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Texas doctors struggle to stay afloat as in-office patient visits drop amid coronavirus outbreak

Billable in-patient visits are down by as much as 70 percent, industry leaders say.

Your family doctor may be fighting to survive the pandemic. 

Some industry experts estimate office visits are down 50 to 70 percent. It's what you want during social distancing, but it also means billing is down and doctors are struggling to pay staff. 

Dr. Chrisette Dharma runs Southwest Family Medicine Associates in Dallas. She has been a doctor for more than 20 years, including owning her own practice for 10. 

Eight female doctors work part and full-time in the office, each carrying about two to 3,000 patients.

“Family medicine is my passion,” Dharma said. “We are what everyone considers like their general doctor that they go to for everything.”

Dharma sees and does it all; she can vaccinate a newborn and treat your 103-year-old grandmother.

During the COVID-19 pandemic, neither should be coming in for a visit.

But they still need their doctor, who transitioned to telehealth and is now trying and failing to answer 500 calls a day.

“Honestly, people are upset because we're not able to get back to them,” Dharma said.

Dharma and her staff return calls one-by-one, apologizing and saying they’re doing the best they can.

“When they're hurting right now, it is really painful to not be able to take care of them in the way that we would want to,” Dharma said. “We take care of a lot of anxiety and depression and holding these people up when they're scared."

Dharma says she talks to her patients daily who have coronavirus, but she doesn't have a test or medicine for them.

"I mean it's literally like live or die," she said. "Make it work. Figure it out and take care of your people.”

The 500 calls don’t pay the bills.

"Even though there's a lot of phone calls, it doesn't necessarily mean that all those are visits," Dharma said. "Visits are down, as one would want and expect, because we've done social distancing and shelter in place.”

Dharma said most of the money in family medicine is in preventative care. And with that largely gone, she already knows what’s going to happen.

“I already see my future through that little ball,” she said. “It's like a tornado's coming. You can see it. It's about to hit. And so you're doing shelter in place, right? I had 28 direct employees, of which I had to furlough eight, based on lack of business.”

Dharma said she offered one $1,000 thousand to each of the furloughed employees to help them make it until unemployment comes through.

Dr. Dharma said six additional people from offices that worked with hers were also furloughed.

Tom Banning, who runs Texas Academy of Family Physicians, has heard Dharma’s story play out in other Texas cities and other practices.  

TAPF provides continuing education for members as well as advocates on their behalf. It represents about 15 percent of practicing physicians in Texas.

“In the last three weeks since COVID-19 has started, we have seen patient volume and patient visits to community practices dropped by 50 to 70 percent, which means that those physicians are not able to bill for and collect money to pay their bills,” Banning said. “They're suffering very much like any other small business, any restaurant or anybody else in this crisis. The problem is that we can't afford to let these practices fold or close because they are so desperately needed.”

Banning said he’s already seen practices begin cutting salaries and staff.

They are tapping all available resources that had become available, including the paycheck protection plan. But we've got to find a way to keep these practices open,” Banning said.

“I don't see how we don't come back with another package from Congress specific to health care providers. My heart goes out to the small employers and everyone who's struggling financially at this time. But our health care system is on the verge of collapse and we can't allow that to occur.”

Dharma’s practice has 24,000 patients on the books. She has applied for the CARES Act and is waiting.

Meanwhile, she’s fighting to stay afloat; she’s fighting to continue being their doctor.

“This is not just today, we are needed to help take care of you and we're not going to be around, and you're going to end up in the emergency room,” she said. “Because you couldn't get even your basic medications refilled, because all the other doctors that were left were inundated and weren't able to jump up to meet your needs, then that's it. You're done. You're toast.”