COVID-19’s blow to GPs

The recent economic stimulus package and fund injection by the government of Malaysia is targeted at keeping the country afloat in the current crisis. However, one important segment of society might have been missed in the commotion—the GPs.

MIMS Doctor spoke to Dr Soo Tai Kang, who runs a private practice in Kuchai Lama, to see how the Movement Control Order (MCO) and the COVID-19 outbreak has affected him.

Perhaps the most evident change is the number of patients visiting his clinic. Soo said there was a sharp decrease from an average of 60 patients to 10 or less patients per day. This was from the onset of the MCO, which was announced on 18 March. The drastic drop has caused a dip in his income.

Due to this sudden announcement and the marked reduction in patient visits, Soo had limited time to make the necessary arrangements. However, in the time since then, he has managed to settle into his new routine. For one, his clinic’s opening hours have been reduced from 12 hours to 10 hours daily. He also had to limit the staff count to two per day. Additional cost saving measures included limiting stock supplies to only essentials and in small quantities.

Should the MCO be lengthened, Soo said he will have to resort to further reducing his clinic hours and perhaps only operate during the weekdays. Other possible cost reduction practices will be to reduce manpower in order to reduce salary payout. He added: “If necessary, I may need to apply for any form of loan from a bank to assist financially.”  

The recent economic stimulus package did much to help the B40 group and there was much chatter about helping the small and medium enterprises (SMEs). Soo said: “It (the stimulus package) is quite attractive and will be helpful for the general public. However, there was no announcement to use this to help private GPs. The Malaysian Medical Association (MMA) has recently sent a proposal to the Ministry of International Trade and Industry (MITI) on how to use the stimulus to assist affected GPs.   

Soo, who is also a committee member of the Medical Practitioners Coalition Association of Malaysia (MPCAM) said their members are reporting the same situation across the board. “Everyone is worried if their clinic can survive should the MCO be extended.”

With regard to exposure to possible COVID-19 patients, Soo said he is thankful that there hasn’t been any possible patients since the beginning of the outbreak. However, he is worried that it might happen one day. He said: “My clinic is not equipped with personal protective equipment, and I am afraid of consequences for myself and my staff, our family members and other patients. We have put a signage at the front entrance to instruct persons possibly infected with SARS-CoV-2 to call the National Crisis Preparedness and Response Centre (CPRC) and follow their instructions on screening.”

Grim news abounds
MIMS Doctor directed the same queries to Dr Raj Kumar Maharajah, current president of MPCAM, and he reported that most clinics, including his, has seen drops of about 70 to 80 percent in patient visits.

Even under such conditions, Raj said: “As doctors, we are trying our best to continue to serve. My clinic is running daily as usual, but staff are using protective masks and sanitizers. We have cut down our clinic hours as nights can be really quiet and dangerous, as well.”

Raj said it was worth noting that while the entire nation is focused on COVID-19 patients, other non-COVID-19 cases still need their follow-up and medications. Due to police roadblocks and the fear of being exposed to SARS-CoV-2, clients have resorted to technology to bypass these restrictions. They are now using Facetime and Skype to consult with him, said Raj. Hence, his members are looking into the option of telemedicine in this trying period.

With regard to cost cutting, Raj said that most clinics will have to cut down their overheads, which include staffing, among others, as they will not be able to sustain otherwise. Raj is privy to the problems faced by his members as they actively report their situation in a closed social media group. 

On the current stimulus package, Raj felt it would not help GPs much and a separate package would be needed to help GPs recover from this downturn.

MMA president, Dr Ganabaskaran Nadason said he received reports of GP clinics facing between 60 and 80 percent drop in patient visits. The worst affected are those clinics situated in or near office buildings. Even among patients that go to the clinic, most are those with chronic illnesses who drop by to pick up their scheduled medicines. The situation worsened with the stricter enforcement under the second phase of the MCO.

Expanding on Soo’s statement regarding MMA’s suggestion to the government, Ganabaskaran revealed that among the proposed items to the ministry were—a subsidy of 50 percent for 3 months of the clinic’s staff salaries; a fixed sum grant to all GP clinics for 3 months (for those who were open during the MCO), tax breaks for GP clinics for 6 months; facilitation of supply of face masks, gloves and PPE to the clinics; and a subsidy of 50 percent of the cost incurred for disposables used in screening for COVID-19.

With regard to encountering suspected or possible COVID-19 patients, Ganabaskaran said his members do sometimes see such patients and they follow the guidelines set by the MOH. Even so, MMA members do receive calls by the District Health Office (PKD) after patients who have consulted doctors for other illnesses are later confirmed to be COVID-19 positive. This situation still arises even though it has been clearly communicated that government hospitals will manage all COVID-19 patients and those who are suspected to have COVID-19 ie, Patient Under Investigation (PUI). Some GP clinics have taken preventive steps to face possible COVID-19 patients. These include infrastructure modification and using adequate PPE. Patients are screened at the entrance or before registration. If the patient fulfills the criteria as PUI, they will be referred to an MOH hospital immediately.

In light of the tough times coming, Ganabaskaran said GPs will probably need to enhance their services and look into niche areas of practice. He added: “They will also need to be more innovative and creative in providing care for their regular patients through various communication modalities. In worse case scenarios, GPs might have to form groups as a one-person army won't improve their practice.”

Note: After the additional SME stimulus package was announced on 6 April, Dr Ganabaskaran gave further feedback to MIMS Doctor. On whether GPs will be sufficiently covered by the new package, he said: “There are some benefits for GPs under the SME stimulus package announced. The government should also consider buying services from the GP clinics at a pre-negotiated rate as this will decant the public sector [into the GP setting].”