As the COVID-19 pandemic continues to hospitalize thousands of people across the country, specialized doctors are being deployed to emergency rooms, some for the first time since they were medical students. Some worry that they are ill-equipped to do so. Others worry that the inability to perform specialized procedures—including plastic surgery, orthopedic surgery, and ophthalmology—will lose Columbia hundreds of millions in revenue.
New York Gov. Andrew Cuomo banned all non-essential surgeries starting on March 25, prior to which NewYork-Presbyterian had already begun shifting its resources to COVID-19 patient care. At Columbia’s medical campus, fourth-year medical students have been offered an early graduation to join the frontlines, non-essential medical procedures have been postponed, and medical staff has been reassigned from individuals’ areas of specialization to the emergency room. Across the University, the reduction in medical practice has opened the way for physicians and researchers with medical backgrounds to be “redeployed” to the frontlines of the crisis in the Intensive Care Unit.
According to Dr. Justin Golub, an otologist and neurotologist, the first wave of physicians to be redeployed included surgeons and internal medicine doctors.
But as critical members of NYP fight the pandemic on the front lines, Columbia must grapple with the financial implications of ramping down profitable medical treatment as the country looms on the brink of recession. At NYP, departments receive revenue streams directly from surgical procedures. For partner universities such as Columbia, medical faculty practice plans are among the top five revenue generators for the University, bringing in over $1.3 billion of revenue in the 2019 fiscal year—over a quarter of the year’s income.
Dr. Michael Shelanski, the senior vice dean for research at the Vagelos College of Physicians and Surgeons, estimated that the medical campus is “losing as much as $100 million a month in revenue because of loss of practice.”
According to Golub, the loss of these services will ultimately be a “financial disaster” for the University.
“In the masses, the majority of doctors that don’t have high-level administrative roles—we’re very concerned,” Golub said. “Most departments are going to lose a crazy amount of money. They’ll be in deficits; it’s a major problem. I think there’s a chance that the hospital will get some relief from these federal relief bills. I don’t know that the hospital is going to make money off of COVID.”
Dr. Lawrence Lustig, a leading expert in hearing loss and chair of the department of otolaryngology–head and neck surgery, said that within his service, revenues are down over 90 percent.
The second wave of redeployment involves specialized doctors. However, some of the most experienced redeployed physicians are the ones that have not stepped into an emergency room since they graduated medical school. According to Dr. Nicholas Mark, a pulmonologist in Seattle, the scarcity of critical care providers will limit the ability for patients to receive effective care.
“It's not just about machines and beds; it’s about the people,” he said. “How can we get more critical-care-trained people?”
Golub, a researcher and ear, nose, and throat specialist who belongs to the second wave, said that his experience has involved learning on the job.
“The next wave is people like me who are subspecialists that really haven’t done any critical care or emergency training since medical school,” Golub said. “So we’re now starting to get redeployed, which is definitely not ideal, because we’re less helpful. So a lot of us are studying to learn what we need to do.”
Lustig described his redeployment experience as akin to “an intern just starting out again.” However, he added that there are enough individuals with advanced ICU and emergency-level training to oversee redeployed faculty like himself and Golub in performing more rudimentary tasks.
“A lot of the jobs we need people to do don’t require a very high level of training—pushing patients’ beds around, making sure patients get to radiology and back, making sure patients get admitted to the floor, making sure correct lab orders get ordered, things like that,” Lustig said.
Mark has worked alongside other critical care colleagues to rapidly prepare educational resources to share on social media with incoming redeployed professionals. In the comments, dozens of specialists ranging from pediatricians to internalists expressed their appreciation of the informative graphics.
“If somebody is coming to the ICU, they won’t have time to read a textbook, but they can read a page,” Mark said.
In order to effectively use non-critical care professionals, Mark said that hospitals could assign them to non-ICU settings where patients are also in critical need. He added that not having critical care experience might not be so unusual given that open-ICU hospitals allow specialized staff within the emergency setting.
ICU and emergency personnel anticipate that, in addition to faculty reassignments, new medical school graduates will join the frontlines. Medical students in their final year at the College of Physicians and Surgeons will graduate a month early on April 15 and be offered temporary employment at NYP to help with the ongoing COVID-19 outbreak; the opportunity is purely voluntary.
“They won’t be put in a position where they feel they’re jeopardized in any way—either them or the patient,” Lustig said. “Again, a lot of the jobs we’re asking people to do don’t require a high level of training to do. And there’s plenty of work to go around where we can definitely use the warm bodies, people with some basic medical skills who can really help out with day to day stuff.”
He emphasized that despite financial concerns, the main priority across the University, and especially at the medical campus, remains to combat the swell of COVID-19 cases hitting New York City. In addition, he said he expected government subsidies to help offset revenue losses and a backlog of patients waiting for surgeries and postponed procedures when restrictions are lifted. Together, he attributed these two sources of revenue as key to facilitating the Columbia University Irving Medical Center’s road to financial recovery.
“Everyone has said this is our number one priority; finances we’re going to deal with later,” Golub said. “Like we’re all worried about that, but we’re more worried about the insanity that may happen in the couple of weeks coming if the [numbers of cases] keep increasing.”