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Re-purposing providers without recent hands-on clinical experience.
Longer-term readers might recall I live not far from New York City, which has been an epicenter for the COVID-19 outbreak in the United States.
Some readers might also be aware that NYC’s current Mayor, Bill de Blasio, has not enjoyed the level of favorability that his predecessor, Michael Bloomberg, did. Not worth going into the reasons why here, but from my perspective, de Blasio has come across, at best, as a well-intentioned blunderer, reminiscent of Chris Farley’s character in Black Sheep or Tommy Boy. Full disclosure: I haven’t much cared for de Blasio ever since he dropped the celebrant-critter on Groundhog Day in 2014, and the poor thing subsequently died.
Another, more recent, example of his less-than-perfect performance in the public eye was during the viral outbreak. Around the middle of March, with Broadway having gone dark and the city’s public schools all closed in the name of social distancing, the Mayor was caught going to his regular public gym for a routine workout. Another innocent gaffe or a display of hypocrisy? Let that be in the eye of the beholder.
My own beholding eyes are situated in the head of a physician, and, thus, widened quite a bit when de Blasio, who couldn’t see his way to sacrificing his personal routine, recently called for the federal government to institute a draft of all private medical personnel. As is all too typical for a politician, he’s more than willing to upend other people’s lives and put them at risk, but he doesn’t seem to see why he, personally, should be even mildly inconvenienced.
In fairness, the concept of a “doctor draft” isn’t new. It’s been floated a few times over the decades as a theoretical way to meet excessive demand-whether as a part of military action, or to deal with critical situations facing the civilian population. To my knowledge, the trigger has never been pulled on such conscription.
Meanwhile, thousands and thousands of docs (and other healthcare personnel) have stepped up and volunteered to pitch in, without governmental coercion. Med students have graduated early, docs have come out of retirement and/or relocated. Other docs, already practicing, have been re-allocated by their healthcare systems (surgeons staffing emergency rooms and intensive care units, for instance)…sometimes in not-very-nice ways, such as “report to your new assignment, or else.” “Else” ranging from payless furlough to immediate firing and permanent blackballing from the facility in question.
I was reminded of when, months ago, I watched the HBO miniseries, “Chernobyl.” I had snarked at the show’s failure to depict Soviet workers, even supervising governmental officials, with any radiation-protection gear as they moved about the deteriorating power plant and the surrounding mileage. Later episodes did address this point: The USSR, indeed, threw its citizens into harm’s way, even if calling them “heroes” in the process. And, when the protective gear did show up, it was frequently inadequate.
Now, here in the USA (and other countries)-a multitude of healthcare personnel and first-responders are being sent in without adequate PPE (personal protective equipment, if you’re not yet familiar with the acronym). And, some governmental and hospital-administrative types are more than a little eager to draft others to join the effort.
It occurs to me that a lot of these “I’ll volunteer your heroic efforts” types don’t comprehend-whether their ignorance is willful-exactly what capabilities their would-be conscripts have.
Consider, for instance, diagnostic radiologists, psychiatrists, dermatologists, etc., who haven’t wielded a laryngoscope in years, even decades. Maybe, if you let these docs self-select (as with the volunteers above), you’d produce a decent workforce that could meaningfully add to the critical-care effort. Others probably have no business being in that mix -- many of whom chose their specialties because they were playing to their strengths and avoiding their weaknesses (such as intubating someone). I saw one rad commenting on a forum somewhere: “I haven’t done anything hands-on clinical in over 20 years. I think patients would have a lot more to fear from having me as their clinician than they would from the virus.”
All of this aside, if such a draft did occur, I would hope that the folks behind such a move would “put their money where their mouths are.” That is, if a politician or administrator feels comfortable making such a move, she or he should be willing to spend some time on the front lines, too. “Leading from the front,” in other words.
Hey, if you’re going to claim that a psychiatrist who hasn’t intubated someone in 10-20 years, if ever, should be drafted into the effort…what’s your argument against a politician or administrator being able to interview incoming patients with a bullet-point checklist of COVID-19 signs or symptoms? Or, if even that is too much to ask, give the highfaluting individual a broom, and let them sweep up the place. Put them in the hospital’s kitchen, and let them peel potatoes. Someone has to do this stuff.
I’m not making up that bit about the potatoes: A molecular biologist I know, who ordinarily works in labs and writes grants, found out that she and her coworkers were in a lottery for “re-purposing.” And, yes, some of her colleagues who got tapped did, indeed, get allocated to potato-peeling. So, there goes the idea of only drafting people with relevant skills to the needed tasks. If that’s going to happen, you might as well institute a draft for the general population.
Moreover, if we’re going to seriously talk about putting people in harm’s way for the greater good, there should also be serious talk about what might be done for them when all’s said and done-aside form calling them “heroes” and thanking them for their sacrifices. How about giving everybody who served on the “front lines” of this thing some sort of permanent recognition? Something akin to the GI Bill.
An even broader scope might be called for: Being a physician already entailed multiple sacrifices – the greater part of an extra decade of schooling and training, a more burdensome, stressful lifestyle, at least during early practice (working around the clock, taking call, etc.), and plenty of financial debt. Now, having earned the special status as a doc, one can be selectively targeted for drafting whenever an emergency is declared? Maybe all of the professionals who are newly at-risk, during this crisis as well as whatever future circumstances might arise, deserve some consideration.
One thing leaps to mind that I’ve seen others discussing online. This might be time to re-examine the predatory medicolegal world. Maybe, in exchange for now having to worry about a new “doctor draft,” physicians should stop having to worry about every moment of their professional career being a potential jackpot for some hired-gun plaintiff’s attorney (and resulting professional or financial ruin for the doc).
I’m sure the trial lawyers would put up a lovely fuss at the notion of their ox being gored, just as they always have. But, unless they’re willing to roll up their sleeves and volunteer for drafting alongside the docs who all too often serve as their cash-cattle, maybe this time society can tell them that they have to take their share of the pain, too.