The city of Fresno gave the OK for all medical and dental practices to fully reopen this week. But many are not ready to do so.

“There’s a lot of different factors that make it really hard to start back up,” said Dr. Paul Hsiao, a Fresno dentist.

“It’s hard to go back to normal because the demand isn’t there. Our costs are a lot higher with our PPE (personal protective equipment requirements). The insurance still pays at a low rate,” Hsiao said.

“If (dentists) are not going to increase their fees or if they can’t run at 100 percent capacity, then it’s hard to make money. So in the end, it’s sometimes better just not open until things get back to normal.”

Restrictions Lifted This Week

Under the city’s shelter-in-place order of March 19, doctors were allowed to perform necessary services. But the order also said “non-essential or optional medical services like eye exams, teeth cleaning, and elective procedures shall be cancelled or rescheduled; if possible, health care visits should be done remotely.”

That “non-essential” clause was removed as of Monday night. Practices can now resume full operation, as long as the adhere to state and county COVID-19 guidelines.

As of Thursday, the California Dental Association says they are awaiting guidelines from the state Dept. of Public Health before fulling resuming non-emergency services. The state has not given its OK, with guidance from April 7 still in effect.

But Hsiao says that doesn’t mean patients will come back. Or the finances needed to run his three dental offices, two in Fresno and one in Caruthers, justify reopening.

Lack of Patients Led to Staff Reductions

Since the shelter-in-place orders from the city and state were imposed, Hsiao said he’s only seen patients with dental emergencies.

“We don’t want to saturate the emergency room,” Hsiao said.

But, the lack of patients for more routine services means he’s had to layoff two-thirds of his staff — including is wife — fellow dentist Dr. Daphne Lin. His remaining employees are working part-time.

Emergency Loans Don’t Change Economics

Hsiao serves as the incoming president for the Fresno Madera Dental Society and is the Chief Dental Advisor for Fresno County.

He’s heard similar concerns from from other members of the society, approximately 500 strong.

“The only way is to dip into your savings,” Hsiao said of surviving. “The owner is usually the last person to get paid.”

Some dental offices are getting federal stimulus loans through the Paycheck Protection Program, he said, but that doesn’t change the economics.

“They can’t hire back everyone, because business isn’t as usual. There’s not enough patients. You can’t really spend the money,” Hsiao said with a sigh.

PPE Shortage Impacting Doctors’ Offices

Nicole Butler, executive director of the Fresno Madera Medical Society, said her members also want to reopen, but are adjusting to new COVID-19 realities.

“Doctors don’t have the proper PPE to return to patient care. We are working on getting these items, but the shortage is just getting worse,” Butler said.

Butler says her office provided guidelines for practices to follow when they reopen, similar to the dental groups.

That includes prescreening patients over the phone, implementing physical distancing, and adjusting scheduling to reduce the number of people in waiting rooms or lobbies.

Telemedicine Encouraged, but Not Always an Option

The guidelines also encourage greater use of telemedicine options. But, Butler says technology isn’t always a viable solution because some doctors and elderly patients don’t have the means to adapt.

Pediatricians also struggle with ‘virtual” office visits.

“It’s very hard to have a conversation (using video conferencing) with a one-year old on how they’re feeling,”  Butler said. “Mom and dad can’t provide an exam to a baby or a toddler.”

Butler says it will vary to what degree doctors reopen their exam rooms. But, seeing patients in person provides a relief to both parties.

“I think there is mental health aspect of those patients feeling that they need to get out and see their doctor. I think that’s going to help. I think it’s going to help on both ends. It’s going to help physicians really understand their patients need them, and then also for the patients to get back seeing their physician,” Butler said.

Business Takes a Hit

Many of her members cut back hours during the COVID-19 crisis.

“(Approximately) 70 percent of doctors offices lost business. That’s a huge hit. They have staff. They have themselves. No (elective) surgery,” Butler said.

A California Medical Association survey showed that nearly every practice experienced a drop in patient volume; 58% lost revenue and 41% of offices experienced layoffs or furloughs.