Being Needed…Or Not…During COVID-19

March 30, 2020
Eric Postal, MD

Not every radiologist is being overwhelmed by virus-related workloads.

One of the peculiar aspects of our current viral outbreak is explaining my personal situation to non-healthcare friends and family. It’s understandable that most folks outside of our field think that we must all be insanely busy: This is an “all hands on deck” healthcare crisis, and we’re the hands of healthcare.

And yet…talk to most medical folks who don’t have skills relevant for ICUs, ERs, and the like, and you’ll hear a very different story. “Elective” stuff has been subjected to the same shutdown that most of the rest of society is experiencing. Imaging volumes are crushingly low, and rad groups all over the place are trying to come to grips with the situation -- along with pretty much any medical specialty having to do with outpatient care.

Put another way: There are overwhelming needs in part of our field, but an awful lot of us are suddenly not needed. (I spent a chunk of a day trying to find ways I could do some remote volunteer reads for hospitals in areas hardest hit by the outbreak, in intervals when my worklist was empty...and found absolutely no takers. Not in my own state, not in my own country, not even the world at-large.)

Some rads are being summarily “let go.” Or indefinitely furloughed, as if the phrase is any more reassuring. Other groups are offering varying levels of compromise: You can work for a percentage of your normal compensation, or you can have a fraction of your usual hours. Some groups’ leaders (such as mine) are sharing in the pain. Others are not,  essentially throwing their subordinates to the wolves in order to diminish or delay any personal sacrifice.

There’s a certain sense of rearranging deck chairs on the Titanic, however. Rad groups function by doing radiological work that generates revenue. Cut off the work, so goes the income stream, and no amount of puzzling at the situation will result in long-term survival. Weeks, maybe a couple of months.

News coverage of the federal “stimulus” hasn’t been all that granular, because, well, most people wouldn’t understand or care. I’ve seen talk of $100 billion-to-$150 billion for hospitals and “healthcare systems,” not to mention the more-widespread assistance for businesses (healthcare and otherwise). How much of that might find its way to keeping radiological and other healthcare groups afloat? I have no idea. Hopefully, the groups’ financial and legal people are being given such information, so they can figure out how to navigate all of this – or make some much-needed noise if they aren’t.

Because, sooner or later, this viral crisis is going to end, and society’s extensive need for healthcare outside of ERs and ICUs isn’t going to have vanished in the meantime. There’s going to be a lot of overdue cancer screening (and follow-up for those who already have a malignant background). Plenty of put-off “elective” surgeries, such as joint replacements and spinal fusions. Ongoing management of chronic conditions-patients who need meds titrated (or changed, if they’re not working well sans adverse effect). Not to mention initial evaluations and diagnostic workups for the newly-symptomatic.

It doesn’t seem right to me that those in need of such treatment are being lumped into the same “you can do it later” basket as people who might have wanted to go on a pub crawl last weekend. Especially when folks determined enough to ignore social distancing rules can still find ways to get together. Because we medical types tend to be the responsible, following-health-guidelines adults in the room (and are the first to get smacked down from a regulatory standpoint when we aren’t), the pub-crawlers at least have the option of doing what they want. Patients seeking non-emergent care don’t, because we’ve obediently helped to take that choice away from them.

When the massive resurgence of non-emergent volume is allowed to happen, much of the healthcare system that’s been forced to sit idle will have undergone some withering. There’s going to be less of a capacity to handle it all. Indeed, the longer we’re in this stranglehold, the worse the shortfall will be. Every week, the amount of overdue/postponed healthcare will increase, and the number of medical groups that have remained viable, let alone fully-staffed, will diminish.

It’s not that we’re not needed. It’s that a massive, near-impermeable barrier has been interposed between us and those who need our services. I hope that the authorities who brought the barrier down, and have the power to lift it, are keeping this in mind.

And, giving some consideration to making the barrier a little more permeable: If an imaging center, doctor’s office, or other outpatient facility is not related to a hospital where viral infections are happening, it might be reasonable to relax some of the shutdown-rules. As rapid-testing for viral infection becomes available, for instance, perhaps patients (and staff) should be able to proceed with regular appointments if they can be proven-negative prior to entering the facility.