“It is not your responsibility to finish the work of perfecting the world, but you are not free to desist from it either.”
Rabbi Tarfon, Pirke Avot 2:21
(Referenced during the AAFP Virtual Town Hall: The Public Health Crisis of Racism)
Welcome to Summer 2020! I hope you are finding success in negotiating socially-distanced gatherings, finding new (albeit, strange) ways reconnecting over these long beautiful days. I am so pleased to be able to share two special offerings in MDAFP’s Summer Edition e-Bulletin.
The first is included here, the voices of those who are arguably the most financially vulnerable among our family physician membership during the COVID-19 pandemic: the independent family physicians. It was only three months ago that the financial outlook was alarmingly grim for many of us. Studies reported April’s earnings for primary care down an average of about 51% (some as much as 80%). Some merciful (though perhaps insufficient) relief came by mid-May when revenue rebounded to an average of “only” a 25% deficit. The economic toll of COVID-19 was an insurmountable and existential crisis to many independent practices and health centers nationwide, with too many having to severely scale back or shutter entirely.
Therefore, I wanted the last words you read before we take a summer break to be that of some of our wonderful independent family physician members, Drs. Amar Duggirala, Adora Otiji, Ramona Seidel, and Simita Talwar! I know you will join me in admiring their flexibility, tenacity, and honesty as you read their words today.
But I mentioned two special offerings.
The second comes from one of our Resident members, Latéy Bradford, MD PhD. In her essay, A Health Equity SOAP Note, are her thoughts about what it means to be a Family Physician at a time when America is once again reckoning with the ugly and painful truth of systemic racism and structural violence. I trust you will be inspired to continue your work in the movement to create lasting change in healthcare equity and beyond. It is long overdue. The struggle can be overwhelming and painful, but I found comfort in Rabbi Tarfon’s words, quoted recently during the AAFP Virtual Town Hall. I hope you do too.
Finally, I wish you all a safe and wonderful summer. I look forward to writing to you again in September and seeing you (before we know it) at our Winter Meeting!
- Mozella Williams, MD MBA FAAFP
- Amar Duggirala, DO MPH FAAFP
Poolesville Family Practice
- Adora Otiji, MD MPH FAAFP
Omni Primary and Urgent Care
- Ramona G. Seidel, MD FAAFP
Bay Crossing Family Medicine
- Simita Talwar, MD
Total Family Care LLC
Independent physicians are frequently admired (perhaps even envied!) for their agility in practice management. How has it been for you leading an independent practice in the midst of an historic pandemic?
Dr. Amar Duggirala: I believe independent small practice physicians are quite skilled at coping with and handling an acute public health emergency such as the COVID pandemic. As the only primary care medical practice in the town of Poolesville and the entire Montgomery County agricultural reserve, our practice is crucial to the health of our community. I have been able to pivot our practice to institute new infection control protocols, office workflows, and adjusting appointment schedules is a short time to allow us to continue to serve our patients through the pandemic. We were also able to quickly transition to Televisits and offer COVID testing. We are proud to have remained open throughout the pandemic without having to close our office for a single day and keep all of our staff working full time.
Dr. Adora Otiji: Being independent, we are able to adapt and make necessary changes quickly, on a day to day basis. When we discovered a patient in our office tested positive for Covid, the clinic staff was in panic mode and rightfully so. Being independent means we do not have access to a central supply of PPE or protocols in place to address situations like this. We closed the office mid-March and converted to telemedicine, which we had been doing only before, but only very limited. Thanks to technology, everyone is able to work from home. We moved to seeing patients in the office 1 day a week to 2 and now going to 4 days a week; no walk-ins allowed, which is very different for us. We are moving to scheduled office visits and acute infectious cases are handled virtually.
Dr. Ramona Seidel: As an independent practice we are nimble, and thus were quick to respond to the crisis by converting our schedule to virtual care within 24 hours. Additionally, once we realized the risk of a complete shut down if all staff needed to quarantine, we created teams to work remotely in shifts. I did not need the permission of a larger system administrator to create these teams, to convert to virtual care, nor to empower staff to work remotely. Finally, we are fortunate as a small independent practice to know our patients well. Under the direction of the Maryland Department of Health MDPCP program, we did outreach calls to all our high risk patients within the first 2 weeks of the “stay at home” order.
The rapid evolution of the pandemic necessitated flexibility in our approach to patient care. From week to week, and day to day (sometimes even hour to hour) our procedures and processes changed. We participated in state level webinars, last minute meetings, and watched each of Governor Hogan’s press conferences. We moved from monthly in person staff meetings to weekly video assisted meetings. As the situation continues to evolve, we continue to serve our diverse patient population with the flexibility to meet their varying needs; we try to meet them ‘where they are’.
I have also maintained ongoing communication with other independent family physicians to share best practices, including how to find PPE, how to apply for PPP and how to best deploy virtual care. The collegial bonds that I have with our family physician community provided solace and solidarity as we walked this journey together. Living and working in the same community creates additional benefits: I have been able to directly discuss our county contact tracing program with public health officials and those who do outreach to our Spanish speaking community.
So, to answer the question: “how has it been?”- It has been exhausting and exhilarating all at the same time. There has been grief, there has been joy in small things, there has been uncertainty and anxiety. There has been a whirlwind of change, many extra hours spent in research, meetings, creating protocols and then re-creating them on the fly. It hardly seems possible that we are 3 months past the news of that first community transmission in Maryland. I am most proud of my staff who have shown incredible resilience and flexibility throughout this challenging journey!
Dr. Simita Talwar: I’m happy and very grateful to my patients who have trusted me in every step of my growth. They are the pillar of my practice. Being in Crofton where everyone knows everyone, my office has also become a social gathering location. The support from mom’s group is huge and word of mouth is great!
Total Family Care our policy is: “Where you’re more than just a patient, you’re family”.
What has been the resources(s) that has helped you the most during this pandemic as an independent Family Physician? (I hope the MDAFP has been helpful so please mention anything the Academy has done if that is applicable for you).
Dr. Amar Duggirala: Webinars and regular communication from the State of Maryland Department of Health and the Maryland Primary Care Program were invaluable in our efforts to adjust our practice protocols. The email updates and resource lists regularly sent out from the MDAFP and the COVID resources on the AAFP website (as well as weekly webinars) also kept us informed and allowed us to change our practices as the epidemic worsened and we developed more information on the virus.
Dr. Adora Otiji: Other independent doctors were the most useful resource during this time. There is a wonderful Facebook group of private practice physicians that is extremely helpful in providing information and support. MedChi, CDC and daily reports for my local community hospital were also very helpful.
Dr. Ramona Seidel: Most helpful resources: Informal communications with other independent family physicians; MDPCP webinars; County Health Department Information; Maryland Department of Health website; Anne Arundel Medical Center staff communications; PRIVIA webinars, meetings, phone calls, town halls
Most comprehensive resource hub: MDAFP
Most comprehensive MARYLAND specific resource hub: https://health.maryland.gov/mdpcp/Pages/Coronavirus.aspx
Dr. Simita Talwar: Both MDAFP and AAFP have been very helpful with resources, policy updates, COVID testing, information about telemedicine and billing codes. Med Chi was also really helpful with all their webinars.
As we enter four months of COVID-19 pandemic in Maryland, what is your best piece of advice for your fellow independent Maryland Family Physicians?
Dr. Amar Duggirala: Although the adjustment to the current pandemic has been difficult and stressful, both financially and emotionally, I believe small independent practices are uniquely suited in answering the call to protect their communities. I would advise my fellow family physicians to use the clinical, management, and financial resources available from MDAFP and AAFP to continue to stay in private practice and encourage our new family medicine graduates to pursue a career in small independent practice.
Dr. Adora Otiji: Advice to other doctors, reach out and share with other like-minded folks. Use this time to rethink how to make your practice better not just for the now but going forward.
Dr. Simita Talwar: Stay strong, adapt to the new era of technology. With telemedicine, we are still able to see patients and keep the revenue going and at the same time managing to keep our office staff employed and safe. Also be positive in your interactions with your patients, staff, be a pillar of strength for your patients as they need support from us, as their primary care. They also need our trust and compassion during this stressful pandemic period. Just talking to their Physician comforts patients. We are scared and worried too and there is nothing wrong in being open with patients.
Dr. Ramona Seidel: Don’t give up the ship! Let’s walk together through this, helping one another as battle buddies fighting the virus and fighting for our future as independent practices. Please reach out to me; I’d love to share what I know and learn what you know!