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Physicians 2020Pandemic’s Effect on and Perception by PhysiciansClearly, physicians in all types of practices and specialties, nurses and a myriad of other healthcare workers are focused almost exclusively on the COVID-19 pandemic as well as providing standard treatment for primary care and other outpatient visits.According to The Physicians Foundation 2020 Survey of America’s Physicians: Part 1 (August 2020), 43% of physicians said they had to reduce their staff, 72% experienced a reduction of income and 8% closed their practice, or approximately 16,000 practices.Almost half (49%) of surveyed physicians don’t think the COVID-19 virus will be controlled and the risk of contracting it until after June 1, 2021, 37% said during the first half of the year and only 8% before January 1, 2021.Two Surveys Indicating Physicians’ Loss of Revenue Due to Pandemic, July and August 2020The Physicians FoundationPercentAmerican Medical AssociationPercent1%–10%-13%Same or more19%11%–25%-32%Decrease of less than 25%29%26%–50%-31%Decrease of 25%–49%32%51%–75%-14%Decrease of 50–74%15%76%–100%-10%Decrease of at least 75%4%The Physicians Foundation, September 2020 and American Medical Association (AMA), September 2020Pandemic’s Effect on Physicians’ HealthPracticing medicine has been a significant burden on physicians during the pandemic. According to Part 2 of The Physicians Foundation 2020 Survey of America’s Physicians, 58% said they have felt burnout, which was 40% during 2018.Withdrawal or isolation from family, friends and co-workers affected 13% of physicians once a week and another 17% had inappropriate feelings of anger, tearfulness or anxiety.The stress and anxiety is so bad among physicians that 26% said they knew a physician who had considered suicide, 15% who attempted suicide and 22% who committed suicide.Factors Causing Physicians To Become Upset or Frustrated, September 2020FactorGreat DegreeModerate DegreeMinor DegreeNot At AllLack of adequate personal protective equipment 23%24%28%25%Lack of reliable COVID-19 tests40%31%19%10%Lack of adequate medical supplies17%26%30%27%Lack of evidence-based treatments for COVID-1932%31%25%12%Lack of patients’ awareness of COVID-19 risks37%31%21%11%Lack of compliance with social distancing and mask-wearing57%21%14%8%Inadequate support from the Paycheck Protection Program16%16%20%48%The Physicians Foundation, October 2020Pandemic’s Effect on Outpatient VisitsAccording to The Commonwealth Fund, visits to ambulatory care providers, typically primary-care physicians, decreased 58% as of March 29 (from the baseline week of March 1–7), but “improved” to -16% May 31 to -4% August 30 and to +1% September 27.While visits from all adult age groups had increased by September 27: 18–64 +4%, 65–74 +4% and 75+ +3%, visits for the youngest age groups of children were still less than the baseline week: 0–2 -18% and 3–5 -14%, but those 6–17 were +4%.Interestingly, visits to dermatologists increased 17% as of the week starting October 4, compared to the baseline week, with adult primary care second at +13%. Visits had decreased the most for pulmonology (-20%) and otolaryngology (-17%).Change of Ambulatory Patient Care Visits, by Insurance Coverage, March–September 2020Selected DatesMedicareCommercialMedicaidFebruary 23-2%0%-1%March 29-63%-56%-52%May 31-11%-18%-23%July 26-9%-8%-13%September 27+1%+1%-1%The Commonwealth Fund, October 2020Pandemic’s Effect on the Future of Health CareThe pandemic has clearly rocked the US healthcare system and caused many Americans to delay or decline medical treatment. 25% of surveyed physicians said that was the case for 26% to 50% of their patients and 23% for 11% to 25% of patients.To ensure access to high-quality, cost-effective care for all Americans, 60% of physicians think simplifying/streamlining prior authorization for medical services and prescriptions is extremely important and 56% want to be reimbursed for providing telemedicine services.A majority (70%) of surveyed physicians strongly agreed chronic conditions, such as heart disease and diabetes, will cause the highest demand on the health care system during 2021. Another 42% cited conditions worsened by pandemic-induced care delays.Physicians’ Rankings (1st or 2nd) of Their Most Favorable Health System Options, October 2020OptionPercentImplement a two-tier system (single payer available for all, with private pay/insurance option)67%Maintain/Improve the current Affordable Care Act (ACA) influenced system49%Move to a market-driven system with Health Savings Accounts and catastrophic policies45%Implement a single payer/Medicare for All system (government-funded and -administered)40%The Physicians Foundation, October 2020Telehealth Only Partially to the RescueAccording to the American Medical Association (AMA) July/August 2020 COVID-19 Physician Practice Financial Impact Survey, 68% of physicians said they were conducting telehealth patient visits during the survey week, compared to 20% pre-pandemic.Despite the benefits of telehealth technology, almost 68% of physicians told the AMA they were still conducting fewer total patient visits (in-person and telehealth) than before the pandemic. Average total visits decreased from 101 to 72 per week.The report from The Commonwealth Fund indicated telemedicine visits had increased from 0.1% for the week starting March 8 to its peak of 13.9% the week starting April 19. Since then visits have steadily declined, with a 6.3% increase for the week starting October 5 and Bottom 5 Medical Specialties’ Use of Telehealth Patient Visits*, October 2020?Top 5PercentBottom 5Percent#1: Behavioral health41%#1: Ophthalmology0%#2: Endocrinology14%#2: Otolaryngology1%#3: Rheumatology14%#3: Orthopedics 1%#4: Neurology12%#4: Surgery2%#5: Gastroenterology10%#5: Dermatology3%The Commonwealth Fund, October 2020 *week starting October 4?usage as a percent of total visits during baseline week (March 1–7)Physician CensusAccording to data from the Kaiser Family Foundation, there was a total of 486,405 primary-care physicians and 535,601 specialist physicians as of March 2020, each increasing approximately 3% from October 2018.Although there were still many more male physicians (651,434) than female physicians (369,540), the number of male physicians increased only 1.0% from October 2018 while female physicians increased 7.0%.Not only did 36% of physicians tell the AMA it was very or extremely difficult to acquire personal protective equipment (PPE) during the pandemic, but also 64% spent more for PPE during than before the pandemic, and the average spending increase was 57%.Totals of Professionally Active Specialist Physicians, by Specialty, March 2020SpecialtyTotalSpecialtyTotalEmergency Medicine57,834Cardiology33,055Psychiatry55,593Oncology20,886Surgery53,673Endocrinology, Diabetes and Metabolism8,237Anesthesiology50,837All other specialties207,022Radiology48,464Total535,601Kaiser Family Foundation, March 2020More Valuable InsightsMedical Economics’ 2020 Technology Survey reveals additional insights about physicians’ use of telehealth during the pandemic.Physicians’ Biggest Challenges Using Telehealth, September 2020ChallengePercentExplaining to patients how to use telehealth60%Internet connectivity/bandwidth issues53%Problems with scheduling/staff efficiency33%Patient becoming distracted while on call25%Establishing the interface22%Integrating telehealth with existing software22%Upgrading technology so telehealth can be used19%Training office staff17%Cost13%Medical Economics, November 2020The top 10 challenges for physicians and their practices for 2020 included in the December 25, 2019 issue of Medical Economics didn’t include the pandemic, but it clearly was the top challenge once it started ravaging the world’s population. Nonetheless, the challenges physicians were facing at the end of 2019 are still relevant.Physicians’ Top 10 Challenges for 2020, December 2019Challenge#1: Administrative burdens, regulatory requirements#2: Being paid#3: Increased competition from urgent care centers, retail clinics, etc.#4: Electronic Health Records (EHR) usability and interoperability#5: Self-care (better nutrition, exercise, sleep, supportive relationships and mindful self-compassion.#6: Avoiding lawsuits (medical malpractice)#7: Reaching patients with chronic conditions#8: Cybersecurity#9: Negotiating better payer contracts#10: Hiring quality clinical staffMedical Economics, December 2019Sources: Merritt Hawkins Website, 11/20; The Physicians Foundation Website, 11/20; American Medical Association Website, 11/20; The Commonwealth Fund Website, 11/20; Kaiser Family Foundation Website, 11/20; Medical Economics Website, 11/20.Updated: November 2020? 2020 Media Group Online, Inc. 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