What is the medium to long-term outlook after all of this?

[deleted128562]

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[TooMuchResearch]

6) No.

 

[bravotwozero]

Mr Hat, the last line of your post is the most salient. The bottom line is that nobody knows. We don't know much about the disease, how to treat it, how long it will last, how long will the economic fallout be, whether or not our profession and livelihoods are going to survive this.

but at the end of the day, is any of this in our control? No.

For your own wellbeing, best to get off this forum, which is doom and gloom central, and focus on

• reviewing your finances to see where you can tighten the belt
• make sure to get plenty of sleep, exercise, good nutrition
• learn donning and doffing of PPE until it's burned into your brain
• if you're up for it, see if there are locums opportunities that may suit you if your hours are cut and you want to improve your cash flow

Why? these are all the things you CAN control, and will do much more for you in the short and long term.

Be well.

 

[erdoc00]

My hope is that we can destroy the current corporate model of healthcare and get back to actually practicing medicine. This also means acknowledging that many ER visits are completely unnecessary and stopping the ridiculous song and dance routine just because it pays well. So many of us are "burned out" because we know this is not how things should be.

 

[lp430]

Mr Hat, the last line of your post is the most salient. The bottom line is that nobody knows. We don't know much about the disease, how to treat it, how long it will last, how long will the economic fallout be, whether or not our profession and livelihoods are going to survive this.

but at the end of the day, is any of this in our control? No.

For your own wellbeing, best to get off this forum, which is doom and gloom central, and focus on

• reviewing your finances to see where you can tighten the belt
• make sure to get plenty of sleep, exercise, good nutrition
• learn donning and doffing of PPE until it's burned into your brain
• if you're up for it, see if there are locums opportunities that may suit you if your hours are cut and you want to improve your cash flow

Why? these are all the things you CAN control, and will do much more for you in the short and long term.

Be well.

Very well said.

Sent from my SM-G965U1 using SDN mobile

 

[docB]

As we all know, ED volumes are way down and hours and pay are being slashed. Hospitals are hurting not just due to decreased ED and admission volumes, but also due to massive cuts in billing from specialists. Our orthopedic group was billing something like infinity billion dollars per month, and now it's down to like $3.50. I'd like to believe quarantines will be lifted soon and things will just go back to normal. But I'm not so sure that will happen. And I wonder what the new normal is going to be, and what the long-term outlook is going to be for our field and for medicine in general. A few questions, among many:

1) Will ED volumes rebound, or are people actually going to realize that so many of their visits were pointless and continue to stay away?
2) Will our pay cuts stay permanent, and will increased competition for jobs (if volumes stay down) lead to further pay cuts?
3) Will hospitals/ employers even be able to afford to pay physicians anywhere near what they're being paid now? Could we end up making half of what we do now? Less? And I mean experiencing big sudden pay cuts in a short period of time as hospitals lose viability.
4) Will specialty services ramp back up quickly or not? Will they even be able to do so if a bunch of infrastructure and employees are lost in all of this mess?
5) If volumes both in the ED/ inpatient side and in various other specialties stay down, what will happen to residency programs and to residents when many of them are not meeting their needed numbers?
6) Will hospitals actually consider jettisoning useless administrators?

I for one have no idea what we're looking at, and I'm not sure how much I should even think about it for my health and well-being. Nevertheless here's the topic, and I'm interested to see what everyone thinks.

Good questions. I'll take a shot:

1) Yes. They always have rebounded and risen. This was the case for all the volume lulls I've seen in the last 30 years (started in ED as a tech in '91). We had lulls post 9/11, post 2008, H1N1 and now. There is no appetite in the industry or the public to curtail the ED on demand model that causes the high volumes of bs but level 5 patients.

2) I don't think so and I am not an optimist. But as I expect volumes to go back to pre COVID levels our pay, which is tied to that volume, will go back to where it was. I do expect that as we all begin to go through contract renewals there will be lots of new clauses that allow our employers to jack us over... I mean protect themselves from future periods of low volumes.

3) Again, as I think volumes will go back to per COVID levels I believe the employers could continue to pay us at per COVID levels.

4) Infrastructure won't determine specialty availability. It will be demand. Once people are ready to undergo their preapproved procedures or pay for the elective bariatric and plastics stuff the hospitals will hire/provide the infrastructure, no question. How long it takes before people are no longer afraid to come to the hospital or have enough money for a gastric sleeve is a different question.

5) If volumes stay down it will take several years at least for CMS to have those volumes cause decreases in residency slots. We still have an aging population and will need the same number of doctors even if we have to redistribute the specialties. I don't think we will but there you go.

6) Absolutely not. Sorry to invoke Orwell but in 1984 he described having workers dig holes and fill them back up. One reason for this was to keep up the appearance of ferocious activity (he also explained other economic reasons specific to dictatorships). In other words you need to appear to be doing something even if it is a complete waste. Many hospital administrators appear to us to be completely wasteful. But they are actually quite important in meeting regulatory requirements and metrics. Now you can argue, as I would, that the regulations and regulators and metrics are a waste but they are not likely to go away. The public believes they are protecting them from us, not wasting have the available resource. For another example of a harmful and wasteful system look at our method of compensating aggrieved patients and rooting out incompetence which is med mal. Does it really fulfill either of those tasks? No. Does it waste dizzying amounts of medical resources? Yes. Is it going away? No.

 

[GeneralVeers]

I think volume will very quickly approach pre-quaratine levels. Hopefully we can defend ourselves against unscrupulous CMGs re-writing contracts. Never let a good crisis go to waste.

 

[Porfirio]

Once the elective stuff starts up again, everyone and their mom is going to get hip/knee replacements, Caths, tumor removed, etc. Those specialists are going to pump out the volume even if the guidelines say “maybe cath.”

The specialists are starving, and they are going to be willing to work long days to make up for this lost volume.

 

[Angry Birds]

I think volume will very quickly approach pre-quaratine levels. Hopefully we can defend ourselves against unscrupulous CMGs re-writing contracts. Never let a good crisis go to waste.

I also think this will rebound quickly. My drug seekers are aching to come back to see me.

 

[deleted859535]

1) Will ED volumes rebound, or are people actually going to realize that so many of their visits were pointless and continue to stay away?
2) Will our pay cuts stay permanent, and will increased competition for jobs (if volumes stay down) lead to further pay cuts?
3) Will hospitals/ employers even be able to afford to pay physicians anywhere near what they're being paid now? Could we end up making half of what we do now? Less? And I mean experiencing big sudden pay cuts in a short period of time as hospitals lose viability.
4) Will specialty services ramp back up quickly or not? Will they even be able to do so if a bunch of infrastructure and employees are lost in all of this mess?
5) If volumes both in the ED/ inpatient side and in various other specialties stay down, what will happen to residency programs and to residents when many of them are not meeting their needed numbers?
6) Will hospitals actually consider jettisoning useless administrators?

I for one have no idea what we're looking at, and I'm not sure how much I should even think about it for my health and well-being. Nevertheless here's the topic, and I'm interested to see what everyone thinks.

1. Rebound. Eventually.

2. Return to what it was. EM is a unique specialty in many rights. I forget if it was Herbert or Weingart (or both) talking about how we're "always there" but that, the lifestyle risks as much as any benefits, and the same reasons we get paid well as is aren't going to vanish into thin air. As cynical as I can be, it seems that at some level, there are forces at play that understand that if you take a specialty as uniquely stressful as EM and decimate part of its appeal, you will suddenly find staffing and recruiting issues. Many of us do this for good and noble reasons and all that, but in the end, it is still a job like the rest of medicine. Personal lives. Families. Other obligations matter both in terms of time and finances.

3. As things smooth out, yes, like they did for years prior.

4. Ramp up, yes; how quickly, who knows? In true "follow the money" fashion, nobody wants this to last any longer than it has to from an admin and organizational standpoint. Painful knees need replacing, etc.

5. Don't know but suspicion is that this isn't going to be as much of a problem for as long as it would have to be to have a long-term impact in that sense.

6. I wish.

Mr Hat, the last line of your post is the most salient. The bottom line is that nobody knows. We don't know much about the disease, how to treat it, how long it will last, how long will the economic fallout be, whether or not our profession and livelihoods are going to survive this.

but at the end of the day, is any of this in our control? No.

For your own wellbeing, best to get off this forum, which is doom and gloom central, and focus on

• reviewing your finances to see where you can tighten the belt
• make sure to get plenty of sleep, exercise, good nutrition
• learn donning and doffing of PPE until it's burned into your brain
• if you're up for it, see if there are locums opportunities that may suit you if your hours are cut and you want to improve your cash flow

Why? these are all the things you CAN control, and will do much more for you in the short and long term.

Be well.

Probably will be the best post in this thread - especially that part about SDN being a little doom and gloom.

We need a new eponym for how online forums tend towards being slightly echo chamber-ish under certain circumstances. SDN does tend towards being a bit critical of EM these days (for understandable reason) and generally sky-is-falling at times. I'll leave it to the social psychologists to give a great reason for that but in the meantime, if being here doesn't seem beneficial, then don't torture yourself. It's the same reason I keep cutting back and presumably why some previous popular members are no longer here.

 

[Birdstrike]

I am an optimist. I think we'll recover more quickly than expected and end up seeing this shutdown as one huge simultaneous pause that led to the end of something terrible and temporary, as opposed to the beginning of something terrible and permanent.

 

[Hercules]

SDN does tend towards being a bit critical of EM these days (for understandable reason) and generally sky-is-falling at times. I'll leave it to the social psychologists to give a great reason for that but in the meantime, if being here doesn't seem beneficial, then don't torture yourself. It's the same reason I keep cutting back and presumably why some previous popular members are no longer here.

I haven’t been on here much lately but had to agree and comment on this one.

Sky-is-falling at times?? SDN is in status caelo cadericus. My former classics profs would cringe at the bad Latin but it’s a blend of status epilepticus and the sky is falling in Latin.

The sky has been falling on this forum for at least the 15 years that I’ve been on here. Yet when my gaze drifts upwards the heavens still seem in their usual place...

 

[Birdstrike]

I haven’t been on here much lately but had to agree and comment on this one.

Sky-is-falling at times?? SDN is in status caelo cadericus. My former classics profs would cringe at the bad Latin but it’s a blend of status epilepticus and the sky is falling in Latin.

The sky has been falling on this forum for at least the 15 years that I’ve been on here. Yet when my gaze drifts upwards the heavens still seem in their usual place...

Yes!

According to SDN, physicians salaries are dropping 10% next year, and have been every year for the past 10! Lol

 

[RustedFox]

Yes!

According to SDN, physicians salaries are dropping 10% next year, and have been every year for the past 10! Lol

Yeah; but the really might this time.
APP has cut us by 10%, with the promise that that 10% be restored and repaid after the CovidCrisis.
I don't expect them to keep their end of the bargain.
Any attempt to get them to put this in writing has been thus far met with: "Look over there! Godzilla!"

 

[bronx43]

I don't see the mechanism by which things go back to normal in the short term. To all you optimists - I hope you are right, but I'm not so optimistic.

I fully expect to see unemployment at 20+%, and longterm contraction of numerous sectors of the economy. Even if CLINICAL volume increases, the ability of society as a whole to pay the system for these services is a different story altogether.

 

[Birdstrike]

I don't see the mechanism by which things go back to normal in the short term. To all you optimists - I hope you are right, but I'm not so optimistic.

I fully expect to see unemployment at 20+%, and longterm contraction of numerous sectors of the economy. Even if CLINICAL volume increases, the ability of society as a whole to pay the system for these services is a different story altogether.

Thought experiment: One day, the whole country goes on a temporary vacation at the same time for 3 weeks. After the vacation, will there be a Great Depression?

 

[bronx43]

Thought experiment: One day, the whole country goes on a temporary vacation at the same time for 3 weeks. After the vacation, will there be a Great Depression?

But this isn't a temporary vacation... the world continues to turn. Supply chains still have to run, therefore money needs to flow, debts have to be repaid. And people are getting laid off, Fed expanding balance sheet into unseen territories, human psyches are changing as 16 million people are already out of work. Food lines are accumulating in various parts of the country.

Here's a thought experiment. When May/June rolls around and another 20 mil people are laid off and we still don't have a vaccine, how many people on main street are going to:
1. Buy a car
2. Buy a house
3. Eat out at restaurants
4. Go to a sports event
5. Go on vacation
6. Buy luxury goods/clothing
7. Splurge on a new TV
8 . Go to a concert/movies

 

[Birdstrike]

But this isn't a temporary vacation... the world continues to turn. Supply chains still have to run, therefore money needs to flow, debts have to be repaid. And people are getting laid off, Fed expanding balance sheet into unseen territories, human psyches are changing as 16 million people are already out of work. Food lines are accumulating in various parts of the country.

Here's a thought experiment. When May/June rolls around and another 20 mil people are laid off and we still don't have a vaccine, how many people on main street are going to:
1. Buy a car
2. Buy a house
3. Eat out at restaurants
4. Go to a sports event
5. Go on vacation
6. Buy luxury goods/clothing
7. Splurge on a new TV
8 . Go to a concert/movies

I can't be 100% certain since it's the future we're talking about. But it's a positive feedback loop once they open things back up. Numbers 3, 4 and 8 will get the ball rolling due to pent up boredom. That will put money in the pockets of a few companies who'll hire a few more people, which leads to more people doing more of the things on your list. Repeat.

I think it'll take some time, but in the end I think we'll be fine. If not, and we do end up in a Great Depression, I'll thank my lucky ---king stars I'm a highly paid worker in an industry that's more depression proof than most.

But until that happens I'm not going to worry about it. I'm going to keep on keepin' on, which includes me getting my 5K time down to 20:51 today while listening to some free and loose, feel-good tunes (4/10/78). Right now I'm sitting back enjoying the natural endorphin high, getting pumped about going out for 9 more miles tomorrow. I've got to get my oxygen carrying capacity to a maximum in case I have to go head to head battling the 'rona with oxygen in short supply.

All the while I have a massive beef brisket roasting over euphoric-smelling hickory wood, to fuel my training.

 

[Cath Up]

I can't be 100% certain since it's the future we're talking about. But it's a positive feedback loop once they open things back up. Numbers 3, 4 and 8 will get the ball rolling due to pent up boredom. That will put money in the pockets of a few companies who'll hire a few more people, which leads to more people doing more of the things on your list. Repeat.

I think it'll take some time, but in the end I think we'll be fine. If not, and we do end up in a Great Depression, I'll thank my lucky ---king stars I'm a highly paid worker in an industry that's more depression proof than most.

But until that happens I'm not going to worry about it. I'm going to keep on keepin' on, which includes me getting my 5K time down to 20:51 today while listening to some free and loose, feel-good tunes (4/10/78). Right now I'm sitting back enjoying the natural endorphin high, getting pumped about going out for 9 more miles tomorrow. I've got to get my oxygen carrying capacity to a maximum in case I have to go head to head battling the 'rona with oxygen in short supply.

All the while I have a massive beef brisket roasting over euphoric-smelling hickory wood, to fuel my training.

That's a solid 5k pace, strong work.

 

[thegenius]

I think volume will very quickly approach pre-quaratine levels. Hopefully we can defend ourselves against unscrupulous CMGs re-writing contracts. Never let a good crisis go to waste.

I think it's going to take some time. There are people who refuse to come in now for fear of COVID. That fear is slowly going to dissipate, not quickly. Some people feel OK coming in now for their tooth pain and ear wax buildup. Others are staying home who are having heart attacks and strokes who clearly have medical emergencies but refuse to come in. I think it's gonna take time (9-12 months from today) for us to get back to full capacity. But I agree it will eventually happen.

I totally agree with the second part. Now, more than ever, we need our professional societies to do some legal action or lobbying or whatever to keep our jobs and pay safe. I want to be part of a gad-damn, powerful frucking union. We need something!!!!!

 

[Birdstrike]

That's a solid 5k pace, strong work.

Thanks. I've put a lot of hard work into not only the training, but the nutritional side of it the last two years. Thanks again.

 

[thegenius]

I am an optimist. I think we'll recover more quickly than expected and end up seeing this shutdown as one huge simultaneous pause that led to the end of something terrible and temporary, as opposed to the beginning of something terrible and permanent.

I'm kind of in-between the positions. Regarding the economy. We can't pause the global economy and start it back up 3 months later and expect everything to be working normally in quick fashion. There will be local, regional, state, and country wide lockdowns here and there again until we are immune to this virus and they will be happening at different times over the next 6-12 months, and that cause the economy to sputter and not work at full force until sometime in 2021. Imagine country A needs a product from country B. Country A is back and ready to work and country B just went on lockdown because of a spike in COVID deaths. Country A will need to wait.

I don't think anything will be permanent, as much as I want there to be permanent changes to the world. We have too many people, we consume too much, we waste too much, we hurt the environment too much, everything is done in excess.

 

[thegenius]

I don't see the mechanism by which things go back to normal in the short term. To all you optimists - I hope you are right, but I'm not so optimistic.

I fully expect to see unemployment at 20+%, and longterm contraction of numerous sectors of the economy. Even if CLINICAL volume increases, the ability of society as a whole to pay the system for these services is a different story altogether.

100% agree

 

[thegenius]

Thought experiment: One day, the whole country goes on a temporary vacation at the same time for 3 weeks. After the vacation, will there be a Great Depression?

Recession yes...depression? Maybe.

We do not have an economy that is powerful enough to withstand the entire country going on vacation at once for 3 weeks

For instance, everybody goes on vacation. Everybody now uses vacation / residential toilet paper. There isn't enough toilet paper out there now for this. Now we have a toilet paper supply problem. And we can't make more toilet paper because everybody is on vacation. 30-40% of toilet paper is used at work, now nobody is at work.

The other problem is that it isn't 3 weeks. It's more like 6-8 weeks. And different parts of the "country" is going on vacation at different times, making this even more difficult to smoothly get back to running at full efficiency.

We will return back to the wasteful ways of 2019 but it will take more time, IMO.

 

[thegenius]

All the while I have a massive beef brisket roasting over euphoric-smelling hickory wood, to fuel my training.

oh man send some out here!

 

[Birdstrike]

oh man send some out here!

It'll be nicely "aged" by the time it gets there from the Atlantic ocean to San Fran!