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A receptionist checks in a patient at A+ TotalCare in Elko on Wednesday, April 4, 2018. (Jeff Scheid/The Nevada Independent)

A majority of Nevada doctors believe they can only keep their doors open for another two to six months unless the volume of patients trickling back into their offices significantly increases, according to a new survey from the American Medical Association.

Ten percent of physicians in Nevada reported layoffs, 15 percent reported pay cuts, 20 percent reported temporary furloughs and 30 percent reported a reduction in staff hours, while 55 percent reported none of those changes, according to preliminary results from the survey, which Dr. Ron Swanger, president of the Nevada State Medical Association, presented to the Patient Protection Commission on Monday.

According to the survey, one in five medical practices has seen a decline in revenue of between 26 to 50 percent, while another third have seen a decline of 51 to 75 percent. A third of physicians say they aren’t sure how long they can keep their doors open at their current patient volume.

The Nevada data is a small subset of a larger survey conducted by the American Medical Association (AMA) of 10 states last month. Nevada State Medical Association Executive Director Jaron Hildebrand said in an email that the data from the Nevada portion of the survey, which included responses from 33 providers in the state, should be thought of as three to four focus groups worth of data and not necessarily representative of all the association’s members.

However, Swanger told the commission that the data tracks with trends that are being seen nationally, and they also hew closely to the results of a larger Nevada State Medical Association survey of 131 members taken in April.

According to the AMA survey, 70 percent of physicians reported being very concerned or extremely concerned about obtaining adequate revenue from their practices, even though many have been able to obtain assistance through the federal Paycheck Protection Program. Seventy-four percent said they have applied for federal assistance, and, of those, 89 percent reported having received it.

“I had received several letters from my colleagues saying that they were eliminating half of their staff,” Swanger said. “Luckily the PPP came through for them, and they're still open today, but I know that their volumes are just like ours, down about 30 or 40 percent. It's hard to cover your overhead and turn any profit at all. I know we're not turning profit right now. We're just trying to keep the doors open and our employees working.”

Though the numbers would be stark in any state, they’re of particular concern in Nevada, which has one of the lowest rates of doctors per capita of any state. The Silver State ranked 48th in the nation for total active patient care physicians and active primary care physicians in 2019, according to a workforce profile compiled by the American Association of Medical Colleges.

“There is always already a shortage of primary care providers in the state as a whole, and if even 5 percent or 10 percent drop out from providing that primary care, we would end up in a crisis,” said Dr. Ikram Khan, one of the commission’s members. “It's bad enough to begin with.”

Khan said he knows physicians in private practice whose costs significantly increased as they secured additional personal protective equipment, even as their patient volume significantly decreased. Other doctors, employed by larger companies, have been laid off, he said.

“These physicians can’t go and open shop next door because it’s fiscally not possible to do so either,” Khan said.

The medical community has been trying to get the word out to patients that it is safe to return for appointments and surgeries, particularly those needed to keep chronic medical conditions under control. But Swanger said that patients have been slow to return.

“We're seeing somewhat of a patient comeback, but it's not strong enough and I'm not sure what else we can do to be honest with you,” Swanger said. “I think the messaging is out there and we continue to push the message that you need to seek care, particularly for chronic health.”

Bill Welch, CEO of the Nevada Hospital Association, told the commission that utilization of Nevada hospitals dropped more than 30 percent. It wasn’t that people stopped needing care, he said, but that they were uncomfortable coming to hospitals for fear of being exposed to COVID-19.

“Whether it's for cardiology, oncology, gynecology, etc., we are starting to see an uptick in patients coming back to the hospital for that,” Welch said. “But again, still not back to the normal volume that we've seen in the past.”

At the same time, the hospitals are preparing for another spike in COVID-19 cases. Welch said that if the spike comes as flu season is starting, it will be a challenge for hospitals to ensure they have enough staff and personal protective equipment to treat them.

“We feel reasonable that we should have beds, if we get hit both with the flu and the COVID-19 continues on,” Welch said. “Will it be a challenge for us? Without question.”

Christopher Lake, executive director of community resilience for the hospital association, added that testing continues to be a challenge for hospitals.

“Testing availability and result turnaround time, again, is a huge concern,” Lake said. “We really, as we enter the flu season, need to shoot for having that COVID-19 test back to the hospitals within 24 hours. We're not there yet, but we really need to strive to get there.”

This story and all others about the Patient Protection Commission are edited by Managing Editor Elizabeth Thompson and/or Assistant Editor Michelle Rindels. Sara Cholhagian, the commission’s executive director, is in a relationship with Editor Jon Ralston.

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