A health worker wearing personal protective equipment performs a nasal swab on a man at a temporary Covid-19 testing station in Diepsloot, Johannesburg. Picture: Emmanuel Croset / AFP
A health worker wearing personal protective equipment performs a nasal swab on a man at a temporary Covid-19 testing station in Diepsloot, Johannesburg. Picture: Emmanuel Croset / AFP

Private doctors are not earning enough to make ends meet, as Covid-19 has brought about a reduction in regular patient numbers. This has led to some of them opting for early retirement, even as fears escalate about SA’s lack of medical expertise during a pandemic.

Patients are staying away from doctors and hospitals out of fear of contracting Covid-19, even though delaying needed medical care may prove worse for their health than the virus.

Dr Frik Potgieter, speaking on behalf of the Ophthalmology Management Group, which represents most of SA’s specialist eye doctors, says that as Covid-19 cases spike, patients are postponing appointments. “The effect varies across the country. In areas where there is high activity of the disease, numbers are significantly down,” he says.

But once people become too sick to avoid the doctor, they’ll have to go to the doctor’s rooms or the hospital – and the concern is that there will be fewer specialists to deal with this deluge. If too many doctors have called it quits, waiting lists will be long.

Dr Mark Human, who represents specialist doctors at the SA Medical Association, warns that if 10% of doctors – especially the older, experienced specialists who are close to retirement – stop practising, “we’ll be in deep [trouble]”

It’s a precarious economic scenario. Doctors, especially specialists like radiologists and ophthalmologists, have high equipment costs and debt. Yet since April many haven’t been earning enough to cover their expenses.

And, ironically, while you’d expect that Covid-19 would increase demand for doctors as hospitals fill up with virus patients, it isn’t quite so simple.

Last week, the 25th week since the virus was first detected in SA, 18% of all tests conducted were positive, up from an average of 3% in the first two months of the epidemic. SA is averaging about 35,000 new cases in a week – almost equal to the 35,812 cases it tallied in the three months from March 5 until June 2.

Human says this means doctors who have been struggling financially for three months have at least another three months to go of subdued income, as hospitals have fewer beds for non-Covid-19 patients. Doctors can tighten their belts, but if you halve their income, it becomes impossible for them to manage their overhead costs, he says.

While telemedicine – doctors doing telephone or video consultations – has been touted as a solution, doctors earn less from this.

Psychiatrists are offering therapy via video calls, but data shows that psychiatrists billed only 48% of their usual amounts in March, 63% in April and 75% in May, said Dr Sebolelo Seape, chair of the Psychiatry Management Group.

“It might seem to be increasing, but it will remain at least 20% less [than they usually earn] for a very long time,” says Seape.

She says patients who run small businesses and are battling to make ends meet can no longer afford to see psychiatrists.

Hospitals are also limiting patient numbers in wards to ensure social distancing, in some cases putting up dry walls between beds. “In the hospital, we are admitting fewer patients, so as to ‘socially isolate’ them,” says Seape.

In-person consultations are also taking longer, since doctors are not only having to constantly sanitise equipment, but need to book fewer patients to keep waiting rooms empty.

Says Potgieter: “Ophthalmologists utilise a lot of equipment during a consultation as well as during surgeries. All these instruments have to be sanitised and wiped down between patients, which also has a significant impact on consulting times and operations.”

In some centres, Potgieter says, the caseload in June dropped to 50% of the normal volume.

He says it’s become a struggle, and he knows of two ophthalmologists who have decided to retire early rather than lose more money staying open.

Dr Richard Tuft, head of the Radiology Society of SA, concurs. As it is, he says some medical practices are asking the older radiologists to work from home for their safety. This, he says, has led to some early retirements.

“Radiology practices employ five to six radiographers per radiologist and another three or four support staff. The major imperative has been to keep these staff in employment, but in some cases there have been forced redundancies or salary cuts to keep the staff on. The radiologist owners of the practices have largely been working without remuneration in this period.”

In April, says Tuft, radiology volumes fell to less than 30% of their usual numbers. “The volumes have recovered somewhat, but most practices are still below the level of income required to cover costs,” he says.

One of the biggest costs for doctors is paying off equipment, which is usually imported and paid for using debt.

Potgieter explains that new practices that are only beginning to pay off this equipment but are now seeing few patients are battling to handle the burden of large monthly obligations toward financial institutions.

It’s also not as if delaying treatment will help the patients.

Says Tuft: “The need for emergency radiology examinations for non-Covid-19 causes is essentially unchanged, but patients are reluctant to come to X-ray departments, which are mainly hospital-based, as they are scared of [catching the illness].”

And in the long run, he says, a delay in the diagnosis of diseases will lead to a worse outcome for patients.

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