was delayed.  Most medical supplies, not just PPE, were suddenly unavailable.  Medical reps were furloughed.  Crucial equipment languished in shipping crates for months because out of state installers and trainers were prevented from traveling.  Even office artwork was trapped in Australia by a force majeure shipping lockdown.  As a new practice in a new state without prior billing or payroll, we haven't qualified for a penny of small business grant or loan assistance.  – Dr Brierly

1. How has the pandemic affected your practice or your practice of medicine?

Meet the participating Physicians:
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Adrianne Forstner-Barthell, MD, FACS, FASCRS

Practice: Arizona Advanced Surgery

Phone: (602) 993-2622

Website: arizonaadvancedsurgery.com

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Pamela Murphy, MD

Practice: District Medical Group Children Rehabilitation Services

Phone: (602-914-1520

Website: dmgaz.org/phoenix-pediatrics-az/

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Ross Goldberg, MD

Hospital: Valleywise Health

Phone: (602) 344-5011

Website: valleywisehealth.org

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Ann Cheri Foxx Leach, MD

Practice: Nocio Interventional Pain Management 

Phone: (480) 818-4314

Website: nociopain.com

 

 

 

 

 

Making the commitment to continue to financially support our employees during the quarantine was an easy decision but has certainly been the toughest to implement. – Dr Foxx

It was not that tough. Our national organization demanded that all Ophthalmologists stay home until they decided we could restart as we could be spreading the virus.  My response was that I took an oath as a physician to take care of problems and not hide from them. Some of the cases I saw certainly were not able to wait two months to be treated through tele-medicine. Want examples? A patient treated over the phone for dry eye who had herpes simplex of the cornea. Another supposed dry eye patient with a piece of steel under his lid. Two very uncontrolled glaucoma patients, again not treatable over the phone. A few retinal detachments and more, with a finale of a new patient in whom I found an unsuspected brain tumor, fortunately in time. Other ophthalmologists have told me similar stories, and in the end, we made our personal decisions about opening or closing. I will not criticize any of them for their decision. – Dr Cooper

Figuring out when it would be safe to perform non-essential, elective (i.e.. cosmetic surgery) on patients and how to provide a safe environment for staff. It is a question that remains challenging. – Dr Edelstein

The toughest decision that we had to make during the pandemic was whether to lay off staff.  We have dedicated and skilled staff, who all have families and bills to pay, and we really wanted to avoid layoffs.  Fortunately, the CARES act, PPP, and HHS grant helped us maintain our payroll, and we were able to continue operations and keep all our staff. – Dr Agarwal

I have been forced to delay hiring front desk and back office technicians until patient volume rises enough to pay their salaries. – Dr Brierly

2. What has been the toughest decision you, your group, or hospital have had to make during this pandemic?

Meet the participating Physicians:
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Dennis Cooper, MD
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Ravi Agarwal, MD
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Jeffrey Edelstein, MD
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Shaun Brierly, MD

 

 

 

 

One positive lesson that I have learned during the pandemic is how telemedicine may fit into my practice.  We started using telemedicine at the beginning of the pandemic, and I have found it to be very useful for follow-up visits and discussing test results with patients.  Patient also seem to appreciate it.  I suspect that it will continue to be part of my practice post-pandemic. – Dr Agarwal

 

We are down staff members and unfortunately, we may not be able to replace them. – Dr Forstner

 

How important it is to be armed with PPE; to read COVID-19 updates daily focusing on pediatric cases and management; reading daily and weekly hospital updates for changes in policies.  Understanding my schedule will be relatively open for shift changes since all my travel vacations were cancelled. Yet, most importantly encouraging everyone I know and interact with on social media to wear masks!! – Dr Murphy

 

We are being adaptive and responsive to COVID. We have put new protocols in place, some will be temporary, some permanent. – Dr Goldberg

 

My hospital has excellent leadership that is transparent and collaborative with their approach. Clinical leadership has had input while these decisions are being made and we are all “hands on deck” on ways on providing high quality care while still being mindful of the financial stresses the hospital is going through. Being at the only public hospital in Arizona, we have dealt with resource shortages in the past, so we are usually good at adapting to the ever-changing environment. – Dr Goldberg

 

This is not my first rodeo, and the same is true for many of us older physicians. I was an intern during the 1971-1972 Hong Kong Flu pandemic when we lost 100,000 Americans when our population was 200 million instead of our current 320 million. I personally lost 30 patients in 30 days. Physicians and nurses just showed up, plugged in gaps as some of us became ill and worked overtime doing the best we could. For me, that is the key. We are physicians, WE SHOW UP! – Dr Cooper

 

I have so much respect for the front line HealthCare workers who risked their own well being and their families to take care of COVID-19 patients at a time when very little was known about the disease.  Furthermore, leadership by the CDC  FDA, AMA and particularly helpful to me, the American Academy of Ophthalmology allowed rapid responses to ongoing changes.  The MCMS and ArMA stepped up to help obtain PPE when none was available!  These groups provided timely updates, options and actionable direction on how to adapt and respond to the numerous challenges of treating patients throughout the pandemic.  I am humbled and honored to continue practicing medicine through one of the most challenging events of my practice history. – Dr Edelstein

 

The pandemic provides an opportunity for us to embrace changes that may benefit our patients in diverse ways.  Forced flexibility is helping us rethink health care delivery.  While telemedicine gets a lot of press, I think there's much more positive change we can effect.  Huge, crowded office waiting rooms with multiple repeat visits for testing and "exams in stages" were never satisfying to patients.  Now that approach is less safe.  Prioritizing one-stop visits with same day exams, testing and procedures can reduce inter-patient interactions and decrease daily traffic going through the front door.  Patients may actually receive more attentive, one-on-one care in this new environment.  Even behind a mask and 6 feet away. – Dr Brierly

 

 It is important to remain hopeful and positive despite the challenges. I have found creative and innovative solutions by remaining committed to our patients and our mission. Although I have had fewer in-person interactions, I feel more connected to my community than before the virus. The common struggle has brought us together. One example is the very positive experience I have had with Maricopa County Medical Society which has implemented programs that have been impactful to my practice. – Dr Foxx

3. Are there positive/negative lessons you have learned throughout this pandemic?