From house calls to drive-thru visits, independent physicians adapt amid COVID-19 crisis

(NEW YORK) — When Dr. Beth Oller sees the newborns in her care, they’re usually cooing and crying in her office. But in a pandemic, it might be safer for her to go to them.

Oller does not quite fit the image of a black bag-toting doctor making house calls, but as the COVID-19 pandemic puts an unprecedented strain on the healthcare system across the country, some physicians are adapting to new ways to protect their patients and themselves.

Oller and her husband, Dr. Michael Oller, both Stockton, Kansas-based family physicians, told ABC News they’ve both expanded their home visits and amid the outbreak.

“I can wear a gown and gloves and a mask and take my own stethoscope and my newborn baby scale and have all my equipment with me and expose them to much less risk than I would bringing the newborn into my office,” Beth told ABC News.

Dr. Michael Oller said he has done three home visits in the last two weeks compared to just one per month before the outbreak.

“The patients that we routinely do home visits for frequently do have chronic diseases or are elderly and they are more vulnerable to COVID than our average patient would be,” Michael said. “By doing a home visit, the patient doesn’t have to expose themselves to door knobs and table tops at at hospital. It keeps them in their environment.”

The pandemic has put both a practical and a financial strain on independent medical practitioners, many of whom are simultaneously scrambling to adjust to new ways of seeing patients while struggling to keep their businesses afloat.

Dr. Richard Harris, a Chicago-based urologist and president of independent physician trade association, LUGPA, said independent practices are down by roughly 50 to 70 percent across the board, and many have already had to take extreme measures of laying off many of their staff members.

“These are exceptionally trying times,” Harris said. “The COVID-crisis is devastating for all, but especially devastating to those of us in the healthcare business, especially independent practitioners.”

Dr. Mark Martindale, a pediatrician who has been leading a family-run practice based in Benton, Arizona, said his facilities went through a complete overhaul of their operations, expanding their telemedicine capabilities and even setting up a multi-stop, drive-thru care system in the parking lot.

“We approach a car with the patient in it like a police officer would approach someone they arrest,” Martindale said. “Normally, we want them comfortable right away. We want them at ease. Now, my first line is a wall to make sure you’re safe first and then we’ll deal with the patient.”

Dr. Mark Abdelmalek, a Philadelphia-based skin cancer specialist who is also an ABC News medical contributor, said he performed a biopsy in a patient’s car in the parking lot of his office because the patient’s autoimmune condition increased her risk if exposed to the virus.

“She was very appreciative of the consideration and care and of course most medical procedures can’t be performed in a car,” Abdelmalek said, “but a skin biopsy in this case in a non-sensitive area and in an area that was not at high-risk for bleeding made sense balancing the risks and benefits.”

Dr. Thomas Cornwell, on the other hand, a Chicago-based family physician and founder of Northwestern Medicine HomeCare Physicians, normally does about 40 house calls a month, but he told ABC News that he’s cutting back amid the outbreak and expanding his use of telemedicine.

“These are not healthy 80- to 85-year-olds. These are the highest of highest risk patients for COVID,” Cornwell said. “And to me it would be devastating if you expose them to COVID and so we’re doing whatever we can to avoid that.”

Other doctors are playing their part to fill in the gaps for bigger hospitals as they struggle with COVID-19 response. Dr. Anthony Buglino, for example, a prominent plastic surgeon on Long Island, said he has been tending to other kinds of patients in the office in an effort to keep them from an overwhelmed emergency room.

“Parents aren’t used to having their kids 24/7,” Buglino said. “It’s unstructured. The kids are running around and getting hurt. … I see more lacerations during holidays. This is like an extended holiday.”

Dr. Joseph Valenti, an independent OB/GYN based in north Texas and a board member of the Physicians Foundation, has been seeing chronic pain patients who are awaiting surgery amid the moratorium on elective procedures. But he’s still struggling to make ends meet.

Federal relief programs are expected to help independent practitioners stay afloat, but the closure small independent practices, Valenti warned, could put even more strain on the healthcare system.

“If we have to close practices and we can’t see patients either in the office or by a telehealth visit,” Valenti said, “those patients will go to already overburdened emergency rooms for care.”

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