The New Normal in the Post-COVID-19 World

April 27, 2020
Eric Postal, MD

The future face of radiology remains to be seen as many questions about the virus’s impact on practice are, as yet, unanswered.

One can barely read or tune into the news without encountering a reference to “the new normal.” I think the phrase started getting overused even before society fully accepted that the COVID mess was going to be a real thing.

This is hardly surprising; making predictions about what’s to come is human nature. Whether to appear wise or simply as an entertaining activity, akin to betting on an upcoming sports event.

Sometimes there’s a more pragmatic intent-whether to alter the outcome of what one is predicting or to influence others who stand to be impacted by it. For instance, convincing a bunch of stockholders that buying or selling is in their best interest...at which point their mass-action results in your financial gain. (Insert cynical reference to Congress here.)

When the matter at hand is as massive as this, with so many unknowable variables, it’s little more than guessing. Even if you happen to know all of the relevant details in your particular bailiwick, any number of outside influences stand ready to intrude and muck up your contingencies.

That doesn’t stop people from trying, of course, and it’s just as well. Thinking through all of the ways that things might ultimately settle should make you readier to hit the ground running once the new normal stands revealed. Or, at least to land somewhat gracefully-more like a cat, let’s say, than a water-balloon.

I, thus, find it a more useful exercise to think in terms of questions whose answers will be revealed in the coming months (or years), than to try to divine the answers themselves.

For instance, a “view from 10,000 feet” question: When might we start to see a “new normal?” As the viral curve flattens and declines, this spring or summer, and economies reopen? Or, will the reverberations of the past weeks continue to be a major disruption, like water sloshing around a pool after someone cannonballs in? Will there be a second wave of infections next autumn or winter? Annually?

Will “social distancing” be able to go away, or even relax? Say, during summertime if that turns out to be the annual lull? Or, will periodic nationwide shutdowns loom as a long-term necessary evil that cannot be predicted?

How will the businesses that make society function be able to survive if there are periods, predictable or otherwise, during which transactions will be drastically cut back, if allowed at all?

If there are to be intervals-predictable or otherwise-of forced reduction in volume, such as in radiology, can what we have considered “normal” fee-for-service models continue to be utilized? Whether a medical group bills directly for its services or provides coverage for a billing-entity, such as a hospital, if the revenue stream is based on each procedure or encounter, damming that off parches everyone who had been watered by that stream. Will it make more sense to negotiate coverage based on time-interval rather than volume-of-services rendered? Or, some sort of hybrid between the two?

And, will this percolate through to negotiations between groups and their members? How can a group know what its manpower needs will be in order to guide recruitment? Might it become a thing to hire newbies on a month-by-month basis, with a more permanent tenure that lasts through dry-spells being the new benchmark of partnership?

Might groups, in a search for survival, become less localized and reach out to provide remote coverage? We are already seeing that some states are more virus-impacted and shut down than others, with differing dates for “reopening.” A group that only has contracts, say, in the New York City area has all its eggs in one basket-but, one providing tele-coverage in Florida, Texas, North Dakota, and Pennsylvania, has better chance of being “open” at any given time. Or, maybe groups in differing locations might find it worthwhile to make alliances: When Group A’s facilities are shut down, its radiologists are allowed to provide some coverage for Group B (and vice versa), such that A and B both have a better chance of surviving famine.

Will it become more commonplace for groups and/or the facilities that contract with them to require their radiologists to be ready for deployment to non-radiological posts? I wrote about how this is already happening in some NYC-area hospitals recently. Forget about your fancy MSK fellowship-the new hot commodity in radiology might be dual-boarded docs, ready to practice IM or surgery as needed. Or, simply younger radiologists, more freshly-graduated from residency and readier to refresh and utilize their clinical skillset.

Might this result in a wave of older radiologists retiring (voluntarily, or pushed out the door by their colleagues), since there’s less work to go around, and they’re being indefinitely furloughed anyway? When things settle down, will there, then, be a sudden availability of higher-up-the-ladder positions for younger docs to move into?

How many rad groups will go under because they could not weather this storm (or were going to end anyway, and used the COVID mess as a handy excuse to, say, declare bankruptcy)? Will there suddenly be a dire shortage of radiologists to do the work of a returned-to-normal healthcare world? An opportunity for enterprising docs to start up their own groups? Or, will the big fish get even bigger by gulping down more and more contracts, such that individual radiologists have increasingly fewer options for employment?

The answer to these and any number of other questions, of course, is “We’ll find out.” How gracefully, or painfully, remains to be seen.