As infections grow on the front lines of the COVID-19 pandemic, so does stress for health care workers.
There were at least 184 hospital staff infected in Massachusetts as of Thursday night, and that’s only counting five hospitals that consistently report their numbers: Massachusetts General, Brigham and Women's, Boston Medical Center, Tufts Medical Center and UMass Memorial Medical.
Then, this week, doctors, nurses and aides began learning of retirement cuts, furloughs and less pay.
Atrius Health, the state’s largest independent physician network, emailed employees Monday with some difficult news. The network said patient visits had dropped 70% since hospitals and clinics began canceling elective surgeries, procedures and office visits.
Dr. Steve Strongwater, president and CEO of Atrius Health, said the drop continues this week.
"Our volume has probably fallen more than 70% — more like 75% — as a result of trying to protect our patients and keeping them home and out of the office," Strongwater said.
And that translates to a big drop in income. Atrius, which includes Harvard Vanguard, is taking two steps it didn’t imagine even a month ago: Some employees will go on a one month furlough, which may be extended. Those who remain at work — mostly nurses and doctors — will have some of their pay withheld — on average, 20%. The lowest paid workers, those earning up to $55,000, will be exempt. Strongwater pledges employee wages will be returned, and 50% of his own salary will be withheld.
"I think that reflects my confidence in the future of the practice and my ability to repay," he said. "What we’re trying to do, is piece together a solution to get through the crisis and keep employed as many people as we can.
Strongwater said it will be important to make sure federal stimulus funds help shore up physician groups like Atrius, which serves 745,000 Massachusetts patients, so that doctors and nurses will still be available for non-COVID-19 health care needs. Atrius is closing some clinics and offices. The centers that remain open will be separated into two categories: care for COVID-19 and respiratory ailments, and care for patients with other health care needs.
Atrius is not the only health care provider already weakened by the coronavirus. A physicians group at Beth Israel Deaconess Medical Center will suspend retirement contributions starting April 1. And Steward Health Care has told hospital employees that furloughs are coming, focused on non-clinical staff.
In a statement, Steward said it took steps to prepare for the pandemic but is experiencing a "seismic financial shock."
"Elective surgeries are the cornerstone of our hospital system’s operating model — and the negative impact due to the cancelations of these procedures cannot be overstated. In addition, patients are understandably cautious and choosing to defer any non-emergency treatments or routine visits until this crisis has passed."
The statement goes on to say that furloughs will be targeted and temporary.
"These are difficult steps taken to address a difficult moment. We believe these necessary measures will help us navigate this crisis while keeping our focus on the future – and our ongoing commitment to caring for patients and the communities we serve."
Dr. Kaarkuzhali Krishnamurthy, a neurologist, said employers need to think more carefully about the ethics of asking doctors and nurses to live on less, when many are working longer hours and putting their health as well as the health of family members at risk. She said many younger doctors and nurses are paying back large student loans, have increased child care expenses, and may have separate living expenses so they can avoid infecting their families.
“At a time when health care systems are calling on doctors and nurses to do more, this is not the time to be making it more difficult to do that,” said Krishnamurthy, an assistant professor at Harvard Medical School who studies medical ethics.
Fallout from the loss of elective care revenue is hitting small physician groups too. Dr. Kathryn Davis practices with four other OB-GYNs affiliated with Newton-Wellesley Hospital. Davis said the group’s income dropped 50% almost immediately after the state called for a temporary halt to routine care, including non-urgent gynecological visits and screenings.
Davis and her partners have presented their 35 nurses, medical assistants and secretaries with two options: move from full to part-time or start collecting unemployment. Davis said the doctors in her practice are taking substantial pay cuts. She’s hearing from colleagues who may have to permanently close their offices if the focus on crisis level care continues for months.
“It’s shocking and everyone has been blind-sided,” Davis said. “In medicine we think we’re relatively immune from the economy. People are always going to get sick, people are always going to need doctors.”
The news is not good on the protection front either. Coronavirus infection rates are climbing rapidly among hospital employees as they are for the public at large. At Boston Medical Center the number of staff infections increased from 15 on Wednesday to 22 yesterday, and dozens of employees have been quarantined. CEO Kate Walsh pointed to one reason: labs are finally clearing the backlog of tests.
"Every single staff infection is very concerning," Walsh said. "Some of them are not new infections but are actually infections that we just discovered through improved testing."
Inside hospitals, there’s rising anxiety among some employees, and not just for themselves.
"When I said goodbye to them at the airport, my dad, who is not an emotional man, became emotional and just said he felt like he was sending me off to war on the front lines."Dr. Renee Salas, Massachusetts General Hospital emergency medicine physician
"Many of us are resigned to the fact that we are likely to contract the virus and we live in fear of spreading it to our patients and our loved ones,"said Dr. Renee Salas, an emergency medicine physician at Massachusetts General Hospital.
Salas said she assumes the virus could be on anything she touches in or outside the hospital. After visiting her elderly parents in Michigan in early March, Salas told them she wouldn’t be back until she was sure the virus was no longer a danger and that she wouldn’t infect them.
"When I said goodbye to them at the airport, my dad, who is not an emotional man, became emotional and just said he felt like he was sending me off to war on the front lines," she said. "It just speaks to the realization that this is an unprecedented time."
Salas said as of now, her hospital is able to provide her adequate protection for that war. But she knows many other hospitals don't, and many doctors agree. They are angry that they are being asked to do increasingly dangerous work and now, in many cases, with fewer benefits or less pay.
This article was originally published on March 27, 2020.
This segment aired on March 27, 2020.