Written by Joseph Smith, DPM, PPMA Past-President 2013-2014

What a tumultuous time these past few months have been! Our entire world has seemingly turned upside down overnight. What better opportunity to revisit Charles Dickens and arguably the best opening paragraph ever written: “It was the best of times, it was the worst of times …” Finding the silver lining in the cloud of losing the independence and freedom we have become accustomed to hasn’t been as difficult as I thought it would be. 

For years, I have fantasized about working at a less frenetic pace, carving more time to spend with the kids, getting in shape, and becoming more active in the community. With the imposition of ‘stay at home’ orders and social distancing, I now magically have time to do all those things. The irony is that it took a deadly pandemic to make it happen.  

FAMILY LIFE 
While it has been challenging to set aside my anguish for those more directly impacted by the COVID-19 infection, or the financial devastation of not being able to work, I have also become keenly aware of my own good fortune. I am so grateful that my family, friends, and coworkers so far have been spared. 

At home, I have one son in high school and one in college. Currently, they are both at home and taking their online classes.  It is a wonderful and completely unexpected blessing having them home and getting to spend more time together. We have been playing cards, board games, doing yard work, and just talking more. I cannot remember the last time we spent so much extended time in such close quarters, doing nothing more than just being a family.  

It has been fun connecting on a different level. It is so rewarding to leisurely watch my ‘little boys’ turn into the fine young men I had always envisioned. Their interest in what is going on in their world, as well as concern and compassion for those who are affected, has made me proud. I particularly enjoyed helping my youngest son start a GoFundMe account to raise money to deliver takeout lunches to our local first responders. The funds raised are for local restaurants to make and deliver lunches for EMS, police officers, fire fighters, doctors, and nurses. It helps the local restaurants stay open and retain staff, while also letting our local heroes know that the community is thinking about them and grateful for their sacrifice at the front line of this pandemic. These unique opportunities to serve would not have happened if not for the strange circumstances of the COVID -19 pandemic.    

PRACTICE LIFE 
At my seven-physician practice, we have remained open as we are considered "Essential."  All elective procedures have been postponed indefinitely or cancelled. Our schedules are limited to emergencies, post-op patients, diabetic ulcers, and acute problems.  The practice continues to see patients to prevent them from undertaking the risk of COVID-19 exposure at an Urgent Care Center or the hospital emergency department.  

Our schedules have shrunk significantly, and we are only seeing about a quarter of our regularly scheduled patients. This whole experience has generated mixed feelings. On the one hand, it feels great to help our patients while keeping them out of the hospital; but on the other hand, every patient encounter is fraught with the anxiety of possible exposure despite all manner of safety precautions having been instituted. 

Everyone always wears a mask, the waiting room is closed, patients are seen alone, and checkout procedures are non-existent. 

Despite the drastic reduction in the number of patients seen and decreased revenue, we have tried to maintain the employment hours of ancillary support staff by giving them other work.  For example, they have pitched in to scrub down the entire office every evening.  This sense of obligation to our staff has been foremost in our minds throughout this crisis. We know they are counting on us to keep them financially solvent. 

What has become abundantly clear is that we are all interdependent. Every once in a while, our need to work together and cooperatively find solutions and tackle crises becomes glaringly obvious. This is one of those times. This is apparent in every aspect of my life: as a business owner, physician, parent, son, and citizen.  Not only is our individual well-being important, but also that of our professional bodies and political organizations. 

PPMA DURING COVID 
During the disruption caused by the COVID-19 pandemic, I have found myself more actively involved in the Pennsylvania Podiatric Medical Association and the Goldfarb Foundation.  Both Boards meet weekly on ZOOM to discuss best ways to help the members and our profession get through these very lean and difficult times.  

The PPMA, under the able leadership of Mr. Michael Davis and President Sabrina Minhas (another fellow Temple graduate), has implemented several new initiatives, details of which are on the PPMA website and are sent out in email blasts weekly— 

• Membership dues for the first quarter of 2020/2021 have been waived.
• Information to apply for PPP loans and information about getting discounts on malpractice insurance during the pandemic have been disseminated.
• The procedures and guidelines to perform a Telemedicine visit has been explained so that doctors receive proper reimbursement.
• The PPMA has also worked with the State Board of Podiatry to make all CMEs available online during this license renewal year.
• At the Goldfarb Foundation, we have made plenty of Online CMEs easily available for all podiatrists through the Foundation website, including 24 online videos and 20.75 CE contact hours (link: https://www.goldfarbfoundation.org/Online-Lectures).

At this point, no one can accurately predict the extent of the damage caused by the pandemic. We worry about how we are going to pay our bills and about how we are going to keep ourselves, our families, patients, and staff safe. There are many unknowns. What is almost certain is that there will be permanent changes in the mode and methods of our medical practice. 

• Telemedicine may play a greater role in our day-to-day practice, at least for a subgroup of patients.
• Masks and social distancing could very well become the norm in the near future.
• Crowded waiting rooms and double booking may become outdated.
• Waiting rooms and patient-flow patterns would need permanent modifications in our practices and our clinics.

Perhaps this change to focusing on the individual patient is a welcome reminder of what is important, and we should start thinking about ways in which insurance companies and other payors can support these changes moving forward. One thing that I am certain of is that our small, but mighty, podiatric medical profession is resilient, and that we will adapt and come out stronger than we were before this pandemic. That is the American way.  We just need to continue to work together as a profession and be grateful for the little things.