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Doximity Members Weigh In on Postponing Elective Procedures

Op-Med is a collection of original articles contributed by Doximity members.

As hospitals tend to the sick during the COVID-19 pandemic, other patients’ check-ups and elective procedures have taken a backseat. On March 13th, 2020 the American College of Surgeons released guidelines for elective surgeries during the pandemic, encouraging physicians to use outpatient settings or reschedule procedures completely. As some states re-open over the next few weeks, it is especially important to think about the long-term ramifications of the shutdown for patients and clinicians, alike.

We asked Doximity members to share how they’ve been impacted by the postponement of elective procedures. Not only did Doximity clinicians share their stories, but they also offered predictions of the challenges still to come. 

Overall, surgeons shared that their hospitals are following guidelines. Only critical cases are making it into the OR, such as patients with emergency bleeding or bone fractures. Some clinicians shared stories of patients left behind in the pandemic, including individuals with cancer, hernias, heart disease, and cataracts. While these patients don’t have life-threatening conditions, clinicians noted that receipt of timely care is still critical. As one general surgeon pointed out, “a hernia could be elective but may be causing chronic pain, the inability to be active, and a host of other non-lethal conditions.” All of these procedures are medically necessary, making it difficult to decide which few patients get priority treatment right now.

For the few clinicians still seeing patients, their practices and hospital conditions have drastically changed. One gastroenterologist shared, “our Endo [area] has been transformed into [a] patient care area and if we want to do even [a] simple EGD [esophagogastroduodenoscopy], [the patient] has to be intubated and procedure done in OR. This is forcing us to be extremely selective.” Clinicians who are trying to treat patients without COVID-19 face other well-documented challenges. A family medicine physician shared her struggle to access PPE, saying, “I had to beg for protective equipment when I was told I could order masks, etc but they wouldn’t ship until May.” PPE shortages are even more acute in the OR, where, one thoracic surgeon remarked, “[s]o much PPE is required to do simple cases.” While these previously unimaginable conditions are temporary, they certainly have affected clinician safety and patient care beyond the front lines.  

There are also significant financial consequences when ORs go unused. One orthopedic surgeon questioned, “If we have suspended almost all of our operative cases and procedures, where is all of that lost revenue?” Hospitals have been hit hard by the COVID-19 pandemic, with new figures estimating a loss of $50 billion dollars per month. To try and compensate for these losses, hospitals and private practices are resorting to desperate measures to stay afloat. An anesthesiologist shared that at his hospital, “OR staff are being forced off or furloughed due to low census and the lack of cases. They are struggling with finances and looking for other work. The hospital itself is struggling with finances and imposing pay cuts to the front line workers.” This story is not unique, as one in five physicians have been affected by furloughs or pay cuts. With elective procedures set to begin in the next few weeks and telehealth visits still on the rise, there is hope the economic strain will begin to lessen. 

In the months to come, clinicians may still see the continuing effects of delaying procedures. Rescheduling patient visits, for example, may allow conditions to worsen. A general surgeon put it simply: “[it is] hard to quantify the overall decrease in health over the waiting time. This may lead to increased complications.” Future complications could also be compounded by patient fear. One gastroenterologist noted that she has already seen patients resistant to coming in for important care. “I find even convincing a patient to have a sono or labs done is a hurdle. They just don't want to go anywhere near any medical facility, no matter how low the exposure risk is,” she said. Patients aren’t getting any better on their own, and the barriers aren’t going anywhere anytime soon. It’s hard to say what the future will look like, but it might involve more PPE, screening patients for symptoms, and a different definition of what is considered medically necessary

This new normal may seem like an alternate reality, but hospitals will reopen soon and patients will return to go under the knife. When they do, there will be lingering effects from postponing procedures: worsened cases, financial losses, growing clinician frustration, and burnout. But, as an anesthesiologist put it, “Everyone is working together, surgeons, anesthesiologists, nursing and administrators, to get through this uncertain time and to survive.” 

What challenges are you seeing from delaying elective procedures? Share your stories with us as you return to the OR!

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