With Virus Surge, Dermatologists and Orthopedists Are Drafted for the E.R.

One of the largest hospital networks in New York has given its doctors an ultimatum: either help deal with the coronavirus crush, or stay home without pay.

At other hospitals, too, all hands are being called to deck. Neurosurgeons and cardiologists, orthopedic, dermatology and plastic surgery residents — all have been pulled into emergency rooms and intensive care wards. Receptionists who normally deal with billing are also being told they will be reassigned, to emergency rooms to help screen Covid-19 patients.

This is what the redeployment scramble looks like as hospitals, girding for a surge of coronavirus cases in the next two weeks, face an acute shortage of doctors and nurses trained in intensive care settings.

From cream-of-the-crop surgical specialists to nurses, physician assistants and administrative staff, health care workers who have not done a critical care shift in many years are having to retool themselves overnight — and not always voluntarily. There is pressure from co-workers, guilt about not helping, and fear about the risks to themselves and their families.

“I feel like I’d be pretty clueless in these units actually,” said an orthopedic physician assistant at a Long Island hospital who usually works on elective surgeries. The assistant, who said she had “zero critical care experience,” declined to be identified because she feared she would be fired for speaking publicly.

She and other physician assistants had received an email from their supervisor, who reminded them that another hospital in the area had made the assignments mandatory. “I did not want to go that route but everyone needs to pitch in,” the email said.

Northwell Health, the network that has told its medical staff to redeploy, has 2,900 Covid-19 patients in its 17 hospitals, which include Long Island Jewish Medical Center, Lenox Hill in Manhattan and Staten Island University.

“If you’re employed by us, it is expected you can be reassigned to an area of need,” David Battinelli, Northwell’s chief medical officer, said in an interview. Those who do not agree will be furloughed without pay, he said.

Dr. Battinelli said clinical staff would be reassigned based on their skills and comfort level. All elective surgeries have been canceled across the Northwell network, and only 20 percent of its patients, he estimated, were coming in for non-coronavirus emergencies like heart attacks, strokes and injuries.

Conference rooms, lobbies and some cafeterias were being converted to intensive care units; the network plans to expand its bed capacity by 60 percent.

“Obviously that puts pressure on trying to find staff to support those patients,” said Terry Lynam, a Northwell spokesman. “That’s the biggest concern — to try to get additional staffing.”

On Thursday, Mayor Bill de Blasio called for a national draft of doctors and medical workers to be sent to places where the virus has hit hardest, starting with New York. Some hospital systems had already been pleading for help from outside their networks. On Wednesday, NewYork-Presbyterian Hospital put out a call on Twitter for doctors and nurses, as it tries to expand intensive care units and emergency rooms in its hospitals.

Late last week came an urgent call from Dr. Augustine M.K. Choi, the dean of Weill Cornell Medicine in Manhattan, whose faculty work in several New York City hospitals.

“We are running out of ICU trained doctors,” he wrote in bold type in an email to a national medical association, asking for intensive care physicians from other states and promising to cover the cost of travel, housing and meals.

Even before the United States had confirmed cases of the coronavirus, it was facing a growing physician shortage because of its increasing and aging population. A recent study projected a shortfall of between 46,900 and 121,900 physicians by 2032.

Last month, the medical association of critical care physicians warned that Covid-19 would strain the country’s roughly 29,000 intensive-care-trained physicians. “Having an adequate supply of beds and equipment is not enough,” the association, the Society of Critical Care Medicine, wrote in a blog post, adding that “the intensivist deficit will be strongly felt.”

In New York State, the exponential growth of virus patients, with nearly 15,000 hospitalized, has stretched medical workers to their limits, both numerically and psychologically.

Stefan Flores, an emergency room doctor at NewYork-Presbyterian/Columbia University Medical Center, had an orthopedic resident by his side recently, and said specialist doctors were helping monitor patient vitals and doing bedside rounds. On a 12-hour shift, he has had to do as many as six intubations.

“I do think we need more doctors,” Dr. Flores said. “It’s unsafe to deal with the acuity and volume we are dealing with. I’ve been on shifts where I’ve never felt so overwhelmed.”

The anxiety among the redeployed is pouring out on WhatsApp and in text messages. “Now doing ED shifts for the first time in 17 years,” one doctor said on a WhatsApp group chat, referring to the emergency department. “Our ICUs are full and vents are pretty much all being used.”

A neurosurgeon at a Manhattan hospital learned last weekend that he would have to work in an I.C.U. alongside an intensive care doctor. He said he worried that at some point, intensive care doctors would fall sick or be overwhelmed by patients and that non-I.C.U. doctors would be managing ventilated patients.

On his first shift, the neurosurgeon, who declined to be identified for fear of retribution, was assigned a N-95 mask and told to use it indefinitely. Several times an hour, code blue alerts were called out on the hospital loudspeaker, indicating a medical emergency. “Everybody is dug in for the long haul,” he said.


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