dostoyevsky-official:“Doctors Are Calling It Quits

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dostoyevsky-official https://dostoyevsky-official.tumblr.com/post/634910465995210752/doctors-are-calling-it-quits-under-stress-of-the :

“Doctors Are Calling It Quits Under Stress of the Pandemic“ https://nyti.ms/3eZ2Mlk

Thousands of medical practices have closed during the pandemic, according to a July survey https://physiciansfoundation.org/research-insights/2020physiciansurvey/ of 3,500 doctors by the Physicians Foundation, a nonprofit group. About 8 percent of the doctors reported closing their offices in recent months, which the foundation estimated could equal some 16,000 practices. Another 4 percent said they planned to shutter within the next year.

Another analysis, from the Larry A. Green Center with the Primary Care Collaborative, a nonprofit group, found similar patterns. Nearly a fifth of primary care clinicians surveyed in September https://static1.squarespace.com/static/5d7ff8184cf0e01e4566cb02/t/5f75da37bde1f0691fc28b0d/1601559097041/C19+Series+21+National+Executive+Summary.pdf say someone in their practice plans to retire early or has already retired because of Covid-19, and 15 percent say someone has left or plans to leave the practice.

The clinicians also painted a grim picture of their lives, as the pandemic enters a newly robust phase with record case counts in the United States. About half already said their mental exhaustion was at an all-time high. Many worried about keeping their doors open: about 7 percent said they were not sure they could remain open past December without financial help.

“The Third Surge is Breaking Health-Care Workers” https://www.theatlantic.com/health/archive/2020/11/third-surge-breaking-healthcare-workers/617091/

Hospitals have put their pandemic plans into action, adding more beds and creating makeshift COVID-19 wards. But in the hardest-hit areas, there are simply not enough doctors, nurses, and other specialists to staff those beds. Some health-care workers told me that COVID-19 patients are the sickest people they’ve ever cared for: They require twice as much attention as a typical intensive-care-unit patient, for three times the normal length of stay. “It was doable over the summer, but now it’s just too much,” says Whitney Neville, a nurse based in Iowa. “Last Monday we had 25 patients waiting in the emergency department. They had been admitted but there was no one to take care of them.” I asked her how much slack the system has left. “There is none,” she said.

The entire state of Iowa is now out of staffed beds, Eli Perencevich, an infectious-disease doctor at the University of Iowa, told me. Worse is coming. Iowa is accumulating more than 3,600 confirmed cases every day; relative to its population, that’s more than twice the rate Arizona experienced during its summer peak, “when their system was near collapse,” Perencevich said. With only lax policies in place, those cases will continue to rise. Hospitalizations lag behind cases by about two weeks; by Thanksgiving, today’s soaring cases will be overwhelming hospitals that already cannot cope. “The wave hasn’t even crashed down on us yet,” Perencevich said. “It keeps rising and rising, and we’re all running on fear. The health-care system in Iowa is going to collapse, no question.”

In the imminent future, patients will start to die because there simply aren’t enough people to care for them. Doctors and nurses will burn out. The most precious resource the U.S. health-care system has in the struggle against COVID-19 isn’t some miracle drug. It’s the expertise of its health-care workers—and they are exhausted.

[…] After SARS hit Toronto in 2003 https://pubmed.ncbi.nlm.nih.gov/17326946/, health-care workers at hospitals that treated SARS patients showed higher levels of burnout and posttraumatic stress up to two years later, compared with those at hospitals in nearby cities that didn’t see the disease. That outbreak lasted just four months. The COVID-19 pandemic is now in its tenth month. “I’ve had conversations with people who’ve been nurses for 25 years, and all of them say the same thing: ‘We’ve never worked in this environment before,’” says Jennifer Gil from Thomas Jefferson University Hospital in Philadelphia, who contracted COVID-19 herself in March. “How much can meditation or mental-health resources help when we’re doing this every day?”

[…] As hard as the work fatigue is, the “societal fatigue” is harder, said Hatton, the Utah pulmonary specialist. He is tired of walking out of an ICU where COVID-19 has killed another patient, and walking into a grocery store where he hears people saying it doesn’t exist. Health-care workers and public-health officials have received threats and abusive messages accusing them of fearmongering. They’ve watched as friends have adopted Donald Trump’s lies https://www.cnn.com/2020/10/30/politics/trump-doctors-covid/index.html about doctors juking the hospitalization numbers to get more money. They’ve pleaded with family members to wear masks and physically distance, lest they end up competing for ICU beds that no longer exist. “Nurses have been the most trusted profession for 18 years in a row, which is now bullshit because no one is listening to us,” Neville said.

So at the beginning of lockdown, I went and isolated with a friend and her two little kids, while her husband was working long hours at a hospital.

He’s an anaesthesiologist. They’re in high demand because to do that job, they’re trained in ICU procedures; they work with patients on ventilators all the time. (General anaesthesia inhibits your breathing, so during surgery one of the things the anaesthesiologist does is literally make you breathe the whole time. It’s intense.)

The first thing the hospital did was shut down all elective surgical procedures, and then they took their surgical staff off those and redistributed them to emergency. My friend opted to stay in the transplant department, and he and one other split the usual work done by six, while the other four were redistributed to the ICU. When the intial wave of the pandemic did not reach our area of New York State, the hospital assembled a team of volunteers, and sent some of their precious ICU doctors down to NYC to help the overloaded hospitals down there.

When lockdown ended, the hospitals were faced with having lost so much revenue on the elective procedures they weren’t having done that they…

fired people and cut pay. Yes, after working through the lockdown, they cut the pay of all the doctors and nurses and nursing assistants. Your Healthcare Heroes, most of them, took pay cuts this year. Because profits are down. It’s expensive to treat COVID patients, and hospitals make their money on the electives that aren’t happening in all this. Even without lockdown, many people are still opting not to have medical procedures.

(When I say electives, that does make it sound like people have surgery for fun. We’re talking about knee and hip replacements, surgeries to rebuild knee tendons, cataract surgeries, carpal tunnel surgeries, reconstructive surgeries after cancer or traumatic amputation recovery– these aren’t things people are getting for fun, they’re just not emergencies. And insurance typically reimburses well for these sorts of things, and they’re what a major medical center often makes most of its money on. And people are doing without these things, because of fear of the epidemic, and because the hospitals are full of people struggling not to die, and so on.)

Now that we’re into a second and third wave, which is affecting our area of the state, these healthcare professionals who have had their pay cut are staring into the void. My friend’s husband actually put in his notice at one of the hospitals he helps staff, because it was already borderline-abusive in the way it did its staffing, and with a pay cut on top of that he could no longer justify doing it– he needs to be able to spend more time with his children now that schools aren’t operating full-time and family can’t travel to come see them and such, and if he’s going to earn less money anyway he might as well have some of that time to himself, especially if his other job might pull him off transplants to do ICU coverage–

anyway. All of the above in the article is true, but it’s also true that hospitals are losing money on this and small practices have had to close not just because of burnout but because people aren’t getting lucrative procedures done and there’s no mechanism in this country to ensure that life-saving medical care exists, so without profits, doctors can’t get paid, and they have to pay rent too.

Our healthcare system is so broken it’s making all of this worse.