The coronavirus outbreak is ravaging North Carolina’s health care system — threatening to shutter medical practices and worsen shortages of care during the coronavirus surge.

Across North Carolina, health care workers and practices are taking an economic beating. With elective procedures canceled and patients wary, revenue streams are dry. Overhead expenses remain, forcing many to furlough or lay off staff. Evaporated federal funds and rumors of prolonged lockdowns stoke growing fear that medical practices won’t survive the pandemic. 

The outbreak forced Dr. Rachael Wruble to lay off all but two of her employees. Like many businesses, she hopes to rehire them all if her optometric practice gets a loan from Congress’ coronavirus relief package. But the loan program she is depending on ran out of money after hitting its $350 billion limit Thursday, April 16. 

“Most offices have had to lay off or furlough their staff,” said Wruble, president of the N.C. Optometric Society. “There’s no paycheck, your staff don’t have paychecks.”

She doesn’t know whether she qualified for the loan before the federal funding ran out. 

“Unless they approve more money, there will be a lot of people who won’t get it,” Wruble said. “Ours is pending approval, so we just don’t know what it means for us.” 

As the outbreak continues, nurse anesthetists are losing hours, taking unpaid leaves of absence, and being furloughed for months in the Triangle area, said Linda Stone, president of the N.C. Association of Nurse Anesthetists.

Nurse anesthetist Kimberly Gordon’s weekly hours were cut in half in mid-March. She doesn’t know if she’ll keep any given shift at the hospital until the day before.

“It’s a lot of uncertainty. And I’m fortunate,” Gordon said. “I have a savings account, I don’t have children. It’s just me I have to worry about. But for a lot of nurses that have families, it’s been a shock to go from 100 miles an hour to zero.”

She’s not alone. A tenth of 354 nurses identified job security as a major concern back in late March, according to a survey by the N.C. Nurses Association. As hospitals emptied beds for the surge, cuts to support staff followed, Gordon said.

Many ambulatory surgery centers are closed across the state. Surgery volumes have plunged to 30% of their pre-virus level, said Peter Lohrengel, N.C. Ambulatory Surgical Center Association executive director.

“The cancellation of all but urgent elective surgeries has hit ambulatory surgery centers very hard,” Lohrengel said. “Many facilities have closed entirely and furloughed their staff for the duration of the emergency.”

Independent and specialist physician practices are suffering a similar drought. Tryon Medical Partners cut a fourth of its staff of some 300 medical professionals, as it made a “model-shift” to telemedicine in response to government requirements.

Revenue at Dr. Mark Scheiderich’s dental practice plunged from $85,000 a month to $4,000. His overhead consumes 60% of that revenue — a low percentage for a dentist. For dentists with student debt or business loans, that percentage can soar past 80%, says Scheiderich.

“This is a thousand times scarier than 2008,” Scheiderich said. “In 2008, even though your revenues were down, you still had cash flow. … There’s only so many months you can go with zero income before you’re underwater.”

His emergency savings are running out. If the lockdown continues much longer, he will have to fire workers to afford the supplies to restart his practice.

“Today was the first day where I sat down, thinking that if this goes further than May, I will start having to lay off employees, even with the payroll protection fund,” Scheiderich said. “Thank God I don’t have loans for my practice still outstanding or student loans.”

Chiropractic practices were exempted from the shutdowns. But that hasn’t saved their industry, said Heather Wrenn, N.C. Chiropractic Association executive director.

“Just like any small business out there, less people walking in your door means less money,” Wrenn said. “It’s just the uncertainty. It really puts a toll on business owners and all of us. When are we going to be able to get back to work, rehire our staff, see our patients. … Everyone knows that the unemployment offices are completely overwhelmed.”

Chiropractor Glenn Jaffe was forced to furlough a member of his staff weeks ago, and he’s cut his own hours nearly in half.

“Right away we noticed the drop in patients. I plan to bring her back once we get out of this mess,” Jaffe said. “But I have to make sure I can still serve my patients, and that meant I had to furlough her.”

Providers hoped to rely on federal relief to weather the pandemic and social distancing. But that money ran out after just 13 days, leaving medical practices without any recourse. Many providers were already worried about the regulatory requirements for loan forgiveness.  

“Now it depends on Congress and their political battle,” said Jordan Roberts, John Locke Foundation health care policy analyst. “I imagine we’ll see some providers close down because they don’t have the revenue, and they’re not getting as much help as they need from the federal government.”

The financial devastation could worsen the shortage of health care workers during the surge of coronavirus patients, Roberts said.

“It’s quite a conundrum,” Roberts said. “Our health care workers are going to be some of the most important people to keep in the workforce to treat COVID patients. But if providers can’t get money to stay open, it’s a double whammy.”

Gordon hopes to eventually see a backlog of elective procedures that will help providers make up for the losses. But she fears the emergence of a second wave in Winston-Salem and the rest of North Carolina. 

“We didn’t get the rush we were expecting to get. That scares me more than anything,” Gordon said. “We’ve done all this social distancing, but that doesn’t mean it’s gone. … Nobody has immunity to this, so everybody is going to get it in some form or fashion unless we get some treatment or vaccine.”