Locums Digest 1: Facing Pay Cuts, Physicians Surge to the Front-lines of the COVID-19 Pandemic

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Locum Tenens Providers Step Up Despite Physician Pay Cuts

Physicians and other healthcare workers quickly became the heroes of the COVID-19 pandemic. People cheered them from inner-city balconies, rallied across from hospital entrances, and rushed to their sewing machines to make masks and other “PPE” to help protect and encourage them.

Locum tenens physicians were no exception. “As the Covid-19 pandemic rages on and many professionals work from home amid government orders, healthcare providers such as doctors and nurses are stepping into the fray. They are on the front lines, putting themselves at risk to save lives. And many are traveling to virus ‘hot spots,’ often leaving behind their own families and love(d) ones to take care of the afflicted. And they are doing so despite being anxious about staying safe, among other concerns,” Staffing Industry Analysts Senior Managing Editor Craig Johnson observed during National Public Health Week.

In his April 9 editorial Johnson relayed a statistic from Floyd Lee Locums CEO Natasha Lee that more than 500 physicians and advance(d) practice providers connected with her healthcare staffing firm in one 48-hour period, “saying they are ready for assignments to fight the pandemic.”

Jumping In to Help

Locum tenens physicians might be among the unsung heroes of the COVID-19 pandemic because, if they do their homework going in, hardly anyone knows they aren’t part of the “permanent” clinical team. As Ripal H. Patel, MD, MPH, wrote recently in a blog post for locumstory.com, “we are trained — through this model — to parachute into any environment, EMR, or situation and be highly functional to optimize patient care.” Dr. Patel suggested several questions a clinician should ask before accepting a locum tenens assignment during the COVID-19 pandemic.

You would think demand for physicians has reached an all-time high within only a few months of a global pandemic. And, to some extent, you’d be correct. So you’re probably shocked to hear that doctors across the country are receiving pay cuts during the COVID-19 pandemic — but it’s true, according to media reports.

Feeling the Pain

Earlier this month, Fox News interviewed emergency room and urgent care physicians from five states. They expressed anxiety and frustration over pay cuts some were already experiencing and others had been notified about. Writer Marisa Schultz described the plight of one of them who had already experienced a 10-percent cut in pay:

“Honestly, my life is hell right now,” said one emergency medicine doctor in Los Angeles who just learned her pay will be cut at least 25 percent. The doctor, who treats COVID-19 patients at three California hospitals, has already seen two of her colleagues infected with the virus. The scarcity of protective gear at work is still so bad that she’s wearing N-95 masks that she found from Craigslist.

She’s isolating from her family out of fear she could sicken her loved ones and now she’s unlikely to make her $4,000 monthly medical school loan payments.

CBS News spoke with ER doctors in at least half a dozen states–including the chair of emergency medicine at the Mayo Clinic–who said they’re taking pay cuts of up to 40%.

Granted, it’s hard to sympathize with professionals who, in the cases of the five doctors Fox interviewed, earned between $215,000 and $260,000 per year before the pay cuts. However, they reported living modest lifestyles, in large part because of the “staggering” student loan debt they took on to pay for medical school, which ranged from $225,000 to $425,000. Thus, the $4,000-per-month loan payment the ER physician makes on top of her mortgage payment and other living expenses.

Taking the Risks

At the same time, doctors fear being infected with COVID-19, as many of their colleagues have been. One told Fox News:

“Every week, when you’re going back to your shifts, you’re just waiting for that fever [to hit you] … So the stress is just eating you alive,” the New York ER doctor told Fox News. “Then, you’re told you’re not worth what you once were worth when you’re doing more and working harder. It’s just sort of disheartening.”

In fact, between February 12 and April 9, 2020, some 9,300 front-line healthcare workers contracted COVID-19 (out of a workforce of roughly 18 million) and 27 died, according to an April 15 report by National Public Radio. CDC researchers acknowledged both counts likely were low, since 84% of those tested hadn’t identified whether they worked in healthcare.

Why cut physician salaries at a time like this? To quote a headline on CNN.com, “COVID-19 is flooding some hospitals. It’s emptying others.”

CNN, Fox News and CBS News have all reported that despite unprecedented ER volume in “hot-spot” locations like New York City and Detroit, ER visits “overall have declined by at least 30 percent nationally since the pandemic started. According to CBS News, “The Mayo Clinic is among thousands of hospitals across the country losing money fast. According to JP Morgan Chase, most hospitals make half or more of their revenue from elective procedures, which have been put on hold.”

Fox News noted, “Elective surgeries at hospitals have been shelved. Patients are scared to seek care for fear of catching COVID-19. Stay-home guidelines mean there’s less chance for routine injuries from sports, car crashes, drunken bar fights, and other traumas.

Unfortunately, according to a recent report, “hospitals could lose about $1,200 per COVID-19 case even with the 20 percent increase in Medicare reimbursement included in the stimulus package, according to a new analysis from Strata Decision Technology. For some health systems, those losses could translate to $6,000 to $8,000 depending on payer mix.

“COVID-19 cases incur unusually high costs, the analysis found using research from Italy, China, and the CDC to simulate characteristics of COVID-19 patients.”

[“Furloughs and pay cuts are just two ways the COVID-19 crisis has changed the physician’s role, according to a new survey from Merritt Hawkins and the Physicians Foundation.

About one in five physicians (21 percent) have been furloughed or experienced a pay cut as a result of COVID-19, revealed survey data from 842 physicians across the country. About a third (32 percent) of physicians also indicated that they would change their employment status because of the novel coronavirus.”

Other findings from the survey include:

  • 38% of physicians are seeing COVID-19 patients
  • 60% of physicians who are not seeing COVID-19 patients are willing to do so
  • 14% plan to change practice settings as a result of COVID-19
  • 18% plan to retire, temporarily close their practices, or opt out of patient care
  • Almost half of (48%) are treating patients through telemedicine, up from 18% in 2018.

“The impact on physicians from COVID-19 is going to be transformative,” said Merritt Hawkins Executive Vice President Travis Singleton. “The way patients access physicians and how and where physicians practice will fundamentally change.”

Recently Noted

  • Writing for Physicians Practice on April 15, CompHealth President Lisa Grabl noted, “The COVID-19 crisis is impacting the healthcare community from two sides: demand for care and a high risk of healthcare worker illness. Under normal conditions, the U.S. is experiencing a shortage of physicians, a predicted shortfall of 46,900 to 121,900 physicians by 2032. The shortage will become more pronounced as the influx of COVID-19 patients increases. For example, California is already projecting the need for a minimum of 20,000 extra beds. Locums will be crucial to meet this increased demand.”
  • “The Centers for Disease Control and Prevention has tripled the number of coronavirus symptoms it lists on its website,” the Belleville (Washington) News-Democrat reports.

“The federal organization previously listed fever, cough, and shortness of breath as symptoms of COVID-19…New symptoms for the disease now include ‘chills, repeated shaking with chills, muscle pain, headache, sore throat and new loss of taste or smell,’ the CDC said.”

Tools to Try

  • AMA’s Physician’s Guide to COVID-19 – “This quick-start COVID-19 physician guide, curated from comprehensive CDC, JAMA and WHO resources, will help prepare your practice, address patient concerns and answer your most pressing questions,” according to the AMA. (Updated as of March 23, 2020)
  • American College of Emergency Physicians (ACEP) continuously updated COVID-19 Field Guide: New resource compiles COVID-19 evidence and best practices into a mobile guide.
  • The Centers for Medicare & Medicaid Services (CMS) is taking action to protect the health and safety of our nation’s patients and providers in the wake of the 2019 Coronavirus (COVID-19) outbreak. CMS has developed this toolkit to help you stay informed on CMS and HHS materials available on the COVID-19.