Dotty Orr took time off from her job as a receptionist for a primary care physician in Akron, Ohio, to get her knee replaced March 4.

Thursday, she found out she's not going back.

Orr, 64, worked for Dr. Pennie Marchetti for eight years. Marchetti laid off Orr and a part-time nurse as patient visits dropped nearly 80% during the novel coronavirus pandemic.

Marchetti said she hopes to bring her staff back when her workload picks back up, but no one knows when that will be.

"I feel guilty not being at work," said Orr, who faces an $8,000 bill for her surgery.

Orr joins thousands of health care workers across the nation who have been laid off, furloughed or are working reduced hours as their services are deemed nonessential and patients skip routine visits during an outbreak of COVID-19 cases, based on reporting from advocacy groups and from news stories from across the nation.

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How many health care workers are included in the record 3.28 million Americans that filed for initial unemployment benefits last week is unknown. Specific data from the U.S. Department of Labor will be released when it reports its March unemployment numbers Friday.

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Thousands of health care workers affected

The workers range from dentists and general surgeons to medical assistants and nurses, from allergists and dermatologists to primary care physicians and pediatricians.

By June, an estimated 60,000 family practices will close or significantly scale back, and 800,000 of their employees will be laid off, furloughed or have their hours reduced as they see a decline in business during the coronavirus pandemic, according to a HealthLandscape and American Academy of Family Physicians report released Thursday.

That represents 43% of the nearly 1.9 million people employed at family medicine offices, including receptionists, medical assistants, nurses, physicians, billing staff and janitors.

The figure doesn't include reductions at hospitals and specialty clinics that also feel the pinch.

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The situation is a Catch-22 of sorts. As hospitals and emergency rooms deal with a surge of patients affected by the coronavirus, clinics and other health care centers see a decline in elective surgeries, procedures and preventive care such as annual physicals, well-woman visits and regular teeth cleanings.

"Here we are in a health care crisis, and you have a situation where we have to be prepared, but at the same time, it's fundamentally changing the demand we have," said Andrew Perry, CEO of McFarland Clinic in Ames, Iowa. "So we find ourselves in this odd position."

The clinic, which employs 1,100 staff and 300 health care providers, is in the process of furloughing employees to match the patient volume to its staffing levels, he said.

The full scope of employees who have been furloughed – meaning they still get health benefits and have a job to come back to – is not known. McFarland Clinic officials make decisions daily. In some cases, the clinic has eliminated positions.

McFarland Clinic has lost about 40% of its business while patients getting routine preventive care are asked to reschedule their appointments after the pandemic is over, Perry said.

"Some of that is us doing it proactively, and some of that is the patient staying home and sheltering in place," he said.

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Private care doctors preparing for the worst, cutting staff

Marchetti said she used to see 17 to 20 patients in her office every day. Now, she sees most on video or talks with them on the phone.

She asks only three or four patients a day to come in – the people who "need to be seen," including patients with unexplained abdominal pain, chest pain that requires an electrocardiogram and possible pneumonia, a risk factor for COVID-19.

"I kept them out of the emergency room," Marchetti said.

Doctors and health care administrators have been making – and changing – decisions about furloughing employees on a daily basis.

Marchetti said she tried to plan for everything to protect her staff and her patients.

"It's like a hurricane – you see it coming, you're not quite sure where it's actually going to go, but you have to prepare for the worst," she said. "After the first case in Seattle, I started to pay attention and get plans together for the office.

"Every night, I’d redo the plans. Every day, I’d say, 'This is what we’re going to do today, but there's probably a chance they will change again tomorrow.' "

As more cases were discovered in Ohio, isolation of sick patients became the approach.

"Then the whole plan changed again," she said.

In Alabama, nurse Talitha Pollard's hours were cut back to three days a week at the family medicine clinic where she works. She's required to use her vacation time for the remaining two days to be paid more than 60% of her salary each week.

She and her car salesman husband had just purchased and renovated a rustic barn in rural Elba, Alabama, to host live concerts when coronavirus hit. Her reduced pay, coupled with a drop in vehicle purchases, leaves the couple in a tight spot as the loan payments on Gilded Oaks come due.

They canceled their family trip to Disney World in October.

Pollard's boss, Dr. Beverly Jordan of Enterprise, Alabama, tried to avoid layoffs despite a 50% to 75% reduction in business.

She started by letting people stay home with their children, who are out of school during the pandemic. Some of her employees work part-time when they can get child care, so they don’t have to give up all their pay.

Still, the five-physician family practice had to prepare a tiered layoff list.

Jordan hopes she doesn't have to use it as several employees are "single moms with no other financial support," she said.

The office has used some of the doctors' salaries to pay employees, as well as the "little bit of a cushion" the 25-year-old practice has, Jordan said.

Orr, the receptionist in Ohio, said she and her husband will be OK as long as she can collect unemployment. The couple pay $1,100 a month for Orr's health insurance until she becomes eligible for Medicare.

Monday, Orr started calling to apply for unemployment and couldn't get through to sign up on the phone until Wednesday afternoon. A recording said the office was experiencing higher than normal call volumes. She couldn't do it online because the site won't accept her new email address. She had a different one in 2009, when she last applied.

Other practices have closed or are preparing to shut down permanently given their financial strains.

The American Academy of Family Physicians has long had a tool kit to help doctors who are going to close their practices. In March, the academy started getting calls from physicians who have cash on hand to pay staff for only the next few weeks, said Jack Westfall, director of the academy's Robert Graham Center for Policy Studies in Family Medicine and Primary Care.

"These are not celebratory closures (like) retirements or the practices getting passed on to children," Westfall said.

Since the Affordable Care Act passed, primary care doctors have been expanding patients' access to care. Some older physicians retired early, while others got bought up by hospitals because of a provision that required providers to use costly electronic health records.

"The cruel irony is that the people who are most able to treat the chronic diseases that put people at risk of COVID-19 are at the greatest risk of suffering a financial blow," Westfall said.

Dental treatment comes to 'a complete halt'

Given that dentists are particularly susceptible to contracting and spreading COVID-19, which is spread by respiratory droplets and by close person-to-person contact, the American Dental Association urged dentists to postpone elective procedures and offer only emergency care.

Some states have taken it a step further.

Dental offices in Colorado, Florida, Iowa, Louisiana, Maryland, Michigan, New York, Oregon and Vermont, among others, were ordered closed by governors, except for emergencies such as pain or swelling.

"This has pretty much brought nonemergency dental treatment to a complete halt," said Sheila Armstrong, president of the National Dental Association and a practicing dentist in Michigan. "So this is really hitting the dental community very hard."

In response, dentists across the nation are severely cutting their staffing levels.

Zach Kouri, a dentist in Des Moines, Iowa, furloughed his entire nine-person staff per Gov. Kim Reynolds' order to suspend all elective dental procedures, including hygienic, orthodontic or cosmetic procedures, through April 16.

Kouri decided to furlough his staff a week earlier than the Reynolds order to help slow the spread of coronavirus.

He said his staff is "on edge" as they deal with filing for unemployment benefits and the uncertainty of when the order may lift. Reynolds said she would extend her emergency declarations if the spread of coronavirus continues.

"Nobody knows exactly what's going on, and that's the scariest part of this," said Kouri, who serves as vice president of the Iowa Dental Association Board of Trustees. "If you had a date where you could say this is going to (end), but everybody understands that what's happening right now can change and probably will change.

"It's a scary time right now, both as a business owner and for my staff, who are dealing with a lot of uncertainty."

Because his and other dental offices across Iowa are closed, Kouri organized a collection of unused personal protective equipment that was donated to hospitals in need. As of Tuesday, 64 dentists in Iowa donated 505 boxes of masks, 895 boxes of gloves, 845 boxes of gowns and 175 containers of disinfectant wipes.

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In the past week, hundreds of hospital employees furloughed, too

Hospitals nationwide also feel the brunt of cutbacks. By order and by need, they have cut elective surgeries and non-urgent medical appointments.

Boston Medical Center announced Tuesday it is furloughing 700 employees, about 10% of its staff, spokeswoman Jenny Eriksen Leary said in a statement. Employees are eligible to use their vacation and sick time when they are not working.

Appalachian Regional Healthcare, one of the largest hospital systems in eastern Kentucky, furloughed 500 staff members last week amid a 30% decline in revenue.

Staff will be recalled when a normal volume of patients returns, Sonya Bergman, Appalachian's vice president of human resources, told The Associated Press. Other staff members will be reassigned to areas directly involved in the COVID-19 response.

Cape Fear Valley Health in Fayetteville, North Carolina, furloughed 300 employees as the health system temporarily closes some services and reschedules nonessential surgeries, procedures or diagnostic testing.

"The closures have allowed the health system to protect our patients and employees and focus care on those who need it most," hospital officials said in a statement.

Nurses and nursing assistants in affected areas will be offered temporary positions at the health system’s hospitals. Qualified furloughed employees will be offered temporary positions at their normal pay rate as the number of patients seeking care for COVID-19 increases, officials said.

Jackson Memorial Hospital in Miami, like many others, requires nonessential staff members to take paid time off, said Dr. Linda Alvarez, secretary-treasurer of the Service Employees International Union Committee on Interns and Residents.

Whom that covers is unclear.

"A lot of hospital systems are not specifying what is considered nonessential," she said. "The rules are kind of changing and morphing with what's happening with COVID."

Furloughs and layoffs are not happening in cities and states hardest hit by the coronavirus pandemic, such as New York City, where it's "all hands on deck," Alvarez said.

As of Tuesday morning, New York City had 40,900 positive coronavirus cases – the epicenter of the outbreak.

In those areas, she doesn’t expect job cuts would occur for attending physicians, whose expertise is necessary, or residents, who are paid far less and whose helping hands are needed.

There's plenty of work for unemployed health care workers, even if it isn't paid.

"We really could use you back in our workforce, even if it’s just to volunteer," said Beth Townsend, director of Iowa Workforce Development. "With the addition of the stimulus benefits, you're going to be collecting money for unemployment, and if you have some time and capacity, we would love you to come and work in our health care facilities where we really need you to work."

Follow Des Moines Register reporter Kim Norvell on Twitter @KimNorvellDMR.

Reach USA TODAY reporter Jayne O'Donnell at jodonnel@usatoday.com or on social media.

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