4ophtho

10+ Year Member
Aug 21, 2009
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Is your office still open?
How are you handling payroll and taking care of your staff?
If you’re still open, how are you protecting yourself and your staff?
Do you wear a mask while seeing patients?

I don’t understand why you would shut down your clinic for 2 weeks, this virus isn’t going anywhere and it will still be there after 2 weeks. Seems like to really get through the outbreak you’d need to shut down for 4 weeks, but then your staff isn’t getting paid and your practice bills still have to be paid and you’re losing many tens of thousands of dollars
 

mjohnsonets

2+ Year Member
Feb 28, 2017
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Roanoke, VA
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Don't own a practice but can report that I have client practices still operating as usual and a few that have switched to emergency only patients and surgery. Some are switching to emergency only at the end of the week. Right now, every doc and admin I've talked to is inundated with COVID-19 planning.
 
Jul 26, 2018
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I own a practice ( 3 months in...yey) . I converted to emergencies only this week. All surgeries cancelled.
The consensus seems to have strongly transitioned to ED only; there is certainly ethical debate about "running as usual".
 
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mjohnsonets

2+ Year Member
Feb 28, 2017
33
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Roanoke, VA
www.etsvision.com
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increscence

10+ Year Member
Dec 27, 2006
64
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It was only today that the AAO officially recommended closing clinics to all but emergency-only cases. We closed at the beginning of the week, as did many of my friends' offices. All of our ASCs also closed to non-urgent cases earlier this week. When we decided to close, it was really just an educated guess that it was the right move, because we lacked official guidance from the AAO.

A few ophthalmologist friends' employers were holding out until today. One of my friends ultimately walked off the job because his boss refused to close.

I am honestly disappointed in the AAO for waiting until today to officially advise clinics to close. They should have given an official directive much earlier, both to reduce confusion, and to avoid giving the naysayers an excuse to keep their doors open.
 
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4ophtho

10+ Year Member
Aug 21, 2009
107
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The AAO guidance is great for employed ophthalmologists who can still expect a salary or some type of protection from their employer or university. But for those of us who run a practice and have staff to support and bills to pay and/or practice in areas that are not yet affected it’s useless bleeding heart dribble without some concrete directions on how to navigate these very scary and uncertain times.
 
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increscence

10+ Year Member
Dec 27, 2006
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But keeping practices open will lead to loss of revenue in the medium- and long-term, because it'll worsen the spread of the virus and prolong the duration of mandated closures. Being proactive in this situation will likely mean softening the overall economic blow. Terrible to characterize official guidelines in this situation as 'useless bleeding heart dribble' (I'm guessing you meant 'drivel'?) in light of the very real threat that we, our patients, and our society face right now, as we speak.
 
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elementals

10+ Year Member
Aug 25, 2008
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The AAO guidance is great for employed ophthalmologists who can still expect a salary or some type of protection from their employer or university. But for those of us who run a practice and have staff to support and bills to pay and/or practice in areas that are not yet affected it’s useless bleeding heart dribble without some concrete directions on how to navigate these very scary and uncertain times.
I realize this is going to sound harsh, but how much do you think you'll make when you, your staff, or your patients start dying? This situation is real and escalating fast. Look at what happened to Italy in a matter of days, because they too were cavalier when this started. Now look at what's happening in Singapore, where they jumped all over this at the first sign of trouble. If you're waiting for positive tests to show up, you're already way behind the eight ball.

We've got a choice here. I know you have real and concrete concerns, but your first priority is to your patients. You serve no one and nothing by helping covid spread. Also, at least you have the option of closing up shop and staying safely at home. As a resident, I'm fully expecting to be called to the front lines in the next few weeks. I'm terrified at the thought. When I'm facing potential infection, illness, or even death, forgive me if I'm not too sympathetic toward your apparent intention to keep your office open, which at this point amounts to aiding and abetting a pandemic.
 

dantt

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Jun 28, 2006
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The AAO guidance is great for employed ophthalmologists who can still expect a salary or some type of protection from their employer or university. But for those of us who run a practice and have staff to support and bills to pay and/or practice in areas that are not yet affected it’s useless bleeding heart dribble without some concrete directions on how to navigate these very scary and uncertain times.
Employed ophthalmologists are not totally immune as many are per diem or payed on production. Of course not a good time to be a highly payed employee but not earning your keep either.

Interesting optometry has not made the same recommendation.
 

LightBox

7+ Year Member
Sep 4, 2011
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It wont matter unless there is a federal mandated quarantine/shutdown. When I run to the grocery score, no one seems overly concerned.
 

increscence

10+ Year Member
Dec 27, 2006
64
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It wont matter unless there is a federal mandated quarantine/shutdown. When I run to the grocery score, no one seems overly concerned.
Two wrongs don't make a right.

But also, if one business stays open while the other one closes, that still does reduce the risk of spread. Something is better than nothing.
 

Iladelphia

10+ Year Member
Aug 24, 2008
66
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Attending Physician
It's painful to realize how "expendable" ophthalmology has become in light of current events. I would have never thought this when entering the field some ten years ago. From an economic standpoint I can't imagine any other field of medicine taking as much of a hit. Sobering

I'm going to go brush up now on my Harrison's Internal Medicine, you know, just in case **** really hits the fan and we are called upon to help.

<insert sad face emoji>
 
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Slide

Finally, no more "training"
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Oct 12, 2005
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Academic medical center - only seeing necessary injection patients, post-ops, and true emergencies. Good or bad, in retina there are some patients that I have to absolutely see that cannot wait.

To all of those who are trivializing this issue, keep perspective of all of this. Many of the patients we see are at the highest risk of actually dying from this. This is not fake news, this is not just the flu. If you look at the data from China and Italy, it is as scary as the epidemiologists say it is. Italy's healthcare has been destroyed by this and the ICUs staff are literally deciding who dies and who lives due to ventilator and staff shortages. If our patients catch it and die from coming to a routine visit just to keep the capital flowing, then morally as physicians we are bankrupt. The excuse that optometry community is not doing it does not mean we should lower our ethical standards to theirs.

If anything, you should be doing this to protect yourself because we are at higher risk:

From a medicolegal standpoint, after the AAO/ACS announcements, if a patient comes in for a routine/yearly visit and catches COVID-19 without a signed waiver, you may be liable. One of my co-residents' dad is a med mal attorney and gave my colleagues and I this advice. Lawyers are already fielding calls about employees suing employers in health care due to lack of proper PPE in clinic visits. This all sucks, but these are also not normal times. Everyone is suffering, but this too shall pass.
 

airplanes

10+ Year Member
Jun 30, 2008
7,392
261
The Danger Zone
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It's painful to realize how "expendable" ophthalmology has become in light of current events. I would have never thought this when entering the field some ten years ago. From an economic standpoint I can't imagine any other field of medicine taking as much of a hit. Sobering

I'm going to go brush up now on my Harrison's Internal Medicine, you know, just in case **** really hits the fan and we are called upon to help.

<insert sad face emoji>
How many patients and procedures do you think dermatology is generating right now? GI? ENT? Ortho is hurting too. It’s not just us.
 

DoctwoB

10+ Year Member
Jan 10, 2010
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Literally everyone who is not a core inpatient specialty (ED, IM, CCM, etc) is going to fare poorly. Even neurosurgery is a good chunk elective. However if you’re an employed doc you can be redirected to other things like running low acuity inpatient floors and paychecks will keep coming in, even if RVUs take a haircut. If you’re running you’re own private practice it’s going to be tough sledding.
 
Mar 20, 2020
1
0
Academic medical center - only seeing necessary injection patients, post-ops, and true emergencies. Good or bad, in retina there are some patients that I have to absolutely see that cannot wait.

To all of those who are trivializing this issue, keep perspective of all of this. Many of the patients we see are at the highest risk of actually dying from this. This is not fake news, this is not just the flu. If you look at the data from China and Italy, it is as scary as the epidemiologists say it is. Italy's healthcare has been destroyed by this and the ICUs staff are literally deciding who dies and who lives due to ventilator and staff shortages. If our patients catch it and die from coming to a routine visit just to keep the capital flowing, then morally as physicians we are bankrupt. The excuse that optometry community is not doing it does not mean we should lower our ethical standards to theirs.

If anything, you should be doing this to protect yourself because we are at higher risk:

From a medicolegal standpoint, after the AAO/ACS announcements, if a patient comes in for a routine/yearly visit and catches COVID-19 without a signed waiver, you may be liable. One of my co-residents' dad is a med mal attorney and gave my colleagues and I this advice. Lawyers are already fielding calls about employees suing employers in health care due to lack of proper PPE in clinic visits. This all sucks, but these are also not normal times. Everyone is suffering, but this too shall pass.
What protections do employed ophthalmologists have if the practice owner regards the recommendations simply as recommendations? My employer said I would be switched to part time if I turned down routine eye exams. I'm forced to choose between doing what's believed to be best for the public health and keeping my healthcare job. Are there other people in the same boat?
 
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4ophtho

10+ Year Member
Aug 21, 2009
107
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We have to learn to work with this virus and not shut down completely. In a few weeks these government mandated lockdowns will be untenable. The economic impact will be too great to bare.
 

LightBox

7+ Year Member
Sep 4, 2011
385
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What protections do employed ophthalmologists have if the practice owner regards the recommendations simply as recommendations? My employer said I would be switched to part time if I turned down routine eye exams. I'm forced to choose between doing what's believed to be best for the public health and keeping my healthcare job. Are there other people in the same boat?
Your boss is facing the choice of bankruptcy vs. giving you part-time work. Feel lucky that you haven't been furloughed. (sorry to be blunt)
 
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Mar 21, 2020
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The AAO recommendations lack teeth. Only when practices stop getting paid for routine visits or are clearly forbidden from doing them will practices stop providing routine care.

Hospitals in FL continued their elective surgeries for several days after ACS recommended their postponement. They started cancelling only after the governor's executive order yesterday.
 
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4ophtho

10+ Year Member
Aug 21, 2009
107
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Any suggestions from those in practice on how to keep afloat?
We are having a rotating skeleton crew come in for daily so at least our staff can receive some income. Wiping down between patients, keeping waiting room chairs spaced, etc. However, we will be operating at a negative cash flow if we see only true emergencies, which we cannot sustain.
 

MstaKing10

10+ Year Member
Aug 17, 2009
584
135
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Attending Physician
Retina only practice. Regular hours for now, seeing only injections and true ER's. Likely next week will have to work reduced hours, close a few offices and only keep a few of our "hub" offices open. May have to furlough staff. Hope we don't have to fire staff but this is possible. Tough times.
 
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Dusn

7+ Year Member
Mar 19, 2011
285
71
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Attending Physician
Still need to do a fair number of injections for patients who would lose vision otherwise. Re-using an N95 mask and wearing eye protection because I'm not too far from the patient's face when I do injections.

If the patient is wearing a mask, I unfortunately feel I need to make them take it off because I worry that it will re-direct their breath toward their eye and the needle and increase their chance of getting endophthalmitis. I have noticed that I feel their breath on my hand and they fog up my handheld lens when they have a surgical mask on.
 

dantt

Member
10+ Year Member
Jun 28, 2006
745
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Medical Student
My RO practice is pumping along. No tiering no delaying treatment just powering through and the MBAs Love it
Short sighted. If your old macular degeneration patients or sick diabetic patients get COVID, there won't be anyone left to do OCTs/FAs/injections on.
 

Equality

10+ Year Member
May 7, 2009
262
28
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Fellow [Any Field]
If the patient is wearing a mask, I unfortunately feel I need to make them take it off because I worry that it will re-direct their breath toward their eye and the needle and increase their chance of getting endophthalmitis. I have noticed that I feel their breath on my hand and they fog up my handheld lens when they have a surgical mask on.
Interesting. I used to put mask ON patients before injections so they would stop talking. Some patients think they're at a hair salon chatting with their stylist during the injection prep.
 

MstaKing10

10+ Year Member
Aug 17, 2009
584
135
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Attending Physician
Still need to do a fair number of injections for patients who would lose vision otherwise. Re-using an N95 mask and wearing eye protection because I'm not too far from the patient's face when I do injections.

If the patient is wearing a mask, I unfortunately feel I need to make them take it off because I worry that it will re-direct their breath toward their eye and the needle and increase their chance of getting endophthalmitis. I have noticed that I feel their breath on my hand and they fog up my handheld lens when they have a surgical mask on.
Totally agree. I have them take mask off for the injection, rinse then back on. I also feel air redirected towards eye. Have heard some people tape the mask on the patient before injection, so that’s an option. I’m using a surgical mask. Not sure n95 any better if we are reusing. Key is no sick patients in the office. Had a patient with a chronic cough sneak in and I almost lost it on my staff. What % of your usual volume are you seeing? I’m definitely at 50% but am surprised how many patients still want to come in.
 

airplanes

10+ Year Member
Jun 30, 2008
7,392
261
The Danger Zone
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Attending Physician
Short sighted. If your old macular degeneration patients or sick diabetic patients get COVID, there won't be anyone left to do OCTs/FAs/injections on.
And not just risk to your elderly patients. At least 4 retina docs in NYC are COVID+. It's hard sometimes for younger practitioners to realize we aren't invincible. The physician whistle blower in China was an Ophthalmologist in his 30s who died from COVID. There is literature showing ENT and Ophthalmologists had the highest risk of infection as well. Be careful out there.
 

MstaKing10

10+ Year Member
Aug 17, 2009
584
135
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Attending Physician
Not trying to disregard any comments or the real risks posed by this very serious pandemic we are facing, but I find it interesting that most of the "data" we are seeing comes from self reported meta-analysis, correlation studies and case studies. In our evidence based era I'm surprised by how much decision making and in some cases fear and hysteria is being driven by the weakest of evidence. Just something to keep in mind as we analyze the literature.
 

speyeder

Attending
15+ Year Member
Jul 24, 2004
421
9
Totally agree. I have them take mask off for the injection, rinse then back on. I also feel air redirected towards eye. Have heard some people tape the mask on the patient before injection, so that’s an option. I’m using a surgical mask. Not sure n95 any better if we are reusing. Key is no sick patients in the office. Had a patient with a chronic cough sneak in and I almost lost it on my staff. What % of your usual volume are you seeing? I’m definitely at 50% but am surprised how many patients still want to come in.
I'm in a retina only practice and I'm at 50% of normal volume.
 

The Doctor

EMH Mark I
10+ Year Member
Mar 21, 2007
239
6
the Delta Quadrant
Status
Attending Physician
Work in private practice as employed doctor but currently not receiving contracted salary, legally or not. Even employees getting hit hard during this time.
 
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