I am scared as I sit down to write about our journey as a small practice as we fight along with the rest of the world against the unthinkable force of nature in the form of a COVID-19 pandemic. My small primary care practice is only two years old. In a time when medical practices are already dying, the financial consequences of social distancing as a response to COVID-19 can be catastrophic. I am afraid for myself, my family, my staff, and, most importantly, my patients. Every one of them is dear to me. They rely on me for their medical and mental needs. I need to be healthy and be there for them.

The biggest challenge has been focusing on personal health. I have lost sleep, felt hopelessness and discouragement at the response of our government, Centers for Disease Control, and medical organizations. The response from the private sector has been encouraging from retailers like Eddie Bauer announcing that they will be focusing on personal protective equipment and companies like Abbot that are working to make a quick turnaround test for COVID-19 a reality. The financial threat to personal assets, as well as running a small business, cannot be understated.

A lot of my staff are afraid as well. They are scared for their safety, for their parents and their children. At the same time, they know that they work in health care and exposed themselves to risk every day. Despite the psychological toll it has taken on them, they must stay strong for the patients and be able to deal with a mountain of paperwork that comes down a primary care practice every day. Our patients still need their diabetic supplies; visiting nurse paperwork has to get done to provide care to the elderly; the transition of care from hospital to home has to be coordinated to prevent rehospitalization, urgent visits which are now being done remotely need to get done to prevent patients from going to the hospital and urgent care, and prescriptions for essential medical conditions that have to be renewed.

Losing a single primary care physician who typically manages a population of about 2,000 to 3,000 patients can be catastrophic. We are the frontline soldiers who are also navigating the mental stress that this pandemic has put on the population. I have had countless calls by patients who are anxious stressed and getting more depressed and not able to access the already saturated mental health system. We must navigate this and be there for these patients.

Although a lot of practices have started providing televisits, adopting this technology can be challenging for some patients, especially elderly patients who are not always able to understand the nuances of zoom, FaceTime, and patient portals. The reimbursement for these visits has traditionally been low, and my initial read based on compensation data is that it is variable depending on the carrier and is less than face-to-face visits.

I would hope that the insurance companies would not complicate the reimbursement for essential televisits with a quagmire off cryptic codes. The best thing is to continue to use the same codes that you normally do for patients when you see them face-to-face in the office. The battle is long, and this is likely to continue for months with the fallout on the national and global psych four years. We are all afraid, and we should be. The enemy cannot be seen, cannot be felt, and is an invader that comes from nowhere and causes mild illness is in most and severe diseases in others. The elderly and those with chronic diseases are especially vulnerable.

Fighting back is the best response. Personal safety is of paramount importance. Our practice rapidly responded to this change and threat. We have been in touch with regulatory bodies and local hospitals to understand the threat and then set up strategies and workflows to counter the threat. From triaging patients to implementing office sanitizing strategies to going completely online to provide televisits. Meeting these challenges and rapidly adapting to change is hard on small practices where the physician is already wearing many hats from manager to IT professional to now also being confronted with unprecedented human resource challenges. This sort of crisis makes you dig deep, and maybe we should get a degree in crisis management by the time we are done with this pandemic.

The staff has shown great resilience. They have kept their cool and rapidly adapted to the changes that I have implemented in the practice. The changes are multifold and include televisits, billing and practice management changes, and setting up infectious disease protocols. These stories of bravery are not unique to my practice. As I survey the area, most small practices have rapidly adapted to this change. Our local hospitals and leadership have also been extremely supportive currently. They say that adversity brings the best out of you. I have seen this in action.

I want to send out a message of hope in this time off despair. We will get through this. There are important lessons to be learned from this, including disaster preparation and response at both the local and national level. In the meantime, we need to be thankful for the response of health care providers who are championing the fight back against the enemy, putting themselves at risk going into battle. I am deeply appreciative of EMTs, physician assistants, nurses, nurse practitioners, respiratory therapists, medical assistants, and allied health professionals.

Small business and medical practices like myself on essential for community health and care. I hope that all state and national health bodies will recognize the services of these small practices at the time of this crisis and support them, so they do not succumb physically, mentally, and financially in the aftermath of COVID-19.

Talal Khan is a family physician and can be reached at Personal Primary Care.

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