The Heart of the Storm: I'm a PT in Manhattan. Here's What it's Been Like
By Katie Parrotte, PT, DPT
It seemed to happen nearly overnight. One day my schedule was full and our clinic was bustling, and the next the cancellations came sweeping in. I wrapped up one work week knowing I was receiving a salary, and came in the next to be told my company could no longer pay me my salary, but would give me a set stipend per patient visit I completed. The next week, I was filing for unemployment — something I never imagined I would ever have to do as a health care provider.
I work in Manhattan, which is currently the U.S. epicenter of the COVID-19 pandemic, for a small outpatient orthopedic company. We serve nearby residents of all ages: from school-aged children to elderly patients brought in by home health aides; from the weekend warrior to newly postpartum mothers. With 14 physical therapists working over a span of 13 hours, five days a week, the clinic was humming with activity. However, in a matter of a few weeks this dramatically changed.
As the threat of COVID-19 became more imminent, the owners and clinic directors began taking steps to protect the staff and our patients. Signs were posted educating patients on Centers for Disease Control and Prevention recommendations to prevent the spread of disease, and all patients were required to wash their hands upon entering and prior to leaving the clinic. Each therapist was supplied with nitrile gloves and a container of germicidal disposable wipes for their treatment station, to clean the tables between patients (in addition to the usual changing of linens between patients). A member of our front desk staff began regularly wiping down frequently touched surfaces and door handles throughout the clinic. While the clinic is fortunate to have these supplies, it is unclear how easy it would be to purchase more in the near future.
When the rate of infection began to increase in New York City about two weeks ago, we still did not have masks at our clinic; one of the owners was able to obtain 10 surgical masks, but was having trouble finding more. This is par for the course, as many health care providers, including those “in the trenches” in hospital settings, are unable to get enough of the supplies they need. I have friends in hospital outpatient settings who are facing the same shortages. One friend was told to make a surgical mask last for three days, so she keeps it in a Ziploc bag between her treatment sessions. Another friend has been given one surgical mask for the foreseeable future. If New York City hospitals and hospital-based physical therapy clinics are facing such shortages, it comes as no surprise that private outpatient facilities will also experience shortages, perhaps to an even greater degree.
Aside from limited supplies, the ever-worsening situation in NYC is greatly affecting the financial stability of the clinic. At first, cancellations began to trickle in slowly, starting with older or at-risk populations. However, since the clinic serves as a community clinic, many of our patients are over the age of 65, so the number of cancellations continued to increase. As more businesses closed and New York State put mandates in place restricting the workforce, more patients began cancelling appointments. After the state mandated that 100% of nonessential personnel stay home initially for two weeks, and now until April 15, many patients have canceled their appointments until at least May.
For patients who continue to come into the clinic, the task of pre-screening is a challenge. As a small business, the company does not have technology such as digital temperature readers, nor does the clinic have an isolated area where patients can be screened prior to having contact with other people. To help minimize the sick or exposed patients coming to the clinic, the company lifted all fees for late cancellation of appointments, and therapists relied on patients reporting travel, exposure, or being ill to determine whether an individual should be treated at the clinic.
Nobody was prepared for this, but it feels like a nearly impossible situation for small private practices. Owners and employees alike are forced to make challenging decisions: Stay open and risk exposure? Close your doors and risk never opening them again? If patients are willing, should therapists continue treatment despite increased risk and decreased pay? Can they afford not to? This is all compounded by the constantly changing circumstances and guidelines that we are all struggling to adapt to on –the fly.
Hopefully this pandemic will be on the downswing within the coming weeks, and other areas will not be hit as hard as New York City and New York State have been. However, for those of you in other areas of the country, now is the time for you to start planning and making changes in your practices to help minimize the impact this has on your patients and your businesses, if you haven’t already.
If your clinic is still open, try to get as many supplies as you can, including gloves, surgical masks, and germicidal wipes. If you have not already done so, begin practices of surface disinfecting (including chairs, door handles, and counters) between each patient to help minimize the spread of disease. Cut out as much nonessential spending (both personal and professional) as possible in an effort to save money, for these are uncertain times, and we do not know how long this pandemic will last, how long individual business will be able to remain open or individual employees will be paid. If you have not already, start going through your patient lists and prioritize patients. Is there anyone on your caseload who is truly essential – whose life would be worse off without having physical therapist services during this time, such as patients who recently had surgery or have acute neurologic complaints? On the opposite side of the coin, are there patients who are in the high-risk category for COVID-19 morbidity and mortality who should stay home? If there are patients who absolutely require in-person physical therapist services during this time, take the appropriate steps to ensure that these individuals are otherwise healthy, and use PPE as it is available. However, if it is not critical that a patient receives in-person services, consider transitioning that patient to virtual care.
In light of the current situation in NYC, I believe that engaging our patients via telehealth is the best and the safest way to continue providing care. We as health care providers have a responsibility to continue treating our patients, but to also minimize the risk of exposure for our patients, especially the most vulnerable ones, and for ourselves. With morbidity and mortality numbers continuing to climb in NYC, we must put the safety of the public as a whole over our fear of losing money.
While rules and coverage for telehealth vary by payer and by state, many payers are becoming more lenient in light of the current crisis the country is facing. There are many great resources available on telehealth, including on the APTA website and on many APTA chapter websites. The New York Physical Therapy Association Executive Committee and chapter staff have been working tirelessly to provide PTs and PTAs in our state with the best available information to help us all continue to practice and to advocate for our profession.
This is a challenging time for us all: Our patients are not getting the type of care we are used to providing, clinics are losing money, PTs and PTAs are losing jobs, and more people across the nation continue to get sick. I think the best we can do is be flexible and think outside the box when finding ways we can provide care for our patients. Overall, we should remember that we are #BetterTogether, and we work together to provide the best care, whether it is in person or virtually. If we can do this, I believe that when we get on the other side of this crisis, we will find ourselves stronger and more dynamic, both as individuals and as a profession.
Katie Parrotte, a board-certified orthopaedic clinical specialist, is director of pelvic health and H&D Physical Therapy. She is a director for the Greater New York District on the Board of Directors for the New York Physical Therapy Association.