Coronavirus: California, Utah among states resuming elective procedures
Health

Coronavirus: California, Utah among states resuming elective procedures

SALT LAKE CITY — Dr. Dan Thomas, 60, is an anesthesiologist who lives in Provo. But at 1:40 on a recent afternoon, he was laying in bed, playing Words With Friends. For about a month now, he’s been out of work.

In the midst of a global medical crisis, even health care jobs are in jeopardy. As states and hospital systems across the country have canceled elective procedures to reduce the spread of the coronavirus and redirect supplies like personal protective equipment to those fighting the pandemic, thousands of health care workers have found themselves with reduced income or without jobs at all. Private practice physicians can’t see patients, and cash-strapped hospitals have let go of personnel.

“There wasn’t a realization of just how many professionals would be put out and idled,” said Thomas, who would like to help by working in a COVID unit, tracking cases or donating ventilators but never found an opportunity to do so. “There’s nothing useful for us to do.”

In mid-March, Dr. Jerome M. Adams, the United States surgeon general, urged hospitals and doctor’s offices to stop providing care that wasn’t urgent. But elective procedures are the lifeblood of most medical systems. By the end of the month, 43,000 health care workers were out of jobs, according to the Bureau of Labor Statistics. In April, unemployment in the field has continued to balloon. By the end of this month, an estimated 19,000 family medical practices will close or scale back operations, affecting more than 260,000 workers, according to a report from the American Academy of Family Physicians.

Surgeons, dermatologists, dentists, allergists, nurses and medical assistants are also feeling the pinch. And now, leaders in states like Utah, California, Arkansas and Ohio are beginning to reverse last month’s executive orders and guidelines that directed hospitals to halt elective procedures.

On Tuesday, Utah Gov. Gary Herbert instructed medical providers to resume elective medical procedures “in a measured and cautious way.”

Thomas hopes he will be able to return to work soon. For now, he is spending time at home with his three adult children, working daily in his garden and taking the opportunity to do “a test run of retirement.”

“This is the best the garden has ever looked. Every leaf is out, ever blade of grass is gone over. There are no weeds anywhere for me to pull out,” he said. “But frankly, I hate it. It’s fun to work in the garden and lounge around in your pajamas, but I find that one day melts into the other. I wish I could do more.”

Out of work

In Washington, Gov. Jay Inslee initially suspended non-urgent surgeries until May 18, but it’s unclear whether that date could change. Dr. Talmage Broadbent, 41, is an ophthalmologist at a private practice in Spokane. He and his partners have decided not to take any pay while they’ve laid off or reduced working hours for 13 employees, including nurses, technicians and office staff.

“The uncertainty is difficult,” said Broadbent. “I feel a lot of responsibility for a lot of people — the employees and the patients who I can’t see.”

Typically, the practice treats 35-40 patients a day. But in the past month, Broadbent has completed just three surgeries, which were all emergency cases. If the ban on elective procedures continues for much longer, the future of the business is at stake, Broadbent said.

According to a survey conducted by the Washington Medical Commission in late March, 63% of solo practice or multi-specialty group physicians in the state had to lay off or furlough staff, others had to close temporarily and some had to shut down permanently. About 31% of those surveyed said they had cash on hand for only 3-4 weeks.

Dr. Court Koshar, 44, is an anesthesiologist and the medical director of a surgery center in Arizona where Gov. Doug Ducey announced Wednesday that hospitals and outpatient centers could resume elective surgeries starting May 1. But the surgery center in Avondale had previously furloughed 75% of staff in the wake of the pandemic and now only does very urgent and emergent cases.

While most of the surgeries he works on are technically elective, Koshar said there can be negative repercussions if they are delayed too long. Waiting to repair a rotator cuff or torn ACL could result in increased scarring or even some permanent damage. Canceling a child’s tonsillectomy could put them at a higher risk of developing respiratory infections and prolong things like sleep apnea, he said.

“Logic tells you it’s not good to ignore these things for too long,” said Koshar.

Jennifer Hanscom, CEO of the Washington Medical Commission, is happy with the strong action the state has taken to stop the spread of the virus, but now she believes it’s time to start moving in the opposite direction.

“We are trying to reassure our governor that there is capacity,” Hanscom said. “We are prepared should there be a surge in cases, and we will do what’s necessary to continue to make sure that we can take care of both COVID patients as well as elective procedures.”

Hospitals

Health care is a trillion-dollar industry in the United States, and without income from elective procedures, hospitals are hemorrhaging money. According to a consulting firm called the Advisory Board, a typical hospital system with 1,000 beds is predicted to lose around $140 million over a three-month period due to the pandemic.

To help health providers offset the loss of income, the federal government has allocated $100 billion to the industry as part of the stimulus package enacted in March. But in the meantime, hospitals are struggling to make ends meet.

Scott Weavil, a lawyer based in South Lake Tahoe, California, who negotiates employment contracts for doctors and other health care workers, said that recent salary cuts of 20% or more are common. For doctors who are typically paid by procedure, like orthopedic surgeons, urologists and even some nonsurgical specialties, income has been reduced to near zero.

“There’s a perception in society that doctors are very wealthy people,” said Weavil. “But a lot of my clients are people who are taking their first jobs out of training, they have $400,000 in student loans, they just bought a house or a car, and they are definitely feeling pushed.”

Intermountain Healthcare, which operates 215 clinics and 24 hospitals in Utah, Idaho and Nevada, is not cutting the pay of physicians, nurses, advanced-practice providers or other caregivers, said company spokesperson Daron Cowley. Cowley said that some staff have been redeployed to areas such as screening desks, drive-thru testing sites and telehealth centers.

One health care worker who contracts with Intermountain Healthcare said she has been redeployed to do groundskeeping on the hospital campus — pruning trees and bushes and weeding for a minimum of four hours a day. The woman, who has a master’s degree and is frustrated by her lack of say in the reassignment, asked that she not be named in this story to avoid retaliation from her employer.

As of this week, Intermountain Healthcare and other hospital systems in Utah, including the University of Utah Hospital, are planning to reintroduce elective procedures.

“We are also working on a transition plan to begin phasing in non-urgent procedures as soon as it is safe to do so, and in collaboration with state leaders and our colleagues at other health care systems,” said University of Utah spokesperson Kathy Wilets.

On the front lines

While health care workers in many states are struggling because they don’t have work to do, in New York City, doctors, nurses and others are busier than ever. Medical professionals in fields from psychiatry to orthopedics are being redeployed to treat COVID-19 patients.

At the beginning of the month, The New York Times reported that Mayor Bill de Blasio asked doctors and other medical workers from around the country to come and help in New York City, where the coronavirus has overwhelmed hospitals.

“Unless there is a national effort to enlist doctors, nurses, hospital workers of all kinds and get them where they are needed most in the country in time, I don’t see, honestly, how we’re going to have the professionals we need to get through this crisis,” de Blasio said in an interview with MSNBC.

Dr. Charles McTavish, 33, is a third year psychiatry resident working at Mount Sinai Beth Israel hospital in New York City. But for the past two weeks, he has been working 12-hour shifts treating COVID patients. He received one N95 mask to use per week as well as a brown paper bag to store it in.

“There’s a range of feelings about that, from very much wanting to help out to feeling uncomfortable being forced to practice in an area not of one’s expertise with some degree threat to well-being,” said McTavish. “But overall, morale is good.”

Dr. Jacques Henri Hacquebord, 38, is a hand surgeon at a New York University hospital who has also been redeployed to work COVID cases.

“People from all specialties are helping out on the floor: dermatology, plastic surgery, gastroenterology, psychiatry, orthopedics,” he said. Everyone is out of their comfort zone. If it weren’t a necessity, I would be resistant, but it is an absolute necessity.”

“What is really fulfilling is how you see everyone coming together and everyone contributing,” Hacquebord added.

According to these doctors on the front lines, the fight against COVID-19 is far from over. Thomas monitors news about New York from afar and wishes there was more he could do to help.

“My biggest gripe is that there’s a mismatch between available resources and needs. There’s no central coordination for this at a national level,” said Thomas, “President Trump has declared a war on this pandemic. All these guys in New York are the ones fighting the battles off in Iwo Jima, and I’m back in Wichita just kind of sitting around saying, ‘Hurrah!’”

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