And while grants are certainly welcome, they’re a “drop in the bucket,” said Debbie Rood, business manager for her husband’s obstetrics and gynecology practice in Manteca. Rood’s husband, Dr. George Scott, said they received about $2,000 since most women over the age of 65 don’t see a gynecologist regularly.

His private practice’s finances are complicated by the fact that insurance companies won’t reimburse him until after patients give birth, leaving him and his staff performing unpaid labor for months. At the same time, their rent tripled, forcing them to downsize to a smaller clinic.

Taking out a second mortgage

Scott and Rood are determined to keep the business running but they may need to take a second mortgage on their home. They are also concerned about the long-term implications the economic crisis will have on access to care.

“If you lose all of your primary care doctors and your (obstetricians) because you can’t make a living,” Rood said, “where are patients going to go?”

It’s a question with a complicated answer, said James Robinson, professor of health economics at UC Berkeley. The economic fallout of the pandemic will lead to the closure of many private practices, but the implications are less clear.

Consolidating practices

Increasingly, in the past decade, independent doctors and private community hospitals have been swallowed by sprawling health care delivery systems through mergers and buyouts. Nearly 60% of Californians received care from an integrated health care system in 2018, which organizes doctors, hospitals, and sometimes insurance companies into one coordinated system, according to Let’s Get Healthy California, a state task force that monitors key health indicators including access to care.

Because small businesses like independent physicians typically don’t have the financial reserves to ride out severe economic downturns, the current pandemic will hasten the consolidation of health care, Robinson said.

“I think that it’s going to drive them into the arms of health plan places like Kaiser,” Robinson said.

The loss of private practices isn’t necessarily a bad thing, experts say. Consolidated health care can lead to better communication between doctors, more efficient use of testing and scans, and more cost-effective treatment, he added.

The problem is many of California’s rural counties, which often face provider shortages to begin with, still rely on private physicians and community health clinics. Forty of the state’s 58 counties had below-average access to consolidated health care in 2018, with as little as 10% of the population in Del Norte County enrolled in a managed health care plan.

Mergers raise costs on patients

A large body of evidence shows that hospital mergers and physician buyouts have increased insurance prices throughout the state.