How will you handle possible stop to elective surgery?

[fakin' the funk]

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I'm expecting this to be a relative non event by May in my neck of the woods as the heat and humidity slow the spread of the virus. Second, I think the lessons learned from Singapore and South Korea will help us keep this contained.

In the grand scheme of things we all can withstand 4 weeks of lost wages or income if needed. I simply don't see the this pandemic getting out of control despite the dire warnings from the experts.

"The C.D.C.’s scenarios were depicted in terms of percentages of the population. Translated into absolute numbers by independent experts using simple models of how viruses spread, the worst-case figures would be staggering if no actions were taken to slow transmission.

Between 160 million and 214 million people in the U.S. could be infected over the course of the epidemic, according to one projection. That could last months or even over a year, with infections concentrated in shorter periods, staggered across time in different communities, experts said. As many as 200,000 to 1.7 million people could die.

And, the calculations based on the C.D.C.’s scenarios suggested, 2.4 million to 21 million people in the U.S. could require hospitalization, potentially crushing the nation’s medical system, which has only about 925,000 staffed hospital beds. Fewer than a tenth of those are for people who are critically ill."

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What lessons that we learned from South Korea and Singapore are we actually applying?
"Relative non event" - you mean like hundreds of thousands of deaths and a significant shutdown of the entire economy?
If you aren't scared you aren't paying attention.

 

[Bryan O’Blivion]

How will I handle a halt or reduction in elective surgery? By providing less elective anesthesia services.

I am also planning to help my hospital and other physician colleagues in any way I can. I’m not trained in intensive care, but I can certainly manage a vent and titrate pressors. I would welcome guidance from those more knowledgeable than myself.

I make my living by fee for service. Yes, I anticipate a decrease in income. However, I have ample savings and zero debt of any kind, and I can easily scale my lifestyle back.

I could carry on that way for months, possibly years. A lot of the finer points of personal finance escape me, but the idea of debt elimination, frugality, and emergency funds made a lot of sense to me back in the day.

So, basically, I’m planning on coming to work and making myself useful. I will also need toilet paper at some point, since I did not participate in the mass buying event.

 

[Mman]

I will also need toilet paper at some point, since I did not participate in the mass buying event.

Perhaps there will be a large increase in the amount of bathroom utilization in the workplace for those that missed their last chance to ever purchase toilet paper.

 

[GravelRider]

I will also need toilet paper at some point, since I did not participate in the mass buying event.

I was at Costco last week and the toilet paper aisle was barren, but then I turned and lo and behold there were boxes of flushable wet wipes. So I grabbed a few. Let me just say, once you go flushable wet wipe once, you don’t go back. I’m now shopping around to see if they make a warmer for them.

 

[Mman]

I was at Costco last week and the toilet paper aisle was barren, but then I turned and lo and behold there were boxes of flushable wet wipes. So I grabbed a few. Let me just say, once you go flushable wet wipe once, you don’t go back. I’m now shopping around to see if they make a warmer for them.

they make warmers for baby wipes that I am sure you could adapt to your personal needs

 

[deleted171991]

I was at Costco last week and the toilet paper aisle was barren, but then I turned and lo and behold there were boxes of flushable wet wipes. So I grabbed a few. Let me just say, once you go flushable wet wipe once, you don’t go back. I’m now shopping around to see if they make a warmer for them.

If they want me in the hospital 24 hours, I need this:

 

[chocomorsel]

I was at Costco last week and the toilet paper aisle was barren, but then I turned and lo and behold there were boxes of flushable wet wipes. So I grabbed a few. Let me just say, once you go flushable wet wipe once, you don’t go back. I’m now shopping around to see if they make a warmer for them.

They may say flushable, but they really truly aren’t. Those things will clog up your septic or sewage system over time.
Read about the giant London poop ball. There have been lawsuits in NYC because of plugging up a whole building.
FYI

 

[GravelRider]

They may say flushable, but they really truly aren’t. Those things will clog up your septic or sewage system over time.
Read about the giant London poop ball. There have been lawsuits in NYC because of plugging up a whole building.
FYI

Good to know. Maybe one of those fancy Japanese toilets with the bidets and heated seats is the answer then.

 

[CHARLESTONMMM]

We employ salaried CRNAs at an outpatient surgery center. I’m not sure what we will do if surgeries are canceled for a prolonged period of time. There would be no way we would be able to continue to pay with no money coming in.

 

[sevoflurane]

Just wondering if any of you guys have thought about how your group will go about things if hospital forces stoppage of elective cases.

This is one good thing about selling. Risk transference. We will get paid the same if elective surgery goes to zero.

 

[deleted480308]

Are you a naturalized citizen? If yes, then they can (your state/country, not your hospital).

And, regardless, if you're in this profession for the money, the public doesn't want you to have a medical license. So think twice before saying No; it may bite you later.

Not to mention the Hippocratic Oath and other "minor" ethical issues...

Nothing about that means work without pay

 

[deleted171991]

Nothing about that means work without pay

Oh, please! This is a major cataclysm. Would you bill after an earthquake?

 

[deleted480308]

Oh, please! This is a major cataclysm. Would you bill after an earthquake?

That would be my default setting. Absolutely.

If I chose to donate my time/supplies that might be what I do, but under no circumstances would I dream of trying to end someone’s career for not working for free.

 

[nimbus]

This is one good thing about selling. Risk transference. We will get paid the same if elective surgery goes to zero.

So it’s not a percentage of collections?

 

[Guillemot]

We are salaried where I am at. So if elective cases stop, Ill be involved in non-elective cases. If required, I will have duties similar to a resident or fellow ICU person under guidance of a critical care doc. Then Ill probably be quarantined at my home after I get infected since I am young.

 

[dannyboy1]

Ten plus years ago I spent a few months in various ICUs. I would not do patients justice in that role now, without significant retraining.
That said, I guarantee I am a better option than most other specialties.

Any scenario that places me in charge of managing ICU patients long term is also a scenario where substandard care is the best one can hope for.

Completely agree.

So it’s not a percentage of collections?

Oh, please! This is a major cataclysm. Would you bill after an earthquake?

yes. Do you think that the ED docs and ICU docs ( and every other specialty that lays hands on these patients) won’t be billing?? In fact we are the only specialty that is going to be asked to work for free because our usual billable volume will be way down but some of you people here think we should volunteer as ICU nurses.....

 

[dannyboy1]

This is one good thing about selling. Risk transference. We will get paid the same if elective surgery goes to zero.

You think the AMC won’t force you to use PTO or lay you off temporarily? Think again. At my shop they have been having discussions about doing just that....

 

[sevoflurane]

You think the AMC won’t force you to use PTO or lay you off temporarily? Think again. At my shop they have been having discussions about doing just that....

Don’t know what your contract says... but they can’t do that to us as it stands.

 

[deleted171991]

Completely agree.


yes. Do you think that the ED docs and ICU docs ( and every other specialty that lays hands on these patients) won’t be billing?? In fact we are the only specialty that is going to be asked to work for free because our usual billable volume will be way down but some of you people here think we should volunteer as ICU nurses.....

We should volunteer as whatever the country and our communities need us for. We should lead by example. We are DOCTORS!

At least I am. 😉

 

[dannyboy1]

Don’t know what your contract says... but they can’t do that to us as it stands.

Your contract says they can’t fire you??
They will try to do something in order to survive. These AMC’s will fall like a house of cards in a few weeks if they have to pay out full salaries with no/minimal collections.

 

[deleted126335]

We should volunteer as whatever the country and our communities need us for. We should lead by example. We are DOCTORS!

At least I am. 😉

 

[dannyboy1]

We should volunteer as whatever the country and our communities need us for. We should lead by example. We are DOCTORS!

At least I am. 😉

Society has told me that I am just a provider and there is nothing special about me. I listened.

 

[Bryan O’Blivion]

Completely agree.


yes. Do you think that the ED docs and ICU docs ( and every other specialty that lays hands on these patients) won’t be billing?? In fact we are the only specialty that is going to be asked to work for free because our usual billable volume will be way down but some of you people here think we should volunteer as ICU nurses.....

Well, having volunteered my time and expertise in other circumstances I’m not opposed to doing it in my own community in the context of emergency. That wasn’t precisely what I was proposing, but since you want to frame it in those terms, I could, and would be willing to if need be.

 

[kmurp]

You think the AMC won’t force you to use PTO or lay you off temporarily? Think again. At my shop they have been having discussions about doing just that....

I’m surprised your bosses have been so transparent with their employees.

 

[dannyboy1]

Well, having volunteered my time and expertise in other circumstances I’m not opposed to doing it in my own community in the context of emergency. That wasn’t precisely what I was proposing, but since you want to frame it in those terms, I could, and would be willing to if need be.

That’s a wonderful and altruistic PERSONAL choice. Good for you. It just shouldn’t be forced on the rest of us ....

 

[sevoflurane]

Your contract says they can’t fire you??
They will try to do something in order to survive. These AMC’s will fall like a house of cards in a few weeks if they have to pay out full salaries with no/minimal collections.

You sound paranoid.
We will see what happens over the next few weeks.

 

[dchz]

I was at Costco last week and the toilet paper aisle was barren, but then I turned and lo and behold there were boxes of flushable wet wipes. So I grabbed a few. Let me just say, once you go flushable wet wipe once, you don’t go back. I’m now shopping around to see if they make a warmer for them.

They do. The ICU at the VA has a wipe warmer. But with your resources i would recommend a TOTO washlet.

 

[Arch Guillotti]

This is one good thing about selling. Risk transference. We will get paid the same if elective surgery goes to zero.

What? Selling out a practice is a good idea just in case a pandemic happens?

 

[Shimmy8]

My live in gf (NP) is in charge of logistics for multiple sites of COVID triage areas for a large academic center for their employees with symptoms.

Pretty much the highest risk place IMO (health care workers with symptoms) and she volunteered for it. Altruistic, yes; but I'm not exactly happy about it.

 

[sevoflurane]

What? Selling out a practice is a good idea just in case a pandemic happens?

Risk transfer. This just falls into the same bucket... like loosing a contract (s).

 

[dannyboy1]

You sound paranoid.
We will see what happens over the next few weeks.

They have definitely been having these discussions. (Temporary layoffs have been called furloughes). Not sure why you think people will still pay you a salary when there is no work to be done. Just look at what happens in every other industry when there is a decrease in demand..,,

 

[sevoflurane]

Still get a pay check regardless of collections.
That is the deal. Don’t know how else to put it.
Risk transference is a very big reason some groups sell.

 

[deleted171991]

My live in gf (NP) is in charge of logistics for multiple sites of COVID triage areas for a large academic center for their employees with symptoms.

Pretty much the highest risk place IMO (health care workers with symptoms) and she volunteered for it. Altruistic, yes; but I'm not exactly happy about it.

If she wears the proper PPE, she's 99+% safe.

We should ALWAYS take care of our own. No man left behind! (I'm not brainwashed, by the way. Just the golden rule.)

 

[dannyboy1]

Still get a pay check regardless of collections.
That is the deal. Don’t know how else to put it.
Risk transference is a very big reason some groups sell.

Yes. In the normal course of business you get a set salary and the AMC tries to make a profit. This thing has taken the entire industry by storm. If the elective surgical volume goes to zero the AMC has two choices, lay you off or cease to exist. The airline, cruise ship and hospitality industries are laying people off by the boatload. I’m not sure why you think we are immune to the laws of economics...

 

[Mad Jack]

No, they cannot force you to work without pay, however, they (the medical "establishment" and the licensing boards) can most definitely make certain that you will never work again. At least as a physician.

Also, credentialing and the like goes out the window. When I did my time in purgatory as a staff officer as an AF physician in the 90's, we developed most of the contingency plans for true national disasters; most involved war scenarios but several included pandemics. This involved the military essentially taking over the direction of the American healthcare system. The necessary legislation was "pre-passed" and was available for the President's signature; I am not a lawyer so I do not know the technical details. This was designed around what could people do with at least a minimal chance of success. Dentist? Congratulations now you are doing anesthesia for minor surgical procedures. Ob-Gyn? Congratulations, now you are doing general abdominal surgery.

So if things get really bad ideas like credentials and "scope of practice" go completely out the window, and there is appropriate legislation ready for the President's signature to make that happen.

I find it highly doubtful that people choosing not to work would be retaliated against unless they were contacted to do a specific thing, as you can't abandon a post you didn't hold to begin with.

 

[Mad Jack]

this is gonna to be a weird 4-8 weeks coming up.

I see you're an optimist

 

[Shimmy8]

If she wears the proper PPE, she's 99+% safe.

We should ALWAYS take care of our own. No man left behind! (I'm not brainwashed, by the way. Just the golden rule.)

She walked in to one of their sites today (small tent set up in a parking lot) and the only people wearing PPE were the ones actively being seen by providers instead of everyone in the tent. Big no no. Lot of education needs to be done.

And this is only going to get worse. 🙁

 

[Mad Jack]

Hopefully less than orthopods or pathologists though.

Hey now, don't leave out psychiatry and dermatology

 

[Bryan O’Blivion]

Society has told me that I am just a provider and there is nothing special about me. I listened.

That’s a wonderful and altruistic PERSONAL choice. Good for you. It just shouldn’t be forced on the rest of us ....

I doubt you would be FORCED to do anything. Look, I understand many of us may be facing uncertainty and potentially difficult times, but my advice to you is to to take a deep breath and cease with the histrionics, or at least limit them to this anonymous forum.

I’m in a position where I could volunteer my time. I get that not everyone is. Frankly, I’d rather be engaged than be at home anyway. But I don’t expect everyone to share my views. Suit yourself.

I sense that you may be having a bad day, but I’d also urge you to reconsider your other statement about society defining you as a “provider”. That’s your choice. You are only defined by your actions.

Good luck.

 

[Monty Python]

Hey now, don't leave out psychiatry and dermatology

Along the lines of ophthalmology or PMR managing vents.

 

[siliso]

Refresh up on critical care now and do airway and vent management, if things get that cataclysmic. You’re better prepared than most. Maybe you could even make some bucks for the vultures among you 😏

 

[Vandalia]

I find it highly doubtful that people choosing not to work would be retaliated against unless they were contacted to do a specific thing, as you can't abandon a post you didn't hold to begin with.

Now that I am retired I can say this:

Physician leaders have long memories.
Physician leaders hold grudges.
We talk with each other.

I have blackballed physicians; in very rare cases (~4) for what I considered serious reasons. (See the previous sentence.)

You may not be contractually or legally obligated to help in an "all hands on deck" situation; but see the above. Your peers have long memories and they will hold grudges. You will get the worse schedule. You will end up doing all the cases with the 80 yo orthopod who takes 6 hours to do a knee replacement. Your contract will not be renewed. You will think you have a job all lined up, and then.... nothing.

I am not talking about contributing to the United Way. I am not talking about doing your time on the library committee.

I am talking about an "all hell is breaking lose" situation. If you do not show up because it is not in your contract.... there will be consequences.

Medicine is a small world; your specialty is an even smaller world. "Sorry, you are just not quite what we are looking for."

 

[deleted480308]

Now that I am retired I can say this:

Physician leaders have long memories.
Physician leaders hold grudges.
We talk with each other.

I have blackballed physicians; in very rare cases (~4) for what I considered serious reasons. (See the previous sentence.)

You may not be contractually or legally obligated to help in an "all hands on deck" situation; but see the above. Your peers have long memories and they will hold grudges. You will get the worse schedule. You will end up doing all the cases with the 80 yo orthopod who takes 6 hours to do a knee replacement. Your contract will not be renewed. You will think you have a job all lined up, and then.... nothing.

I am not talking about contributing to the United Way. I am not talking about doing your time on the library committee.

I am talking about an "all hell is breaking lose" situation. If you do not show up because it is not in your contract.... there will be consequences.

Medicine is a small world; your specialty is an even smaller world. "Sorry, you are just not quite what we are looking for."

to clarify here, are you referencing change in job duties temporarily or (like one poster mentioned specifically) not being paid.

Those are very different situation

 

[Arch Guillotti]

Risk transfer. This just falls into the same bucket... like loosing a contract (s).

It's called selling out for a reason.

 

[siliso]

 

[MoMoGesiologist]

If people are dying and the hospital is broke and can’t pay you and you decide you won’t come in to help because you aren’t getting paid, that is your right as an American but you are not someone I want as a physician or colleague and would not wish u well once the storm is over. Sorry not sorry.

If you’re not coming in because you’re quarantined, sick, other obligations, or maybe even you’re scared, that is fine. But purely for financial reasons? Shame! Shame! Shame!

 

[sevoflurane]

It's called selling out for a reason.

Seems like your knowledge on the subject lacks clarity. Get back to the point of the thread. This isn't a the place to start this argument all over again. I am merely pointing out what risk transfer means in this context. If you don't get it, I can't help you here.

 

[deleted480308]

If people are dying and the hospital is broke and can’t pay you and you decide you won’t come in to help because you aren’t getting paid, that is your right as an American but you are not someone I want as a physician or colleague and would not wish u well once the storm is over. Sorry not sorry.

If you’re not coming in because you’re quarantined, sick, other obligations, or maybe even you’re scared, that is fine. But purely for financial reasons? Shame! Shame! Shame!

that's a ridiculous standard to expect of your colleagues. "Work for free or I don't want you around me"?

 

[deleted126335]

Yes. In the normal course of business you get a set salary and the AMC tries to make a profit. This thing has taken the entire industry by storm. If the elective surgical volume goes to zero the AMC has two choices, lay you off or cease to exist. The airline, cruise ship and hospitality industries are laying people off by the boatload. I’m not sure why you think we are immune to the laws of economics...

If my contract calls for me to be paid for my availability, I expect to be paid. If it calls for me to be paid for my productivity, well that's something else.

 

[GravelRider]

that's a ridiculous standard to expect of your colleagues. "Work for free or I don't want you around me"?

I’m going to agree with you on something.

We’re hearing talk about the government bailing out the cruise ship or airline industry, but folks are entertaining the idea of having to go “all hands on deck” without pay. I will personally lead a riot in the streets if the cruise ship industry gets a billion dollar bail out and I am working an overwhelmed healthcare system without compensation.