October 3, 2020 By [email protected]_84 Off

Some doctors retiring early because of covid

Peck, who is 66 — an age that raises his chances of severe covid-19 disease — already was semiretired and working part time in the Maryland suburbs of Washington. But that unsettling April day was his last on the job.

“The environment was frightening,” he says. “It wasn’t so much when I was wearing the stuff, as when I was taking it off,” he says, referring to the possibility he could expose himself to viral particles clinging to his protective gear. “I thought: ‘Why am I doing this? Why run this risk?’ ”

The coronavirus, which causes the disease covid-19, has changed the landscape of medicine in profound ways, prompting some physicians to retire before they had planned and others to close their practices because so many of their patients stopped going to the doctor once the pandemic began.

A survey of more than 3,000 U.S. physicians released this summer by Physicians Foundation, a nonprofit group, reported 4 percent said they wouldn’t return to work, fearing for their personal health, while more than a quarter (28 percent) admitted having “serious concerns” about catching covid-19. Nearly half (47 percent) described their anxiety as “moderate,” while about a fifth (21 percent) said they weren’t too worried about it.

Louis Korman, 73, a gastroenterologist based in Washington, D.C., and Chevy Chase, Md., has not performed a colonoscopy or endoscopy since March. Both are invasive procedures that involve threading a flexible scope into the body to examine the colon or digestive tract. Korman thought it was risky for him because anesthetized patients often cough, and the tubes can pick up potentially infectious materials.

He requires patients to take a coronavirus test 48 hours before their procedure, but he still was nervous. “You are putting yourself into a prolonged exposure to an aerosolized environment,” he says.

He still sees patients via telemedicine, but refers them to his younger associates for hands-on diagnostics.

“It’s scary stuff,” he says, referring to the threat posed by his age. “The mortality increases exponentially with each decade.”

He is considering retiring, as did two of his colleagues in their mid-60s this past summer. Treating patients during a highly infectious pandemic “takes a real emotional toll,” Korman says. “Not just to myself, but also to my family. I like what I do. But I’m not going to risk my life to do it.”

The physician survey also found that 8 percent had permanently closed their offices — although they weren’t specifically asked why — amounting to an estimated 16,000 practices, and 43 percent reduced their staff. Nearly three-quarters (72 percent) reported having suffered an income loss as a result of the pandemic.

“I absolutely would’ve kept going at least in some fashion or other if not for this,” says Stephen Rockower, 70, a Rockville, Md., orthopedic surgeon who recently retired, albeit reluctantly. “We went from seeing 15 to 20 patients in a half-day to maybe one or two. There were weeks when we’d see maybe three patients. People were afraid to come in. I started doing some telemedicine, which was okay — you can do some things — but it’s really tough to examine somebody. You can say: ‘Bend over and touch your toes,’ or ‘Put your hand over your head,’ but there are things that have to be done in person, for example, feeling if the skin is warm to see if there is an infection. It was not very satisfying.”

Gary LeRoy, a Dayton, Ohio, family physician and president of the American Academy of Family Physicians, says that when the pandemic began to worsen, his practice went from all in-person visits to nearly all telemedicine, a scenario that he believes can be harmful to patients.

“I begin my examination from the moment I lay eyes on you, the way you walk, the way you dress,” he says. “If I look at you only from the neck up, it doesn’t allow me to really see you. Why are you limping? Why do you look so pale? I had one patient who looked fatigued. It turned out she had a partial heart block, and needed a pacemaker. The fact that I was sitting there looking at her [in person] probably saved her life.”

LeRoy, who has been practicing family medicine for 30 years, admits he worries about his personal risk, especially the danger of inadvertent exposure.

“I hear individual physicians who say, ‘I’m older, I have a chronic health condition, I value my life too much to risk dying from this thing.’ It does make you think about your own survival, that you aren’t invincible,” he says. “But we’ve been well trained in universal precautions. We know how this stuff spreads and how to take care of ourselves. I’m not going to stop doing my job.”

Still, experts say that other pressures on doctors have been growing in recent years, and the pandemic probably was the final event that sent many to the exits.

“Physicians were challenged already, and any sort of major disruption in practice and income could send them right into retirement,” says Susan D’Antoni, executive director of the Montgomery County Medical Society. “In Maryland, we have a fair number of independent and much smaller practices than many other states. This kind of disaster is certainly pushing these physicians out of practice.”

Changes in medical practice in recent years, including the transition to electronic medical records and the need for independent practices to compete with large health systems, “put great stress on them even before the pandemic,” says Gary Price, president of the Physicians Foundation. The pandemic also forced physicians to invest in personal protection equipment and disinfection measures, and required them to switch to telemedicine, a new skill for some.

A second survey from the Physicians Foundation found that nearly one-third (30 percent) felt “hopeless” and without purpose as a result of the pandemic, nearly one-fifth (18 percent) had sought mental health care, and nearly one-fifth (18 percent) had increased their use of medications, alcohol or illicit drugs.

“Practicing medicine has always been a psychologically stressful thing,” adds Price, a plastic surgeon and clinical assistant professor of surgery at the Yale School of Medicine. “I think the pandemic made an already bad environment worse.”

Rockower’s decision to quit was driven more by economics and less by personal fear, despite his age and having had quadruple bypass surgery in 2006. He says his daughter, an emergency room nurse, and his physician son, concerned about his safety, convinced him it was time to retire.

“I wasn’t too worried, but my kids were,” he says. “They are on the front lines treating covid patients. I kept going into the office, and they didn’t like that. They didn’t even want me to leave the house.”

Such departures are expected to exacerbate an already growing shortage of American physicians. A report released in June by the Association of American Medical Colleges predicted a shortage of between 54,100 and 139,000 physicians by 2033, up from last year’s report, which predicted a shortage of up to 121,900 physicians by 2032. The newest study expects shortfalls in primary care of between 21,400 and 55,200 physicians, and in specialty care of between 33,700 and 86,700 physicians.

“An exodus of physicians from practice could not come at a worse time,” says Kelly Rakowski, group president and chief operating officer of Strategic Talent Solutions for AMN Healthcare, a national health-care staffing organization. “We’re already facing a shortage which will now be on steroids thanks to the pandemic. For people to get the care they need and what they’ve put off, we need more physicians, not fewer. Assume a physician manages about 2,500 to 3,000 patient encounters a year. We could be talking about tens of millions of patient visits that will have to be absorbed by other physicians, or go without access.”

Some of these patients have been showing up at urgent care centers, having nowhere else to go.

“The stories I hear from some of the patients who come in are that they lost their primary physician because their doctor has retired, or left the practice,” says Irfana Ali, medical director of Fast Track Urgent Care in Silver Spring, Md., and Kensington, Md. “I think we are getting more of them. They used to have someone they could call, and now they don’t. So when they get sick with an urgent problem, they come see us.”

She tries to help by giving them a list of primary care physicians willing to take on new patients. “I wasn’t shocked when they started coming in,” she says. “I think the risk of catching something from a patient puts a real demand on older physicians.”

D’Antoni agrees. “I can understand why older physicians with underlying health conditions are looking at this, and asking themselves, ‘Why would I risk the rest of my life?’ ” she says. “You can’t blame them at all.”

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