Do clinicians have the appetite for market research in the age of the coronavirus?

The coronavirus pandemic is here, and 24-7 news coverage reports on the huge impact it’s having on health care providers. As market researchers we wanted to speak to physicians directly to understand the personal impact it is having on them. We also wanted to understand their views about the implications the pandemic will have on patient care, clinical trials and healthcare market research during this unprecedented time. We spoke to physicians in the US and UK working in areas that have had some of the highest numbers of COVID-19 to-date. Because of our place in healthcare, we’ve found it useful to understand physician’s thoughts, feelings and concerns, and we’ve highlighted some of these below. We hope you find these insights useful too.

How is the coronavirus pandemic impacting physicians’ day-to-day roles?

The level of impact varies greatly by specialty and in the US by practice setting (i.e. office vs. hospital), but all physicians have been impacted in some shape or form. At one end of the spectrum, we spoke with an endocrinologist in the US who closed her private practice and is now fielding patient phone calls (without reimbursement since the practice is not set up for telehealth), to a HEM-ONC who is still seeing patients but with a skeleton crew (meaning only her). In the UK, we heard from an oncologist who is shutting down two out of three oncology wards and is moving to a mixed ward consisting of oncology, care of the elderly, diabetes and endocrinology. The oncologist also told us that some of his oncology colleagues will be moving across to NHS Nightingale at London’s Excel Centre, to support the temporary hospital set up for COVID-19 cases. Physicians in both markets are doing what they can to minimise their oncology patients’ potential exposure to the virus as well as their own exposure, to preserve their health for a potentially all-hands-on-deck approach as the surge in COVID-19 cases approaches. In the US, some practices have laid off their administrative support staff, which has caused a lot of sadness and stress for providers.

Physicians who are in the midst of COVID-19 surges noted a few key changes:

(1) Days are longer than usual to cover for an influx in patients, and to cover for colleagues who have become sick;

(2) In the US, hospital-based PCPs are now working more hours within the Emergency Room as hospitalists, pulmonologists and infectious disease specialists have shifted to primarily testing and identifying COVID-19 cases.

(3) In the UK, PCPs are turning away all non-essential patients from the GP practice and fear a significant backlog of patients and buildup of undiagnosed conditions.

(4) Finally, across both markets some physicians are experiencing a new fear that they haven’t felt before: getting the disease they are treating patients for themselves, spreading the virus onto loved ones or seeing colleagues become sick.

Some specific comments from physicians:

“Preparing to care for very ill COVID-19 patients, it’s a bit of a draft. My transplant patients can be very ill, but I can’t bring their illness home to my family.”
– Academic Hem-Onc, Philadelphia, US

“We have stopped all procedures and only see patients with heart attacks or at risk of cardiac death. Therefore, half of the patients I’ve see today are COVID-19 patients. It isn’t my field but I’m trying to learn from my colleagues how to diagnose and treat these patients.”
– Cardiologist, Sheffield, UK

What does this mean for patient care and clinical trials?

Patient well-being is still the focus of HCPs, however they are having to change their approach to care. Oncology practices are still seeing patients who are undergoing active treatment (chemo suites are still up and running), but routine monitoring such as blood counts and regular follow up appointments have been paused or converted to telehealth. In the UK, oncology is taking this a little further where oncologists are making very hard decisions and will only treat patients where there is curative intent; the vast majority are otherwise having treatment delayed or even stopped. Physicians hope this will only be for 4-6 weeks but in oncology this is a long time, and even then, they do not know if there will be a ‘return-to-normal’ after 4-6 weeks. Doctors feel this is going to have a knock-on effect of a huge backlog of surgeries and treatments and it will impact the presentation and diagnosis of new cancers – essentially the whole pathway is being upturned. One hematology-oncologist in the US told us about a patient of hers who developed frozen shoulder and needed a steroid injection but can’t get it at this time so must manage the pain. Surgeons are paring down their practices, postponing elective procedures to limit exposure as well as to free up space with some operating theaters being turned into wards for COVID-19 patients. In a similar vein, ONCs are weighing the risk of potential coronavirus exposure with delayed monitoring. What the long-term effects of this will be is very much unknown, also the effect on patient volume, once it is safe to resume to ‘normal life’. Some ONCs are already halting clinical trial participation, others are continuing to participate but only for patients already enrolled or where there is no other possible treatment for the patient.

Some specific comments from physicians:

“I’m telling a lot of my patients to stay home…it’s not worth the risk.” 
– Academic Hem-ONC, Philadelphia, US

“Science should move in parallel, not sequentially.”
– Cardiologist, New York, US

“You can only change the normal structure for so long: we will have a backlog of issues which will need to be dealt with eventually.”
– GP, London, UK

“Yesterday I talked to a patient who had disease progression and he’s interested in being treated, I’ve known him for a while…I have to judge over the phone whether he’s a candidate for treatment or not.  Then his wife called and asked if he was going to die…these are conversations I would have liked to have in person, not over the phone.”
– Oncologist, Philadelphia, US

Is it ethical to continue market research during this time?

Doctors said yes, but that it’s important to be transparent about the topic as some HCPs may not be interested in less personally relevant topics. (HCPs were very interested in taking part in this interview though, given the topic was coronavirus). HCPs agree that normal life needs to continue, as does new drug development, and they feel market research provides them with an opportunity to contribute to this cause. Some HCPs — private practice or office-based practitioners in the US especially – have more time on their hands now that they are not seeing patients, and view market research as a welcome distraction. Some also view it as an important source of education and income, which is especially valuable during challenging times. They said that recruitment will need to be flexible based on practice setting (i.e. academics or those based in hospital settings may have less availability), specialty, and geography (for example, cities nearing their peaks – NYC, London – are to be avoided for a time).

Some specific comments from physicians:

“Physicians are happy to do these interviews because it gives extra income – most are bound to home.” 
– Endo, Maryland, US

“I personally don’t think [conducting market research now] is an insensitive approach.”
– Cardiologist, New York, US

“The world moves on and this won’t reduce my appetite for market research. Generally we enjoy finding out about new treatments and new ideas.”
– Oncologist, London, UK

“Doctors are humans and we can’t work 24/7; we have homes and families and we like to do market research in our downtime, so it should still continue.”
– Cardiologist, London, UK

Sample:  Research conducted by THE PLANNING SHOP 26 – 30 March 2020 with n=10 HCPs across the US and UK.  US physicians were recruited from NYC, Philadelphia, DC areas. UK physicians recruited from London and the North.  N=4 Oncologists, n=2 PCPs/GPs, n=2 Endocrinologists, n=2 Cardiologists.