Dan Gorenstein: Earlier this week, we told you about the financial challenges facing primary care providers in the midst of the coronavirus.

Chuck Jones: There’s not a light right now at the end of this tunnel that I can see.

DG: Many community health centers and physician practices are seeing half as many patients as they usually do, making it hard for them to keep their staff paid and their doors open. 

Amy Richardson, MD; OB-GYN; La Grange, Kentucky

Doctors and nurses, of course, are also worried about the health of their patients that they’re no longer are seeing.

From the Annenberg Studio at the University of Pennsylvania, I’m Dan Gorenstein and this is a bonus weekend episode of Tradeoffs on Saturday, March 28.

Dr. Amy Richardson: I am an OB-GYN in a small community right outside of Louisville, Kentucky.

DG: Not all OB-GYNs consider themselves primary care providers, but Dr. Amy Richardson does, in part because she has no choice.

AR: Unfortunately, in Kentucky, we’re such a rural state and people have such poor access to health care in general, that we function as primary care doctors in a lot of situations because women don’t necessarily have access to all the primary care that they need. So we are reluctant primary care providers.

DG: I caught Amy at the end of her work day Friday, March 20. For the past three years, her practice has been part of a large hospital system.

AR: We were the third to last practice to fall as I like to say, to be bought. We really wanted to stay independent as long as we could. 

DG: Amy says the coronavirus pandemic is the first time she’s actually glad to be part of a big hospital. Even though she’s seeing far fewer patients than normal, she’s confident the hospital will keep her financially afloat. What she worries about are the women she’s not seeing.

AR: Those are big losses to those people. I mean, maybe they don’t need ventilator support, but maybe they’re bleeding down and becoming anemic every month on their period. You know, maybe that’s the person who doesn’t get colon cancer screening that time. I’m not sleeping well. It’s a panic-inducing thought. I know all my patients. I know their problems. I know what it’s going to cost them when I cancel their appointment.

DG: And can you tell us the story of one of your patients, you don’t have to name them, of course, but like what’s going to happen to one of your patients that you’re worried about, that you’re having a hard time sleeping over?

AR: You have a patient who I know well. She hasn’t been to see me since 2018. So she was one of the people on the schedule that got canceled. And so I actually picked up the phone and called her and said, “Hey, I saw you on the schedule and I know you’re getting cancelled. But what is it? I’m assuming you’re not worried about your pap smear. What is it that you’re worried about?” She said, “You know, I’ve been having all these problems with my stomach and I feel like there’s something wrong.” And so I looked and I said, “Remember, you know, we did this test back in 2018 and it was abnormal. You’re supposed to get a colonoscopy,” and she’s like, “I know I never did it.” She’s like, “And now this appointments gotten canceled, and I’m not going to get a colonoscopy and I’m afraid I have colon cancer.”

DG: Amy got off the phone and lined up a CT scan for her patient and an appointment with a colorectal surgeon to get a colonoscopy.

AR: So then it just makes me think, oh, my gosh, it’s like when you’re almost in a car accident, like, wow, if I hadn’t stopped at that red light, then I would have been in that car accident. What if I hadn’t picked up the phone and called her? So I think about that kind of stuff a lot.

DG: Where you are in Kentucky, how do you think providing primary care is going to be impacted?

AR: Oh, well, basically no primary care is going to be done. I mean, that’s the problem right now. I have patients call me all the time, you know, would you take a look at my brain MRI? And I’m like, you know, that I am a gynecologist and that looking at your brain MRI is not going to tell me, you know, and they’re like, but can you just do it? Can you just look? I think people are so in need of some sort of access point. I see husbands all the time who say, are you taking new patients? I need someone to manage my diabetes. You know, primary care was already like on oxygen. It wasn’t on a ventilator, but it was definitely like carrying oxygen. I mean, it’s not even going to exist. I mean, it was already so ill to begin with. You know, it was one of the critically ill patients that couldn’t tolerate getting COVID-19.

DG: Amy says in just the last week they’ve pared back their caseload even more. She says, “We are hunkering down, as if for war.”

You can find all of our Coronavirus Conversations on our website, tradeoffs.org.

I’m Dan Gorenstein, and this is Tradeoffs.