By Cory Hoeferlin
In the midst of an unprecedented public health crisis, physicians in all specialties want to assist their frontline colleagues.
Yet after being removed from critical care environments for countless years, many are no longer comfortable when lives hang in the balance.
Putting aside the impending physician-shortage for a moment, a key issue laid bare by the COVID-19 pandemic is not workforce capacity, but capability.
Aspiring physicians complete four years of medical school learning the foundations of human biology and disease, including rotations in emergency rooms and intensive care units (ICUs). Upon graduation, these newly minted doctors begin residency in their chosen specializations, ranging from a minimum of three years in internal medicine and pediatrics to seven years in neurosurgery. The majority of these residents then pursue fellowships, adding additional years of training before entering the physician workforce.
Each additional year enables mastery of advancements in diagnostics, imaging, and pharmaceuticals, yet takes these physicians further away from the fundamentals.
Some hospital systems, particularly in hard-hit areas such as New York City and Los Angeles, managed to redeploy clinicians to care for COVID-19 patients, however the processes remain non-standardized and highly variable.
An early year-over-year (YoY) volume analysis revealed that, on average during the COVID-19 pandemic, across all medical specialties and in all regions of the country, the number of patients seeking hospital-based care declined by 54%. Surgical specialties were disproportionately impacted as governments and health care systems cancelled elective and non-emergent surgeries in order to reallocate PPE, maintain auxiliary support staff, and comply with social-distancing mandates in waiting rooms and surgical centers.
Among those specialties most impacted, otolaryngology (ENT) reported a 72% decrease in patient volume, orthopedics declined by 74%, and ophthalmology experienced an astounding 81% YoY loss.
These data underscore a significant limitation in the current state of the physician workforce: a multimodal segmentation of labor that is a consequence of the ever-increasing specialization brought about by our medical educational system.
To meet future needs, hospital systems must develop contingency plans that will enable the safe and rapid redeployment of health care workers to roles outside their traditional scope of practice, either as standalone onboarding programs or through an existing continuing medical education (CME) curriculum.
Research into existing redeployment methodologies, conducted primarily through extensive interviews with health care providers and administrators, have identified a number of key elements that must be included in future frameworks to ensure success.
Chief among these is the medical knowledge needed to succeed, from standards of care and emerging research, to patient population and medical comorbidities, all of which affect how care is delivered.
Reassigned health care providers must also be taught the practical skills needed to succeed in their new clinical environment, such as electronic medical record (EMR) use and departmental policies and protocols.
Similarly, understanding the care team framework, communication practices, roles, and organizational hierarchy are vital components to providing high quality care.
Finally, for any cross-functional contingency plan to succeed, it must provide adequate professional and personal support: open dialogue with leadership, adequate PPE and other necessary resources, and dedicated time off to improve mental and physical well-being.
Through carefully crafted educational curricula that address both shortcomings in medical knowledge and practical logistics of transitioning to roles outside the traditional scope of practice, the workforce can be effectively and efficiently redistributed before the system is overburdened.
A recent survey revealed physician burnout over the past year reaching an all-time high of 42%, increasing to 51% among critical care providers. Even more shocking, 13% of all respondents admitted to contemplating suicide, with 1% attempting to take their own lives.
Immune systems compromised by long shifts and lack of sleep, coupled with a well-documented lack of personal protective equipment (PPE) put health care workers especially at risk of contracting the novel coronavirus. Constant life-and-death situations and rising casualty counts left many emotionally exhausted. Even after-hours, fears of transmitting the coronavirus to loved ones led many providers to sequester themselves in hotels, further increasing isolation, anxiety, and depression.
In the post-pandemic health care system, contingency plans must be developed to address future health crises and mitigate the drawbacks of having a highly specialized medical workforce.
Organized and efficient onboarding processes will not only improve clinician performance and reduce physical and emotional impacts, but ultimately improve health care delivery and patient outcomes.
Cory M. Hoeferlin, MD, is a resident in ophthalmology at the Stein Eye Institute, UCLA.
This post is part of our digital symposium, In Their Own Words: COVID-19 and the Future of the Health Care Workforce.