Dispatches from the vascular front: Consequences of COVID-19 on a Florida private practice

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Vasana Cheanvechai

The impacts of the COVID-19 pandemic have landed like a sledgehammer on vascular surgery, reducing much of practice to a standstill. For those in private practice, the effects have perhaps been even more profound, with practitioners forced to all-but pull down the shutters, reduce staff hours and even let employees go: In many cases, the economic consequences have been devastating.

No one needs to tell that to Fort Lauderdale, Florida, vascular surgeon Vasana Cheanvechai, MD. For the solo practitioner of Lauderdale Vascular and her team, the knock-on effects have been manifold—the timeline brisk.

Based on her strict understanding of the guidelines, Cheanvechai brought her practice to a near close, with the financial implications seeing all but one member of a six-strong staff—an ultrasound tech—let go.

“We had our first positive COVID case reported March 9—at that point there were three people who tested positive in our county,” Cheanvechai—19 years into her practice—explains of the situation as it started to unfold locally in Broward County, which neighbors Miami-Dade County, another of the hardest-hit areas in the United States. “Then by the next week, I had cut down my practice to less than half because, with a vascular population, they tend to be over 60—and we wanted to keep those vulnerable patients over 60 at home. By the 16th, my practice pretty much shut down completely.”

The flow of directives from government authorities accompanied the quickly developing situation felt on the ground at Lauderdale Vascular.

“Starting March 16, it was first suggested that elective procedures be postponed—then Florida’s governor made an executive order March 23 that all non-emergent, or non-life threatening or limb-threatening cases, should be postponed until May 8,” Cheanvechai continues. “This forced a lot of practices to close down or significantly reduce volumes.

“My colleagues who are in primary care are able to do more telemedicine effectively—so that’s helped those practices. I believe from the vascular standpoint, it’s more difficult just to do telemedicine. You cannot run a vascular lab through telemedicine and for us that was a significant part of the practice.”

COVID-19 wreaks havoc on economy

It quickly became apparent just how far-reaching the financial impacts were likely to be as Congress worked on legislation to aid the economic devastation. “It’s been difficult to navigate,” Cheanvechai says. “Around the 30th [of March] I heard about the SBA [Small Business Administration] economic injury disaster loan program [EIDL], which was $10,000 as a grant that would go towards payroll and other expenses.”

As that piece of the pie disseminated by the federal authorities wended its way out across the country, the sands continued to shift. Cheanvechai just received the EIDL grant cash over the weekend—though not at the level initially anticipated. “It now grants $1,000 per employee, which helps some,” she says. “Originally, it was supposed to be $10,000 per application, though now they have changed it to be based on number of employees. But anything helps at this point.”

Other forms of financial aid remain elusive, Cheanvechai notes. “By April 1 or 2, [the government] started talking about PPP, which is the Paycheck Protection Program—that also was to be a grant, and not have to be repaid if used to to keep staff on payroll. At this point, I was still keeping employees on. I was coming up with all sorts of different ways to minimize contact: have one staff member work one week at a time and at least try to get partial salaries to my staff somehow.”

Cheanvechai describes a chaotic process by which the PPP could be accessed. “We were told that on April 3 the PPP was going to open up. First thing that morning, I was online trying to get an application in. You had to apply through a bank: My business bank is Wells Fargo, and they are very limited in the amount of loans that they can give. They didn’t roll out on the 3rd. The only bank that did was Bank of America. Then Wells Fargo opened up on Sunday [the 5th] morning just to take names on a wait list. I got on that list but, by Sunday evening, it was closed. So if you didn’t know to go online and get on the wait list, if you were a Wells Fargo business banker, you were done, because most banks are not taking applications unless you already have a business account with them.”

From there, the pursuit of assistance continued as Cheanvechai threw a wide net.

“I was scrambling around trying to find a bank that would take me in case Wells Fargo wasn’t going to be able to provide the PPP,” she explains. “I found one lender in Michigan but I wasn’t sure because I hadn’t heard of the bank before. I found another, a small lender here in town, who originally said they would take me if I opened up an account with them, but then later they emailed me and said they could no longer take anyone who wasn’t a previous account holder. Then, by the Monday, I was able to find another lender where I have some personal accounts, and they said I could apply through them if I opened a business account.”

Alas, as of today’s writing, PPP remains out of the grasp of Lauderdale Vascular: “When my bank went to submit my application to the SBA, they had just run out of money,” says Cheanvechai. “The bank actually sent me an email on Thursday in the a.m. saying the application went to the SBA but by the afternoon they had sent another email saying it did not get in in time. Hopefully the government will approve the additional funding this week.”

In attempting to access the PPP, Cheanvechai was hoping to be able to re-hire her staff. As things stand, she says, they may be better off claiming unemployment. “It’s hard—it really is a hard thing to go through. Especially as, we as surgeons, we tend to think that there is nothing that we can’t do.”

Yet, the picture of the larger economy—and where aid ends up—continues to confound. “It’s disappointing to hear that some national restaurant chains were able to get their PPP applications in and receive a $20 million grant but those of us with true small businesses could not get funding.”

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