Debra Hibbeln and her partner found ways to get by when their Dental practice was closed because of the pandemic. Now they’ve re-hired their employees, and spent a lot of time and money putting new equipment and safety measures in place.
But instead of re-opening as soon as they can on Friday, they’re taking things slow. A lot has changed after all.
“Oh it’s new everything,” Hibbeln said. “I mean this is just a sea-change in how we do everything.”
Regular dental, medical, and veterinary services can resume on Friday. Governor Gretchen Whitmer previously ordered those businesses to delay “nonessential” procedures in those fields because of the coronavirus pandemic. Most dentists are small businesses with fewer than 50 employees, according to the Michigan Dental Association, and they weren’t immune to the resulting economic shock.
Hibbeln is waiting to re-open her practice until Monday June 1, giving her and her staff more time to practice how to properly wear their new personal protective equipment, and consider even the tiniest details like, where is it safest for employees to eat lunch? It’s all an effort to keep patients and workers safe.
PPE for office staff is one of many new steps Hibbeln and other dentists are taking to protect against the spread of coronavirus. Hibbeln says she’s spent hours reading and researching the public health risks of the pandemic. In her office, she’s following guidelines from the Centers for Disease Control, American Dental Association, and the Michigan Dental Association.
“There’s layer upon layer upon layer of what we’re doing,” Hibbeln said. “PPE is the first layer. There’s lots of things that are just as important, if not more important."
Patients may be asked to wait for their appointment in their cars rather than office lobbies. If patients have questions about their treatment or a follow-up, Hibbeln says she’ll have more of those conversations over the phone rather than in person.
Friday, there may be a few dentists, periodontists, and oral health professionals that go back to seeing patients at a more-or-less regular pace. The Michigan Dental Association expects most dentists will make a more gradual return to seeing patients, like Hibbeln, who says she’s scheduling appointments further apart to allow more time for cleaning in between patients, and giving patients a chance to voice any questions or concerns.
Other dental offices may not re-open quite yet. Hibbeln has concerns about keeping enough personal protective gear on hand. Michigan dentists donated PPE to hospitals across the state when supplies where scarce at the height of the COVID-19 outbreak in Michigan. Hibbeln says it’s still “impossible” to find paper gowns or KN95 or N95 masks.
“If you weren’t on the ball a month ago looking for (PPE), you don’t have what you need right now to get going,” Hibbeln said.
Hibbeln has the PPE she needs for now, and she says she wouldn’t open up her office if she didn’t feel confident in her ability to protect patients and staff.
Michigan Dental Association President Steve Meraw, also a practicing periodontist with a practice in Ann Arbor and another with several offices in metro Detroit, says safety measures like the extensive use of PPE, wellness screening questionnaires for patients, virtual waiting rooms and plexiglass barriers at the reception desk are going to be necessary until accurate rapid tests for the coronavirus become widely available, or the development and broad use of a COVID-19 vaccine.
“I know some folks who think it seems like overkill,” Meraw said. “On the other hand … everyone needs to know that a dental office is a safe place. All dental offices should be following the guidelines and should be responsive to patients’ questions.”
New PPE, new suctioning equipment to cut down of the spread of aerosolized microdroplets by 90%, and other new equipment comes at an added cost for oral health businesses at an undesirable time. Meraw and Hibbeln's practices have been closed for weeks. They both received forgivable Paycheck Protection Program (PPP) loans to help cover some of the costs at their respective businesses, but they each worry the money won’t be as helpful as it could be because of the strings attached.
More than 113,000 Michigan businesses have been approved for more than 15.7 billion in PPP loans as of May 23.
To get the loans fully forgiven, businesses have to spend the PPP money within eight weeks of receiving the loan, and three quarters of the PPP money must be used to meet pay for employee wages and benefits. Many businesses in all areas of the economy want more flexibility. Hibbeln said she received her PPP loan May ninth, but she’s not opening her office until June first. If Congress doesn’t expand PPP loan forgiveness eligibility, Hibbeln and other business owners could end up paying back some of the money from what was supposed to be a forgivable loan at a 1% interest rate with a two year maturity.
Hibbeln’s also wishing she could use more of the money to pay for the added cost of newly added safety measures.
“it would be great if we could extend how long the PPP could be used, and it would be really, really nice if there is some wiggle room so that we could use (PPP money) for some of these other things that we desperately need.”
Meraw said a lot of his colleagues are “stressed out” about the PPP forgiveness requirements. He’s thankful the program exists and grateful for the $125,000 PPP loan he says he received for his Ann Arbor practice which he says has sixteen employees.
“However, you know, it’s going to be tough if we’ve got to pay that all back, because, business is down quite a bit. We’ve have a couple months with no money coming in. We have added costs with our equipment.
The U.S. House of representatives passed the “Paycheck Protection Program Flexibility Act” on Thursday, which would reportedly give businesses up to 24 weeks after receiving PPP loans to use the money and remain eligible for loan forgiveness, and change the requirements to allow businesses to use up to 40% of a PPP loan to cover non-payroll costs, according to CNN.
U.S. Senators have advocated for similar legislation but have not yet passed a bill.
Meraw says even though he expects most dentists will re-open at a slower pace than before the pandemic for the sake of public safety, that’s going to likely mean many dental offices will see lower revenues than they’re used to.
However eager to return to work medical professionals, dentists, vets, and anybody else might be, the people who own small businesses are dependent on a lot of factors outside their control.
Some patients might decide to delay that check-up appointment, or that tooth cleaning. And a resurgence of COVID-19 could undo any progress these businesses make.