For independent physicians, obtaining PPE is an ongoing struggle

Maintaining personal protection equipment for patients and staff has become a full-time job for independent health care providers who have not received the help from the state that their counterparts in health care systems have.

Facing a potential second wave to the COVID-19 pandemic, Jackson Siegelbaum Gastroenterology in East Pennsboro Township, Cumberland County, created a four-person team to monitor the stock of PPE at its offices and laboratory.

Through the inventory management team, the gastroenterology clinic maintains its supply of PPE and calculates a burn rate that tells management how long the facilities will be able to operate if supply chains fail.

Since the beginning of the pandemic, Gov. Tom Wolf’s office and the state Department of Health distributed over 5.2 million N95 masks, 621,000 gowns, 4,782,000 gloves and more to hospitals, long-term care facilities, first responders and other providers in need of PPE. But the state has yet to provide the same equipment to independent physicians, instead encouraging them to seek PPE through their own vendors, health care coalitions or the state’s COVID-19 PPE and supplies business to business portals.

However, PPE continues to be difficult to obtain for providers, 20% of whom have only a one week supply in stock, according to a survey of 983 physicians conducted in late April by the Pennsylvania Medical Society (PAMED).

Since the April survey, the stream of PPE to providers has continued to be slow moving.

“Hospitals got what they needed but for practices to open up and keep patients out of the hospitals, we need more PPE,” said Dr. David Talenti, vice president at PAMED and a gastroenterologist at Wayne County-based Northern Gastroenterology Associates.

To ensure that its members have the PPE they need to stay open safely, PAMED purchases provisions through Action PPE, a collaborative bulk PPE supplier launched by the Charleston County Medical Society in South Carolina. The collaborative allows PAMED to increase its buying power and access more PPE than a single office. But, even with the increased buying power, some equipment is still hard to find.

“There are some things that we are scraping by with,” he said. “We have K95 respirator masks that expose our providers to a higher risk of infection. The N95’s were stockpiled by larger systems and the K95 respirator doesn’t seal properly.”

Jackson Siegelbaum Gastroenterology is using PAMED’s access to Action PPE in concert with its own management team and has been able to stock more than a month of PPE.

“When you are a smaller practice, you are really reliant on your own internal resources and relationships with vendors to get the necessary equipment,” said Dr. Wilson Jackson, a partner at Jackson Siegelbaum. “The society helped us get access but we’ve also worked really hard to get access to what we needed.”

Talenti’s office has also been stuck by the lack of provisions. He noted that the facility has one staff member on the phone contacting between 20 to 25 suppliers daily just to ensure that the clinic continues to have a supply.

If there is a large second wave of the virus and the state elects to pause elective surgeries as it did earlier in the pandemic, gastroenterology clinics such as Jackson Siegelbaum and Northern Gastroenterology would close, he said. Jackson said a more pressing concern will be if the pandemic continues to smolder and the practice needs to continue to stock PPE in the way it is now.

In late April, PAMED sent a letter to the Governor asking the state to make a percentage of the PPE stockpile available to independent providers. In the letter, Dr. Lawrence John, the society’s president, said that the lack of PPE in private practices could result in a closure of practices and an increased stress on local hospitals.

“These private practitioners are keeping patients away from emergency departments so that health systems can effectively treat COVID-19 patients, yet they cannot obtain PPEs,” John wrote. “Daily we are hearing of practices closing or indicating that they are within days of ceasing life sustaining care and treatments. Without help from private practitioners, patients will have no choice but to go to hospitals for care.”

Neither the DOH or Governor Wolf’s office have responded to the letter.