What are the greatest challenges for you in the practice of allergy in 2022? Here are the two that I think are the biggest.
Challenge 1 – Disruption in the “standard” practice of allergy
What do I mean by “standard” practice of allergy? It is your typical office-based situation where you care for patients from 9:00 am to 5:00 pm Monday through Friday with some night hours and maybe a Saturday morning. Disruption to this type of practice is happening now and will continue to grow. You have probably seen the large telemedicine companies that offer allergy services. More and more telemedicine allergy practices are opening in the U.S. Right now, they are taking the low-hanging fruit: allergic rhinitis. Valid IgE allergy blood tests can be done in the home and mailed to the lab, with allergen immunotherapy sent back to the patient in sublingual drop or tablet form. You may be saying, “What about other conditions like asthma? Don’t they have to be seen in the office?” With the advent of inexpensive home spirometry, home eNO in the near future, and digital inhalers to track treatment and others, many asthma patients can be cared for remotely. It could definitely be done for atopic dermatitis and chronic spontaneous urticaria, too. Let’s face it, a great many of the things we do daily in the office could be done without visiting our offices. Also, these types of “practices” are not restricted to 8:00 am to 5:00 pm, five days a week. They can easily be “open” any day of the week, at any time. Patients want convenience and these services can provide it.
We all are aware of the remote practice of allergy by other specialists and some generalists. The next disruption is the nurse practitioner (NP) “allergist.” I think NPs offer a great service for our patients when working with us in the standard practice of allergy. In 23 states and the District of Columbia, NPs can have “full practice” status, which allows them to assess, diagnose, interpret diagnostic tests, and prescribe medications independently. This may lead to NPs setting up their own allergy practices. You may see venture capitalists, health care systems, and others hire NPs to practice allergy with no allergist input.
Challenge 2- The Costs of Running an Allergy Practice
Last year saw a dramatic increase in inflation. It was up 6.8%, the highest level in more than three decades. No doubt you are paying more for supplies, insurance, rent, salaries for nurses and other staff than in the past. In fact, many practices are having major problems just recruiting nurses and keeping them from leaving. Unfortunately, your fees are not going to rise enough to make up for these increased costs. Unlike all other businesses, you cannot pass on your higher costs to the consumer, i.e., the patient. It is highly unlikely that you will see any commercial insurance increase your rates to make up for inflation. It is estimated that you will see a 0.8% overall decrease in Medicare payments for 2022, compared to 2021. You may try to start or increase cash services like food OIT and sublingual immunotherapy, but will that be enough? This may further escalate the trend of selling your practice and becoming an employee.
What about the allergist who is already employed? It is likely that salary increases and bonuses will not rise by much, if at all, in 2022. There may be the push by the “bean counters” for you to see more and more patients and do more and more immunotherapy to keep the practice’s profitability.
Of course, there will be other challenges to confront in 2022. Hopefully Omicron is the last major variant in the COVID pandemic and we will transition to the COVID endemic. Burnout will continue to infect more and more allergists and lead them to leave practice for other opportunities or retirement.
Every year has its challenges. The College is here to help you with these and any others. Our mission is to promote excellence in the practice of the subspecialty of allergy and immunology. Our president, Mark Corbett, will be putting out an initiative in promoting what we do to reach other physicians and the public later this year. Stay tuned.
Do I have it right? Are there other challenges for the allergists in 2022 that I missed? If so, please email me at firstname.lastname@example.org. I can address them in a future column.
By the way, watch your email for the College Membership Survey. Here is your chance to provide input regarding other challenges you are facing and areas the College can help with.