Neal S. Birnbaum, MD, FACP, MACR, on How I Practice Now: Telemedicine and Financial Challenges of the Pandemic

In this video, Neal Birnbaum, MD, from Pacific Rheumatology Associates, talks about the challenges he has faced during the COVID-19 pandemic, including those associated with telemedicine and the financial burden. 

Neal S. Birnbaum, MD, FACP, MACR, is director of the Division of Rheumatology at California Pacific Medical Center, clinical professor of medicine at the University of California, San Francisco, and managing partner of Pacific Rheumatology Associates in San Francisco, California.



Neal Birnbaum: Hello, I'm Dr Neil Birnbaum. I've been practicing rheumatology in San Francisco for 43 years. I'm currently the managing partner of Pacific Rheumatology Associates, a for rheumatology practice in Pacific Heights in San Francisco.

This has been a rather unique time for all of us. And I've been asked to comment about how COVID-19 has affected my life and the life of our practice and our patients. I'm certainly happy to try to provide some input.

As any practicing rheumatologist knows, the effect on our personal practice and our interaction with the patients has been dramatic. We overnight went from seeing everyone in the office to seeing most of our patients by either Zoom telemedicine or by phone call. I find it ironic that after so many years of having that capability, but no one would ever pay for it, that suddenly we are forced to do that, and we are being compensated.

I think it is a change that will probably persistent to the future and that we will likely see a significant number, particularly of established patients, by telemedicine in the future.

It's been a difficult time for our staff. They have been working many, many hours to call patients and change appointments, postpone appointments, find out if they want to do telemedicine vs a telephone call. It's really been a challenge for them. I'm very grateful for the help that they give us on a daily basis.

Despite this, the overall volume of patients that we are seeing is dramatically less. Many patients have cancelled or postponed appointments. I think people are concerned about finances and whether they continue to have health insurance. I think for many rheumatology practices, they will have difficulty needing overhead, let alone providing any income to the physicians.

It's going to be a real struggle over the next few months. Our hope, of course, is that the economy makes a rapid turnaround once we are finished with shelter in place.

It's been an interesting experience in that regard, because as I read the regulations for the Small Business Administration Payroll Protection Plan, forgivable loans are practicing to be a perfect example of a group that could benefit under this. However, when I went to the bank where I have done all of my personal and business banking for the last 30+ years, I found out that they opened and closed the application process for these loans within hours.

Although the program supposedly would accept applications through the end of June, in fact that they closed them the same day, claiming that they had had such a volume that they would be unable to deal with any additional applications. I subsequently found that going to other banks was not useful, because they didn't want to deal with anyone with whom they did not already have a standing business relationship.

So, I am hopeful that Congress will act to increase the dollars available and make that plan work far better than it is currently working. I have written to my congressman, and I'm waiting for a reply.

With that, I want to thank you for listening in. I would be very interested in knowing how all of you are coping with this unique coronavirus pandemic. Be well, stay safe. Thank you.

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