Urology practice advice: Adapting and surviving during the pandemic

One recent Friday afternoon, my wife and I were sitting on the patio of our favorite local brewery enjoying a hazy IPA when she asked if I had stopped and had my haircut before meeting her. She was, of course, correct. For the first time since March, I had stopped by my local barber for a trim.

My wife wasn’t very happy. You see—and I love my wife to death—she’s more of a cheapskate than I am and when the pandemic hit and my barber closed, my wife acquired a trimmer and started to cut my hair. And it was her opinion on that sunny Friday afternoon that she did a better and cheaper job than the barber.

Which made me start to think, because it turned out before the pandemic, my wife and I would not infrequently stop by the local brewery on Friday afternoons for a beer and this happened to also be the first time we had done that since March. And I was receiving no grief from my wife about the bar tab.

And then there was my clinic. When the crisis hit, I assumed that urology was facing a medium-term cash flow problem. My logic was that patients would continue to see us for stones and cancer and such and would delay the more elective portion of our work. But, importantly, once the crisis settled down, all of our patients would return. We, like most practices, then worked to adjust our clinic for the new realities of COVID-19 while optimizing our telemedicine services.

The problem was once the crisis settled down in our area, not only did the temporary compensatory increase in patients I was expecting not materialize but our actual volume stabilized at about 10% less than what it was before COVID-19.

Why? I’m not sure. Urological disease is still out there and my doors (both real and virtual) are still open, but we are missing patients. Interestingly, not only has urology seen a decline in clinic volume with the crisis, some centers are even reporting declines in the number of urological emergencies.Where are the patients? I went so far as to look at my patients by age, gender, and diagnosis and, at least for my practice, there is no obvious trend as to who is missing.

Faced with the decrease in volume, my barber let an associate go and seems to have accepted that her business will simply be smaller than it was before. My brewer has increased prices to compensate for the decrease in seats available and is offering more take-out options. Since I’m not about to accept a smaller business and I can’t charge my patients more (tempting though, isn’t it?), we have to do something else. We are searching our database for patients who missed appointments or are overdue and are aggressively reaching out to them to offer real or virtual visits. We have reached out to the local labs and radiology groups to ensure that our patients can easily and safely get all required tests before visits so that no one can use that as an excuse to skip a visit. We are keeping a ridiculously clean office and are doing our best to make the entire experience of being in our office safe. We have also reached out to referring providers directly and reminded them that we are open and available for consults at the patient’s convenience. I’m not sure if it is working yet, but I’m not going down looking.

Unlike the big hospital systems in town or the local private equity-backed group, small-town urologists don’t have the luxury of significant outside financial support. We survive by doing good medicine and being agile businesspeople. I strongly recommend that every group evaluate their patient volume, identify any trends, and actively work toward fixing those problems, because the simple truth is that if the virus isn’t spiking again in your area, it will.

Stay safe and be smart about your practice!