GGFL COVID-19 Commentary Week #5
By: Donna Ho-Faloon
Dentists and doctors are not professionals typically associated with economic vulnerability but the COVID-19 pandemic is proving to be a blight on the entire small business community of which dentists and doctors are very much a part.
We understand enough about how the virus is spread to understand how precarious working life has become for both professions.
For this reason, some have laid off staff and closed practices completely, others are dealing with emergencies only, and some doctors have changed to consulting with patients over the phone in the interim.
Personal protective equipment has become scarce and similar to hospitals and long-term care facilities, they are finding it impossible to restock. Dentists are now attempting to source N95 masks as standard medical face masks typically used offer little or no protection against the virus.
In common with most small and medium size businesses, rent is a significant expense for dentists and some doctors. With reduced or no income, dwindling cash flow is becoming worrisome as the government has yet to announce emergency measures to provide relief to those who pay commercial rent.
Also in common with other business owners, doctors and dentists are trying to navigate government emergency response programs. However, these programs have been slow in implementation, program details change on a daily basis, and deciphering eligibility requirements are complex and confusing.
While the pandemic is negatively impacting dentists and doctors in similar ways, there are different issues they each face based on the way their businesses are structured.
Dentists can sell their practices, doctors cannot. For dentists currently planning to retire and sell the practice they have spent their working lives building, the pandemic will impact the timing of the sale.
Dentists are experiencing a deferral of revenues as practices are closed and patients cannot be seen. However, the revenue declines happening now are abnormal. Once the crisis passes, and practices can return to normal, patient treatments will resume and there will likely even be a backlog to catch up on.
For this reason, the value of practices would not be impacted. Buyers may try to panic owners into selling now at prices below fair market values, so dentists selling their practice should wait out the pandemic.
Dentists may have a high level of outstanding debt if they have recently purchased a practice, or invested in dental equipment and office improvements. These dentists should get in touch with their banks immediately to start discussions to defer loan payments and to make other arrangements to get them through this period. They should also apply for the Canada Emergency Business Account (CEBA) if eligible. Banks are being supportive as they understand the revenue streams of a dental practice and that this downturn is transient.
The key question, especially for dentists struggling to make ends meet, is how long will the shut down last? That uncertainty, and its impact on all aspects of their business, is causing huge stress.
The majority of physicians earn income, either directly or indirectly, through a provincially regulated fee-for-service model. COVID-19 has financially impacted almost all of them.
Some physicians, mostly specialists, work within partnership groups where their income is earned from clinical fee-for-service billings and non-clinical (research, teaching, etc.) work.
Other physicians, including family doctors, are paid under a direct fee-for-service compensation model. Others who are part of Family Health Organizations (FHOs) or Family Health Networks (FHNs) receive income in the form of a monthly payment – known as a capitation payment – based on rostered patients, plus fee-for-service payments. Those doctors part of a FHO or FHN would be least impacted as they continue to receive their regular monthly payment.
All non-emergency patient care, including elective surgeries, has been cancelled along with routine patient appointments. This means many physicians have seen a drop in the volume of regular patient work, translating into a decline in billings.
As a substitute for patient visits, some physicians are consulting with patients by telephone however the Province has yet to activate codes with which doctors can charge for these services. The delay means that for services today, doctors are unlikely to see income until the summer. (Update: On April 19th, the provincial government released a statement saying they would begin providing advance payments to doctors. But the head of the Ontario Medical Association says nothing has changed. See story in Ottawa Citizen).
Clients who are emergency physicians estimate their income to decrease by 50 percent because unless the emergency is critical, people are staying away from hospitals for fear of contracting COVID-19. They are more concerned that these people may be suffering at home.
Another client who operates a dermatology practice has seen income drop to zero. They had to close because they are deemed non-essential. He is also concerned that when the government gradually opens the economy again his practice may be one of the last businesses to open as the nature of their practice demands close proximity to patients.
Of course, some physicians are still working – those taking on shifts at COVID-19 assessment centres, others already treating patients who have contracted the virus and those preparing for the onslaught of patients should there be a surge. While a bleak prospect, the only physicians likely to return soon to regular income levels will be those whose skillsets are required for that same unenviable and highly risky work.
Donna Ho-Faloon is a GGFL partner with more than 300 clients who are either physicians or dentists.