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First Person

Administrator to COVID-19 Staff: We're Not Making Enough Money

doi: 10.1097/01.EEM.0000669300.57614.7a
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    coronavirus, COVID-19

    Dear administrator, Thank you for taking the time to talk to the senior leadership team yesterday to boost our morale and spirit. Things have been tough lately, and this was something to look forward to, something to help us get through our day.

    Our usual way of life and work has changed forever. No more coming to work in scrubs and going home the same way. For most, it's an ordeal, from staying in a hotel to ritually changing outfits at work, undressing in a garage, and being isolated to another part of the house until decontaminated (usually by a shower and laundry). This has fundamentally changed our work and home lives forever.

    I am always worried about my family's safety but never as much as now. The chance that I may bring home a deadly, easily communicable disease from work and infect a family member (young or old) and cause morbidity or mortality is unfathomable to me. I do what I can to protect myself and therefore my family. I used to wear nothing above my neck to work. Now, I wear a surgical cap, almost-airtight goggles, a rigid-fitting N95, and a face screen. This obviously adds to the physical stress, but it also adds to the emotional strain.

    A day before a shift, I am anxious about work (what will I see, who will I intubate, who will I pronounce, what will I touch, what will I bring home?) and therefore not completely present with my family. Then I finally get to work, and epinephrine and cortisol course through my body from my adrenals for eight hours nonstop, all along unknowingly clenching my jaw and using all my neck muscles to keep my weighted head upright. When I do get home, I can't calm down because my adrenal glands are still seeping their chemical wares into my body systems (cardiovascular, CNS, and GI) where they do more harm.

    This pesky pandemic prompted the cancellation of a lot of outpatient procedures from numerous specialties. This is for the safety of patients and providers. The safety of our patients, their health, and the best care for them are what health care providers strive for every day.

    I am very sorry that we are doing the right thing to help patients not get sick (which I thought was the goal of medicine) and that not ordering outpatient procedures caused a financial loss to hospitals. This is no fault of the specialists. They are physicians; if they could work, they would, but they can't, and this is altering the bottom line of the hospital.

    The people who make millions (or billions) on health care are not happy, and when they ain't happy, we ain't happy. There are some doctors who are not sidelined, who are working like they always do, and in most instances, they are working even harder than before: the emergency physician, the intensivist, the hospitalist, the infectious disease physician, not to mention prehospital providers, nurses, respiratory therapists, housekeeping, and so on.

    We literally put ourselves in harm's way with minimal complaining and maximal compassion. I am told that volumes are low, so I'm not really working harder. Hmm, I thought I was. Silly me. The number of patients may be fewer because people with nonemergent issues aren't coming to the emergency department (I applaud them), but the patients I do see are immensely more physically taxing (because I have to wear specialized protective gear) and emotionally demanding (young, previously healthy people panting for air). Their status changes from minute to minute, from healthy to extremis, from sick to very sick, from ready for discharge to let's intubate.

    Like I said in the beginning, I was grateful for your pep talk, that you asked what we can do to make up this financial deficit moving forward. Your timing was impeccable. You brought this up the day before our death rate from COVID-19 was supposed to peak. I didn't think our goal was to make up the financial deficit. I thought the goal of medicine was to take care of sick people, but it's not. Its goal is to make money. We live in a capitalistic society, and people need to make money, and now we're running at a loss.

    I am at the peak of my stress, anxiety, and burnout while this disease is at its peak. I try my best every day to take care of myself (I shaved), my family (they are fed), and my patients (they lived), but you have the gall to tell me that I have to work harder, do more, bill more, and bring in more income to the hospital to make ends meet. This is ludicrous. I am doing the best I can, seeing the sickest and helping the most I can, but there is not enough money being brought in, so you had to tell me there are consequences.

    At first, I thought I was going to get a pat on the back or an atta boy! Just the opposite. There may be pay cuts and furloughs and stipends lost. This is all secondary to the emotional toll this will take on thousands, not just families who have and will lose people but on health care workers. The emotional distress will be astronomical. The PTSD, the burnout, the feeling of loss and hopelessness, the feeling that we were let down by our superiors and the government that we thought cared about us.

    The United States is the wealthiest nation in the world, but we don't have enough supplies to make sure we keep our health care providers safe and from becoming statistics? What's one more death if we can get a good deal on gowns? What's one more death if we can get the economy going a month earlier? I am just a sticky cog in the machine. I will get PTSD, I will have anxiety, and the answer will be to see some more patients, maybe start doing some outpatient procedures, and go see a specialist (so he can bill for my care), so we can get things back on track.

    Once again, thank you for piling on to my anxieties and worries just before the death rate peaked from the only pandemic we have ever experienced. It seems we are already looking past the peak and are willing to take the hit to get things moving again. I think this is a mistake. People will see a slowing in the number of cases and stop isolating, and then we will see more peaks over the future months and the cycle will continue.

    I would write more, but that doesn't make any money for the hospital.

    Sincerely,

    Emergency Physician #102,158

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    The author is an emergency physician at a metropolitan Level 1 ED on the East Coast.

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