"We do everything a little different now," Jennifer Perry, Norwood Clinic administrator, says. When Alabama shut down in March to slow the spread of COVID-19, the multi-specialty, 20-physician practice had to stop elective surgeries, ophthalmology visits, and even mammograms. Once the state reopened in May, they had to adapt to new restrictions. They began by sending daily email updates to physicians and staff.

"We did this because so much was happening then," Perry says. "We kept the staff informed about what was going on, new guidelines, and how we were addressing things. I believe that the more knowledge they had about it, the more at ease they're going to feel."

"The challenging part for us was retraining the staff," says practice manager Robin Smith at Eastern Surgical Associates, which operates five locations. "It changed the way they were accustomed to doing their job because now patients had to test negative to COVID-19 prior to surgery."

That means patients must come to the clinic for testing days before their surgery in time to get the COVID-19 results. "I had a patient who didn't want to come in and do her pre-admission testing today," Smith says. "That would cause her to have to cancel her surgery on Monday. In the past, that would not have been an issue, because we could do the testing the morning of."

At Andrews Sports Medicine & Orthopaedic Center, the changes for social distancing meant banning visitors in the waiting room at all four locations, unless mental or ambulatory issues require it. The practice notifies patients three times about the new policies before each appointment, including a call two days beforehand.

"I have nine doctors. If everyone brought even one visitor, can you imagine how full my waiting room would be?" says CEO Lisa Warren. "Of all of the changes required by COVID policies, the limitation on visitors is probably the most difficult and unpopular policy. We tell them they can still be involved in the care. All visitors are encouraged to connect with the patient and doctor via Facetime while in the exam room. A lot of time, that makes them feel better."

Despite the multiple warnings, just that week, a patient arrived with her husband, father-in-law and a four-year-old. "That's not infrequent," Warren says. "They didn't take it well. But that would have been four exposures for one patient for my staff and other patients, when it only really needed to be one."

Once in the clinic, Andrews Sports Medicine shifted their flow of patients to mitigate contact. Instead of moving from the waiting room to the x-ray area, and waiting there for an exam room, patients wait in the exam room before x-rays. "We changed our flow to avoid patients congregating in that area," Warren says.

Norwood Clinic doesn't use the waiting room anymore. "When a patient gets to the office, they call us and wait in their car until a room is ready," Perry says. "Then they go straight into the exam room."

Some of the re-opening changes meant some new duties for staff. "Nobody in administration was used to running around Dollar General buying toilet paper, wipes, Lysol and hand sanitizer," Perry says.

The lack of supplies, including masks, remains a stressful dilemma even now, as does the ongoing explanations of changes to patients. "It is wearing on staff to enforce and educate on the rules. It has been tough," Warren says. "Staff is having to tell people calling for appointments 'no' because we only have so many office visits available today so they're going to have to wait, when our typical answer before was 'sure, come in.'"

Despite the constant change in requirements, staff at clinics have kept a good attitude. "I was impressed with the way our doctors and staff approached this with the attitude of 'okay, let's just get it done,'" Warren says. "Because they're as frustrated as I am with the rules constantly changing."

And clinics are regaining their financial footing as well. "It took us a month or more after the reopening to get our numbers back to normal," Smith says. "During the shut-down, when elective surgeries were banned, the phone hardly rang. But we're pretty much back to capacity now."

"We are blowing and going," Perry says. "We saw 73 patients in our after-hours the night before last. We tested about 50 COVID patients last night. We're good."

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