Will medical practice still be the same post-COVID?

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Growing up as a part of an Asian Indian family, it was always instilled into us that my brother and I would need to become either a doctor or an engineer. Obviously being a doctor was supposed to be the choice as the belief was that as a doctor, I would never have to struggle financially.

In addition, in private practice in the field of pediatrics since that is what I wanted to do, I would be told that people will always have babies and they would need to come for pediatric care.

I had fulfilled the wishes of my family and had become a physician. After several different employment roles in the field of medicine, I had decided to start my own small part time private practice.

There were no patients initially but over time, I was able to build it up to the current practice with 4 locations and 5 pediatric providers. My practice had been doing well but who would had ever imagined that a pandemic would happen and place everyone in a tizzy including a thriving private practice like ours.

When the COVID pandemic hit, there was a lot of uncertainty and fear that had built up rapidly within a few days. The fear had created havoc in the community to the point where the staff did not even want to leave their homes and come into the office. The news and the community forums kept on discussing how serious an issue this was and how people were dying by the dozens.

Patients were petrified to step out of their houses, and older pediatricians whom we wanted to keep safe, as we had no Personal Protective Equipment in the office, were advised to stay home. All of a sudden, the practice had come to a grinding halt within a few days.  We knew we had to do something as we had bills to pay, and staff that was relying on us for their livelihood.

To make the matters worse, a few of the staff members who were showing up to the office contracted COVID and we had to shut the office down completely. It was in the peak of the pandemic and we had no guidance. We had never thought about a disaster management plan so were totally lost.

We researched the information through the Centers for Disease Control and our local and national pediatric medical associations for outpatient practice guidelines on management of facility and staff.

However, no one seemed to know or have a clue on what to do to ensure the safety of the staff and the patients. All of the guidelines that people were talking about were at the hospital level but not at the office level.

Variable recommendations came to the office for facility closure of 3 days up to 14 days and get a “deep cleaning” which no one knew what it entailed. It seemed as if we were totally lost in this tsunami that had taken over the entire world.

The government had stepped in and started to provide some financial reprieve. They made emergency recommendations to have telemedicine become a reimbursable service. As such, we started to perform telehealth services but even that was for only a few patients a day.

Since children were not interacting with others, they were not spreading the common childhood illnesses and not getting sick. The preventive care visits were not coming in for fear and the rest of the children were just not getting sick.  This had taken a huge toll on the practice.

We started marketing campaigns by sending messages to the patients that we were open and not to delay any immunizations and also started calling the children with chronic illness to ensure their follow ups, We knew that delaying of the vaccines was jeopardizing the health of our children. The kids with chronic illnesses needed to be evaluated in person but were managing with just telehealth evaluations. The fear of the Corona had become so deeply ingrained in everyone that they just were not willing to come in.

Then another ray of hope filtered in from the government in the form of the Paycheck Protection Program to help us financially to continue our business and continue to maintain the employees and the facility. We did receive some support from the PPP to pay the rent, the utility bills, the staff salaries, the medical and office supplies needed to run the practice.

However, we could not predict how long this would help.  As of this week, when the state has started to relax the restrictions, the younger infants have started to come in for their immunizations. The decline in immunization rates in children worldwide has become a cause for concern internationally.

The fear is that as fewer children get immunized with the routine vaccines, the rates of those childhood illnesses will rise. There have been reports of cases of children with chronic illness dying at home due to the fear of going to the hospital when it is required.

We, as well as many other pediatricians, are reassuring the families that we are only seeing well patients during limited hours, but we are still not sure where the health of our children is headed.

Starting next week, we will open more office hours and bring more staff in to the office.  The hope is that the children will come back in through the doors and receive the appropriate care as in the earlier days. Are we going to have a new normal which will still keep our children healthy, a profession which continues to be as rewarding as it has been for centuries?

I am really not sure if all of the South Asian families should still continue to coerce their kids to go into medicine. Is this a profession that is still recession proof or just subject to disasters like everyone else? Will we still be able to provide the type of care we want for our patients?

(Dr. Naveen Mehrotra is a pediatrician and an adjunct faculty member in the Department of Pediatrics at Rutgers – Robert Wood Johnson Medical School and the Assistant Chief of Pediatrics at the JFK Medical Center in New Jersey.  He is the Medical Director, My Whole Child Pediatrics, based in Elizabeth, NJ. Practicing in Central New Jersey with one of the highest concentrations of South Asians, Dr. Mehrotra is dedicated to improving the health of Asian Indians. Dr. Mehrotra helped found the SKN Foundation, a community based non-profit organization with its main program- Special Needs Community Outreach Program for Empowerment (SCOPE) which brings together and empowers families of children of Special Needs.  To give back and to help special needs families in India, he started the My Whole Child Center for Special Needs in GK2, Delhi which brings the integrative model of care for treating children with special needs holistically. To aid the indigent child, he later helped found the My Whole Child Trust which ensures that no child is left behind due to lack of finances.)