By Debra Wood, RN, contributor Jul 10, 2020
Some physicians and advanced practitioners are busier than
ever, responding to a surge of COVID-19 patients who arrive at their hospital
critically ill. Yet others are seeing a reduction in their work hours—or
worse—due to the cost of COVID-19 on their health system or practice.
While the pandemic continues to wreak havoc on the public’s
health, with millions infected and tens of thousands of Americans dying from the
virus, some fear the financial fallout in healthcare will also have significant
effects. Hospitals, medical groups and the clinicians who work for them are
already feeling the impact—but in varying degrees.
“In our clients, the vast majority of providers are
working,” said David W. Miller, a founding partner at HSG, a health care consulting
firm in Louisville, Kentucky. “The level of layoffs or furloughs varied widely,
depending on the financial strength of the employing hospital and health system.”
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The financial problem for hospitals
The American Hospital Association (AHA) anticipates the pandemic’s
financial strain will continue through the end of the year. From March 2020 to
June 2020, AHA reported $202.6 billion in hospital and health system losses,
equaling around $50.7 billion per month. From July through December 2020, AHA
estimates the loss to health systems will be at least $323.1 billion, which
would push the average losses to more than $53.8 billion per month.
“Certain hospitals that saw high numbers of COVID patients
needed their providers and were looking for providers,” said Richard Becker,
MD, MBA, senior managing director of ToneyKorf, a management and advisory firm
in New York. “Orthopedic surgeons were asked to work in ICUs.”
COVID-packed hospitals did not tend to lay off staff; in
fact, many brought on additional clinicians, including travel nurses and locum
Many hospitals in areas with small numbers of coronavirus cases
had few choices beyond shedding staff, especially if they were restricted from
performing elective procedures. “At some point, you run out of money,” Becker
In some regions, patients continue to avoid elective
procedures, emergency department visits and physician appointments, especially
in states where COVID-19 cases have been high.
“In late March, patients were staying away from primary care
practices, receiving care via virtual visits,” Miller said. “In many markets,
that situation has returned to normal, although spikes, like we are seeing in
Florida and Texas, are again reducing volume. Because patients are insecure
about going to an office. We have seen consistent cutbacks in office staffing
due to this phenomenon.”
in Health Affairs, published online on June 25, 2020, noted primary care
practices will lose more than $65,000 per full-time physician (on average), due
to COVID-19, for a nationwide total of $15 billion.
How physicians are affected by hospital finances
A recent survey of 842 physicians, by Merritt Hawkins
in collaboration with The Physicians Foundation, found 21 percent had been
furloughed or had a pay cut. Eighteen percent plan to retire, close their
practices or no longer provide patient care.
“A big factor in provider staffing has been the suspension
of elective cases, which significantly damage hospital finances,” Miller said. “That
led to many furloughs. Two weeks ago, the vast majority of states were allowing
those cases, although the recent spike has reversed that trend. For physicians
who depend on elective cases, that puts them at greater risk for
Although physicians, nurses, therapists and many other
clinical staff are employees, how they are dealt with may differ. Some have
“It depends on what the contract says,” Becker said. “That
may include cutting a physician’s salary, especially when there are no patients
to be seen. The reduced amount is often enough to pay the rent or mortgage and
buy food, cover the basics.”
“Practices and health care systems are approaching it that
way; ‘What can we continue to give people that is sustainable for the system?’”
Becker said. “That does not mean people have not been hurt. They have
Other providers also
Nurses have been affected by the decline in hospital
revenues. Some have worked at the same hospital for decades. Many never
expected to lose their jobs.
“You have to think through all of your expense areas and how
to best manage that,” Becker said. “You try to preserve people’s livelihoods.”
In some cases, such as at Trinity Health, a 92-hospital
system based in Livonia, Michigan, staff have been furloughed, are working
fewer hours or receiving reduced compensation. The extent of the damage depends
on the hospital and the unit where the nurse works.
“The one area that is hard hit and not getting better on
average is emergency department volume,” Miller said. “Staffing cuts there are
slower to be reversed.”
The loss of elective cases has also negatively affected
rehabilitative services, he added. “For example, the reduction in elective
ortho cases would reduce the demand for rehab of all kinds.”
Across the country, physicians, nurses and allied health
care professionals are feeling the financial cost of COVID-19 and hoping the
pandemic ends soon.
“Everyone wants to go back to business as usual,” Becker
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