The practice of neurology has changed dramatically in the wake of the novel coronavirus pandemic. That’s been seen most dramatically in the virtual shift to meeting with patients via Doxy.me, Zoom or even FaceTime.
How these changes are playing out in the day-to-day care of patients varies widely between practices and practitioners. Some are adapting better than others. We spoke to Dr. Laurence Kinsella, a neurologist in St. Louis, about his experience practicing neurology right now – both on the ground and in the cloud.
NI: What was your initial response, as a physician, to the COVID-19 pandemic?
Kinsella: I’m 60 years old, and I fall into a high-risk group, and that weighed on me a bit, I have to say. It’s been quite a process, hasn’t it? There was initial fear and even terror and a real calling up of physicians to ask themselves — certainly I was asking myself — why did I go into this job?
This is it; this is the reason, so I am going to step up and see these patients and, if need be, I’m going to volunteer for the surge force. I had internal medicine training before I did neurology, so I could potentially work in the ER or ICU. I was ready to do all those things, but thankfully the surge has passed.
NI: How has COVID-19 impacted your practice these last few months?
Kinsella: Within our healthcare system (that’s SSM Health) we were one of the first departments to uniformly adopt telemedicine for outpatient visits. And because of that we’ve been able to maintain about 80 percent of our pre-COVID productivity.
We have one in-office day for procedures like botox injections for patients with chronic migraine—that really can’t wait. The other four days a week I am based at home or in my office in front of a computer. We’re trying to reduce exposure and conserve PPE.
NI: How have the new regulations surrounding telemedicine affected your practice?
Kinsella: It’s allowed us to put the accelerator down on the use of telemedicine. [The Centers for Medicare & Medicaid Services] did a wonderful thing by removing the regulations. That has allowed me as a physician with one state license to serve anyone in the country. It has also allowed us to bill any inpatient or outpatient code as a telemedicine visit.
We were already dealing with a scarce resource: the general neurologist. This has dramatically changed the landscape of our shortage. It has allowed us to leverage our scarcity to be able to expand our reach to those who traditionally have not been able to receive this level of care.
NI: How have your patients responded to telemedicine?
Kinsella: I think patients have really liked having the convenience. I saw a young girl today, and she was still in her pajamas and still delighted to be able to be seen and not have to trek two and a half hours into the office.
In June we are hoping to ramp up our practice to pre-COVID levels, but I am telling my staff (particularly for follow ups and certain new patients as well) that we are going to offer them telemedicine. My hope is to be about 60 percent in-office and 40 percent telemedicine.
The curve is flattening here in St. Louis. People are giving a tentative sigh of relief but knowing that we’ve entered a new normal.
NI: How are you adjusting to this new normal?
Kinsella: I am generally done earlier in the day. I’m not running and gunning all the time, and it’s actually been better. My mental health is better and I’m more relaxed. It’s probably going to hurt my pocketbook but I’m at a point in my career where I am willing to make that exchange.
Special thanks to Laurence Kinsella, MD, neurologist at SSM Health Neuroscience Institute, St. Louis, Missouri, board certified in internal medicine, neurology, neuromuscular medicine, electromyography and autonomic disorders.