From the desk of the EMD: Coronavirus and the future of allergy practice

April 27, 2020

As I stay sheltered in place, I have had plenty of time to think about the “new normal.” In my last Insider column, I mentioned two things that I thought the COVID-19 pandemic would change in allergy practice. One was the use of telemedicine on a regular basis. I have heard that it has worked for many allergists during these unprecedented times, though some patients prefer the “old time,” in-person visit. If payment for telemedicine visits stays on par with office visits, I do think it will continue to be used by allergists after the pandemic. With the ability to have inexpensive home spirometers, patients with asthma can be followed as well at home as in the office. Do you really need to see the allergic rhinitis patient on immunotherapy back in the office for a checkup? If you have a large uptick of food allergy business due to peanut oral immunotherapy (OIT), telemedicine can help free up much needed examination rooms for performing up-dosing and observation. It may also be beneficial by making the waiting room less busy and allowing easier social distancing for your in-office patients. Telemedicine was coming to allergy; the coronavirus simply sped up its adoption.

The second prediction was the consolidation of allergy practices. Will the different government bailout loans be enough to keep practices from drowning? Many have very high overhead even in good times. Now, with the volume of patients way down and the loss of spring 2020 income, the added strain may be too much for the small practice, and for that matter, some of the larger ones. How long will it take in the post-coronavirus world to get patient volume back to previous levels? Clearly, we will be in a recession; how long and severe it will be is not known. Many of our patients or parents of patients may not get their jobs back and consequently will lose their health insurance. I don’t want to sound all doom and gloom, but I believe that, for many allergists, either merger or buyout by other practices, hospital entities, or private equity groups may be the answer for survival.

I have a third prediction – allergy practices that do survive will become leaner – meaning less staff, cutting back expenses and closing satellites in order to reduce overhead. All practices will stock up on PPE so they won’t get caught flat-footed if another crisis hits. There may be less of the “bread and butter” allergic rhinitis patients beginning subcutaneous immunotherapy. We will have to look at other revenue streams. Will peanut OIT increase incomes? Will increased use of biologics in allergic disorders bring more patients and generate needed revenue? Are there any services for which you can charge cash instead of seeking payment through insurance providers? Are there side gigs that can add to your bottom line?

By now you are saying, “Does he have any good predictions for practicing allergy?” Yes, I do. Here comes my fourth prediction. The allergists who stay in practice, learn to control overhead and use telemedicine effectively, will prosper and thrive. The number of allergy patients will continue to grow, but the number of allergists will not. This pandemic will probably push many older allergists to decrease workload or just completely retire, and the reduction won’t be completely made up by new allergists from fellowships. Therefore, the allergists out in the community will have increased patient loads which may make up for some, if not all, of the decrease in income. In some communities, we may see “concierge” allergists who only accept cash payments. There are allergy services that nonallergists have no desire to perform which will increase our need. We will survive the “new normal.”

The one constant is change and this pandemic will make change occur faster than before. But the practicing allergist will adapt as we have done in the past. I’ll bet we will come out stronger, and the College will be with you every step of the way.

Michael Blaiss, MD, FACAAI, Executive Medical Director