On Sunday night, Tom Banning received an email from a young solo practitioner working in New Braunfels whom he has known since she was in medical school.

"Tom," she wrote. "I am one of these practices that will need to start letting staff go (even though it goes against every fiber of my being, in not being able to financially support my staff during these difficult times). But as my volume has plummeted and virtual visits are not paid at the same rate, we are struggling to maintain financial viability."

Banning, CEO of the Austin-based Texas Academy of Family Physicians, said he is hearing from people constantly. On Monday morning, a community health center in Austin called him "literally begging for masks" for their staff, he said.

The coronavirus pandemic is causing a critical cash flow problem for physicians in private practices and clinical settings. Without the support of a corporate owner, many are worried about their financial viability as appointments are cancelled, elective procedures are postponed and insurance payments for telemedicine are negotiated for patients whose plans are not regulated by the state or federal government.

Banning said TAFP members are seeing a 50% to 70% decline in patient volume.

"When you're operating in a fee-for-service system, which we are, and your revenue is determined by volume, that's highly problematic for your ability to make payroll [and] pay your mortgage," he said.

Samantha Bray, a therapist and owner of Bray Counseling in Westlake, worries that existing patients may cancel appointments because of their own financial hardships as a result of this pandemic.

"I think that businesses across Austin are going to suffer and folks are probably not spending money on things that they feel are not necessities right now," she said.

Bray added that she is unsure if her four-person practice will qualify for small business assistance or other federal support.

According to a March 27 press release from the American Medical Association, the $2 trillion federal stimulus package includes a number of measures that could benefit physicians in private practice, including small business loans up to $10 million to help cover payroll and overhead costs for practices with 500 employees or fewer; $100 billion in direct support to practices, hospitals and other healthcare providers; and possible waivers for telehealth coverage requirements for new patients.

Dr. Linda Villarreal, chair of the Texas Medical Association, said assistance may be hard to access, given demand.

"I would love for President Trump to dial the [Small Business Administration] number and see how quickly he gets an answer," she said.

Physicians are facing a wide range of challenges as a result of the pandemic.

Those who provide what may currently be considered elective procedures—such as ear, nose and throat doctors, orthopedic surgeons, dentists and plastic surgeons—are facing low demand.

Family doctors and those specializing in internal medicine, on the other hand, are on the frontlines of the pandemic, Banning said.

"What's happening is almost criminal," he added. "These physicians are putting their physical health and their financial health on the line and we're treating them like this...There are going to be long-term consequences in burnout, morale and their ability to practice medicine."

These doctors and their staff are also at risk of contracting COVID-19, which could further affect their ability to work because of recommendations to self-quarantine for two weeks.

Without revenue, doctors may be unable to pay their bills or their staff, many of whom may not come into work without pay.

"So yes," Villarreal said. "Offices are closing everywhere."