Before the governor of Illinois called on retired healthcare workers to come back to work—to pitch in during the COVID-19 crisis—retired emergency medicine physician Scott Altman, MD, MPH, MBA, CPE, had already volunteered. He soon returned to the Chicago-area hospital where he had worked for decades.
“On the one hand, it’s so nice to go back and see all my old friends who I haven’t seen for quite a while...On the other hand, the circumstances are so trying,” he told WGN News.
But those trying circumstances were just the beginning. About 3 weeks after he began working again, Dr. Altman contracted the illness that he sought to prevent in others. Symptoms of COVID-19 left him feeling “like I had been hit by a train,” he said.
Fortunately, Dr. Altman recovered at home within a week, already planning to return to work.
“Healthcare workers, this is what we do,” he said. “We really don’t go into healthcare with a sense that we are immune to what ails our patients.”
Dr. Altman had a choice to go back to work (and to go back again after illness). Not all decisions are quite as cut and dry. Some decisions we make, and some decisions are made for us. The impact of the SARS-CoV-2 virus has compelled physicians to face both types of decisions, sometimes with life-long consequences.
Let’s look at some of the major life decisions that physicians are making because of this pandemic.
Staying away from family
You’ve probably seen this photo that went viral—it shows a doctor in scrubs who’s greeting his baby son through their glass front door. The doctor can’t come into the house and touch his son because he doesn’t want to risk infecting his family.
The doctor, Jared Burks, MD, a resident physician at the University of Arkansas for Medical Sciences–Northeast, Jonesboro, AR, hadn’t been home for more than 2 weeks. When he came to his front door, he saw his 1-year-old son Zeke crawl for the first time.
“As soon as [Zeke] saw his dad, he just raced to the door,” Dr. Burks’ wife, Alyssa, told KATV news. "He got up on the glass because I think he wanted him to hold him, so it was sad, it was cute, but it was really heartbreaking because it’s hard.”
Sadly, Dr. Burks isn’t the only doctor making the heartbreaking decision to stay away from family during this time.
Dara Kass, MD, associate professor of emergency medicine, Columbia University Irving Medical Center, New York, NY, sent all three of her children to live with her parents in New Jersey while she works in the hospital treating patients with COVID-19.
One of her children is at even greater risk because he had a liver transplant when he was 2 years old, she explained.
“One of my first concerns when I knew this was happening...was that if I was going to be in the ER taking care of patients, I couldn’t be in the same house as my child,” Dr. Kass told NPR.
Good thing she did, because she came down with symptoms of COVID-19 just a few days later. She tested positive for the virus but, after a few days of sickness, was soon seeing patients again via telemedicine and looking forward to returning to work in the emergency department.
With stay-at-home orders and fears of infection, patients aren’t keeping or making doctors’ appointments. That means lost revenue for many, many practices. According to a recent MDLinx survey, at least 68% of practicing physicians say the COVID-19 crisis has decreased their revenues substantially.
With dwindling revenues and staff who aren’t seeing many (if any) patients, physicians have logically, albeit reluctantly, been laying off or furloughing staff. According to our survey, about one-third of medical practices have laid off staff, and another third are considering it.
However, doctors are doing whatever they can to cover payroll before having to make tough choices about cutting staff. Some physicians aren’t paying themselves. Some are reducing pay for everyone in the practice by, say, 20% or 25%. Some are dipping into their own reserves.
“[I’ve] been paying staff as full time out of savings,” said a beneficent Illinois ophthalmologist in solo practice.
But physician practices can’t keep the wolf from the door forever.
“We’re not making enough to cover overhead,” said a private-practice pediatrician in Alabama. “[We] can’t do this for long, or we’ll have to close shop.”
If things don’t change soon, some doctors will be forced to make another hard decision: to either close their offices for good or to sell their small independent practices to large healthcare corporations.
Losing and finding child care
Schools and daycare centers have shut down all over the country, leaving working parents to deal with daycare on their own. While it’s been a good move to slow the spread of the virus, closing schools and child care centers has created a hardship for essential workers, like physicians and other healthcare providers, who are busy working.
“I lost child care, so my toddler keeps barging into all of my [telemedicine] appointments. And that’s probably a HIPAA violation,” said clinical psychologist Ali Mattu, PhD, in an interview on YouTube’s Doctor Mike.
Dr. Mattu isn’t alone. At least 15% of healthcare providers with children ages 3 through 12 are in need of child care during these closures, according to a recent preprint study in The Lancet. This figure already takes into account households in which an older sibling or a non-working adult can step in to handle child care. But, it doesn’t include households with children under age 3, who require much more attention.
Fortunately, volunteers in many areas have stepped up to help. In Minnesota, hundreds of medical students (whose clinical rotations have been suspended) formed a volunteer network, MNCovidsitters, to provide healthcare workers with free child care. Similar organizations have sprung up all around the country, from New York to Florida and from Maine to California.
Coming out of retirement
In late February/early March, it became apparent that there just wouldn’t be enough medical personnel to provide care for the tens of thousands of incoming COVID-19 patients across the United States. Who could make up for the medical shortage?
“URGENT! NYS is calling on recently retired health care professionals to sign up to be part of a reserve staff if the need arises,” New York Governor Andrew Cuomo tweeted on March 19.
Like superheroes, retired doctors and nurses answered the call. Within just 10 days, more than 76,000 healthcare professionals in New York, including many retired doctors and nurses, volunteered. Likewise, throughout the country, thousands of retired physicians, nurses, and other healthcare workers also answered the call.
“We have a reservoir of experienced physicians who can alleviate, at least to some degree, the doctor shortage if they have access to expeditious reentry programs,” surgeon Leo Gordon, MD, physician advisor, Cedars-Sinai Medical Center, Los Angeles, CA, told AAMC News. “There’s a clear path into medicine. Now we have to work on creating a path back.”
Because the virus is especially dangerous to people age 60 and older, and because their skills may be a little rusty, most of these retired providers haven’t been assigned to the “front lines.” Instead, they’ve been lightening the load by providing telemedicine, support services, and the like.
That was not the case for Dr. Altman, the retired emergency physician from Chicago. He was working on a hospital’s COVID-19 strike team within their command center when he developed symptoms of the disease.
Before he even came down with COVID-19, Dr. Altman told WGN News: “There’s a number of different ways that retired doctors can contribute clinically. Clearly, it’s a little intimidating because we are in the higher risk group…On the other hand, there is an enormous need and how can we healthcare workers, who are nurturers by nature, how can we not step in and help?”
Dr. Altman was eager to go back to the hospital, once he was free of symptoms for 72 hours and cleared to return to work.
Writing a living will
Whether you’re a doctor on the front lines or you’re bunkered at home, this pandemic has been a wake-up call for physicians to consider their own long-term life choices. Seeing patients pass away while on a ventilator—or even just seeing it on the news—is enough to make you think about what could happen when your own time comes.
“These are times when it is a great idea to pause and assess one’s health and one’s values and goals, and then record wishes in a living will,” Danielle J. Doberman, MD, MPH, HMDC, medical director, Palliative Medicine, Johns Hopkins Hospital, Baltimore, MD, told MDLinx.
She added that people should create or update living wills and other forms of advance directives at any change in their health status—before a major surgery, an upcoming childbirth, a milestone birthday, and even at major exams like the Welcome to Medicare visit.
“Given COVID, and the severity of impact on the lungs, and the tremendous case fatality rate for some age groups and patients with certain comorbidities, it is an important time to re-evaluate what people have written in the past, or record wishes for the first time,” said Dr. Doberman, who is also an assistant professor at Johns Hopkins University School of Medicine.
Ask yourself these questions, she advised: In my current state of health, what do I wish to prioritize? And if I were to die soon, what would I prioritize in my healthcare? Would I want treatments aimed at longevity? Treatments aimed at maintenance of function, cognition, and independence? Or solely treatments aimed at comfort care and relief of suffering?
Once you’ve decided, how do you make sure that your advance directive is adhered to when the time comes?
“The key is to educate your family, primary care doctor, and medical teams about your desires, as well as fill out paperwork,” Dr. Doberman said. “However, it is the conversations and education more than the paperwork that helps a person to ensure their wishes are carried out.”
She added: “The biggest mistake people make when writing up their advance directive and selecting a medical power of attorney is either not telling that person they have been designated or not truly educating that person adequately to be an advocate.”
Have a frank and thorough conversation with your designee about your wishes, including the specifics of what is to be done, Dr. Doberman explained.
While you’re taking care of your living will, now would be a prudent time to finally write up a legal will, too.