NOTE: This blog is an edited version of a podcast with Dr. Bill Chapman. Listen to the full episode here:
I’ve been a surgeon for the last 25 years, with nearly 21 of those years spent in an academic setting as the Chief of Bariatric and Minimally Invasive Surgery. For the last 4-5 years, I’ve been in private practice with a partner and we do nearly as many cases as the entire academic program does. So, I know what it’s like for a practicing surgeon on either side and I understand that the effects of the COVID-19 shutdown on surgeons have some similarities as well as some differences.
For an academic surgeon, case volume is almost irrelevant. Your salary wouldn’t have changed during the pandemic with a precipitous drop in procedures unless your institution enacted cost-cutting measures. For my partner and I, however, we saw 95% of our caseload cancelled at the outset of the pandemic, which obviously had a drastic financial impact on our practice.
My typical case load is split 90/10 between what was defined as elective cases and urgent/emergent cases. During the OR shutdown, every single procedure submitted for approval was reviewed by the Chief of General Surgery and then the Chief of Surgery. We had to include a detailed scenario of why a particular case needed to move forward.
Although most of my cases fell into the elective category, to me, that’s a very difficult distinction to make. If a patient comes to a surgeon in the first place, they are symptomatic. They have an issue that requires attention. A hernia, for example, might sound like it’s simple to categorize as elective, but that’s an issue that’s easily exacerbated in 2-3 months. It can go from manageable, to distended, to a bowel problem. Now a procedure that would’ve been very straightforward before becomes a much more complicated case because we had to wait.
With these procedures cancelled, we needed to call all our patients, explain the delay, and instruct them to head to the emergency room if they experienced worsening symptoms. My partner and I were eager to provide care but didn’t have the facilities.
Fortunately, we do have our own surgi-center and could perform some procedures there, but otherwise the practice was essentially frozen. We needed to react and furlough some of our employees, which is never easy to do. After receiving a loan from the Paycheck Protection Program, we were able to bring back our employees, but at this point we’re still requiring everybody to take off one day a week to manage expenses.
In speaking with colleagues at multiple health systems, chaos and confusion reigned during the spring. The CDC and CMS guidelines, supposedly based on the best available data, changed frequently and scared everybody into a complete shutdown. Even with things opening back up, patients are still afraid of coming into a hospital. I’ve had to explain to my patients that the hospital was shut down initially to maintain enough space and supplies to be able to treat COVID-19 patients, not over concern of the virus spreading. But that’s been a very tough message to get out. I’d like to see our health system launch a broad public relations campaign to announce that it is open, fully functional, and working safely.
Despite that reluctance, our practice has been able to ramp up operations pretty quickly since reopening, and we’re just about back up to our previous volume. That said, we do have about a 3-month backlog of endoscopy cases and a 2-month backlog of surgical cases to work through before things are back to normal.
Most people feel a second outbreak will be coming this fall or winter, and while I’m inclined to agree, I do think that we’ll be more prepared this time and be able to manage changes better. In our practice, we’re holding on to the PPE that we do have in our inventory and our surgi-center can be ramped up if needed, which makes us more prepared than other practices. But the main hospital still houses 60% of our volume, so if they’re not prepared, we’re in trouble.
As a surgeon, I want to give care to all of my patients and get them back to health. As somebody who manages a private practice, I want to ensure that all of my employees are able to work and maintain their pay. Having both take such a severe hit because of circumstances entirely out of my control has certainly been frustrating at times. But I do know that we’ll get through this together and get back on track.