The Paradoxical Below-employment of Rehab Physicians Through the COVID-19 Pandemic – Higher Well being


I used to joke that for all of the hardships of being a doctor, at the very least we had job safety. Little did I do know {that a} viral sickness would put some physicians “on the bread line.”

The COVID-19 pandemic has negatively impacted the doctor workforce in each anticipated and unanticpated methods. Whereas stay-at-home orders lower momentary demand for beauty and elective surgical procedures by dermatologists and orthopedic surgeons, inpatient rehabilitation amenities are additionally feeling the squeeze, although the variety of sufferers who want their companies are rising exponentially (as a result of post-COVID syndromes).

In states of emergency, hospitals at (or over) capability have the correct to commandeer beds from different models inside their system. So for instance, if there’s a unit dedicated to the rehabilitation of stroke or automobile accident victims, the hospital may re-allocate these beds to COVID-19 sufferers. There may be additionally monetary incentive to take action as a result of Medicare pays 20% increased charges to hospitals for every COVID affected person that requires admission.

So what occurs when the rehab unit turns right into a COVID unit? A number of issues. Firstly, the sufferers who want inpatient rehabilitation with shut doctor monitoring are turfed to nursing houses. Fragile stroke sufferers, these with excessive danger for neurological or cardiac decompensation, and inpatients with advanced medical issues (equivalent to inner bleeding, kidney failure, or infectious illnesses) are despatched to a decrease stage of care with out suficient oversight by physicians. These sufferers usually crash, get readmitted to the hospital, or within the worst case, decline too shortly to be saved.

Secondly, the physicians who care for rehab sufferers (rehabilitation physicians, also called physiatrists) hand over care of the COVID sufferers (within the former rehab unit) to hospitalists, decreasing their very own workloads considerably whereas the hospitalists are overwhelmed and in danger for burn out.

Thirdly, hospitals are struggling to chop prices because of the suspension of their profitable elective surgical pipelines throughout COVID surges – and put a moratorium on hiring further physicians who would usually be helping with progress and enlargement efforts in neuromuscular, mind and spinal wire harm rehabilitation.

Lastly, in some circumstances rehab models are experiencing low censuses not as a result of their beds have been commandeered for COVID sufferers, however as a result of elective surgical procedures have diminished and sufferers are afraid of coming to the hospital. A lot of these with signs of coronary heart assaults, strokes, mind accidents, and so on. are staying residence and “gutting it out” whereas reversible or treatable accidents and disabilities change into everlasting. The devastating toll will likely be troublesome to quantify till regular medical surveillance and care resumes.

In the meantime, physiatrists with outpatient practices and ache administration clinics are experiencing a dramatic drop in affected person throughput, with telemedicine visits largely inaccessible to the poor and disabled populations they serve. These outpatient physicians search to reinforce their earnings with part-time inpatient work, and unprecidented numbers are in search of employment by locum tenens businesses. Sadly, businesses have scant inpatient jobs to supply for the explanations I mentioned above, and competitors is fierce amongst businesses and physicians alike. It’s usually the case that 7 or extra businesses will contact a doctor inside hours of a brand new job posting, and that job will likely be stuffed earlier than the doctor can reply – and at an hourly fee 20-30% decrease than pre-COVID days (primarily based on my private expertise).

These are a number of the sudden underemployment penalties of the COVID pandemic for one sub-specialty group: physiatry. I think about the forces at play could also be comparable for my friends in oncology, neurology, or preventive drugs, for instance.

One factor is for certain: emergency drugs physicians, internists, and significant care specialists are dealing with a tsunami of sufferers whereas others of us are sitting on the bench, wanting to assist however not skilled to take action, “sheltering in place” because the non-COVID march of illness and incapacity continues apace.

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