COVID impact on outpatient visits varies widely by specialty: study

While the U.S. experienced an overall drop in outpatient visits due to the COVID pandemic, the extent of the decline differed significantly among specialties, according to a new report.

On the bright side, the report found that outpatient visits had returned to nearly pre-pandemic levels by the end of 2020. But here, too, total visit numbers masked wide differences by specialties and patient age.

The report, the sixth in a series from The Commonwealth Fund tracking outpatient visits during the pandemic, found that pediatrics and pulmonology experienced the sharpest dropoff in visits, down 27% for the year.They were followed by otolaryngology and physical medicine and rehab (25%), and dermatology (22%). Adult primary care visits were down 11% for the year.

Overall visits fell nearly 60% during the early months of the pandemic, before beginning a rebound. By December, in-person visits were virtually unchanged from what they had been during the study’s baseline week of March 1, 2020. However, not all specialties experienced the same degree of recovery. Weekly pediatric visits, for example, were off by 24% compared to the beginning of March, while physical medicine and rehabilitation, pulmonology, and otolaryngology practices each saw declines of 11%.

On the other hand, in-person visits in some specialties were higher by December than at the start of the pandemic. Among these were rheumatology (up 8%), urology (6%), and adult primary care (5%.)

The resumption of office visits also varied according to patient age. For example, visits by children between the ages of three and five were down 38% in December compared to the start of the pandemic. Among adults 75 and over, however, the decrease was only 1%.

The report found that trends in telemedicine visits, for the most part, have been the reverse of in-office visits. After peaking at 12.5% of total baseline visits in early June, they fell to 6% in the fall before ticking up to 8.4% amid year-end COVID outbreaks.

Similar to in-office visits, telemedicine showed wide variation in use by specialty. Behavioral health showed the biggest gains by far, up 56% in December compared to the baseline. The next-largest increase was in endocrinology (25%) followed by neurology and rheumatology (17%) and gastroenterology (14%). at was followed by endocrinology.

The smallest gains were in ophthalmology (0%), podiatry and otolaryngology

(1%) and orthopedics (2%).

The full text of the study, “The Impact of COVID-19 on Outpatient Visits in 2020: Visits Remained Stable, Despite a Late Surge in Cases” is available on The Commonwealth Fund website.