As the COVID-19 pandemic stretches across the country, physicians have had to modify schedules, evaluate patient needs and change the way their businesses are run.
The American Academy of Ophthalmology and the American Society of Retina Specialists have recommended ophthalmologists restrict seeing patients to urgent or emergency cases, as well as screening any patients coming into their offices for symptoms of the novel coronavirus.
Laura M. Periman, MD
Healio/OSN Board Member
Seattle, Washington
Laura M. Periman
Our practices and our lives have changed dramatically from early to late March and continue to rapidly evolve. With the prime directive of “do no harm,” I canceled all elective procedures and nonurgent visits. I agree with the strongly worded March 18 letter from the AAO calling for postponement of all elective procedures and nonurgent visits. Doctors are concerned about the rate of spread, the high contagion factor and the high mortality rate in the vulnerable population. Additionally, we now know that infected patients do not always have a fever (thus, temperature screening is insufficient for protecting our other patients in the clinic), and we now know that healthy people well younger than age 70 years are vulnerable and dying (thus, age screening is insufficient). The rate of viral shedding and infection from asymptomatic individuals is much higher than previously estimated. While I appreciate the creativity behind the idea of repurposing plastic folders as makeshift slit lamp shields, this provides a false sense of security because newly published research indicates that the COVID-19 virus lives on plastic for 5 days and lingers in the air for hours.
Doctors are also concerned with conserving resources. Washington State Department of Health is calling for inventory of equipment in our ASCs in case we need to convert to makeshift critical care facilities. I have enormous respect for our Italian colleagues who have come together and leaned into the crushing workload of the hospitalized and critical care patients.
I am glad to see we have some relief on telehealth and HIPAA requirements. This will help us continue nonurgent care. The AAO has posted excellent guidelines on how to implement and bill for telehealth. I am finding patients respect and appreciate the decision to postpone elective and nonurgent visits. I am also finding that patients very much appreciate my personal phone call rather than simple postponement of their nonurgent visits for an undetermined period of time.
These are unprecedented times, and we all need to shoulder into the workload of the COVID-19 response. While the massive yet necessary changes are indeed painful for our patients and our colleagues, it is also an opportunity to lead, pivot and reinvent how we serve our patients. With collegiality, innovation and persistence, I am optimistic that we can contain and defeat this viral foe that unites us.
Eric D. Donnenfeld, MD
OSN Cornea/External Disease Board Member
Long Island, New York
Eric D. Donnenfeld
The world of ophthalmology has changed dramatically over the past several weeks with the COVID-19 pandemic. We closed 80% of our offices Friday, March 13, and we are only doing emergency surgery. A couple of second eyes in patients with significant anisometropia had cataract surgery the following week, and that is the end of cataract surgery. Our OR is open only for emergent cases such as retina corneal perforations and glaucoma.
We have opened four regional emergent offices that are staffed by a skeleton crew of office staff, a retina doctor and a glaucoma doctor. We have a cornea person on call but not seeing routine cases. All of our offices are being cleaned several times a day, family members stay outside in their cars, and only the patient is allowed in the waiting or examining room. We have outfitted many of our slit lamps with homemade splashguards.
We are still following up with some postops from the last few weeks, but the busiest part of the practice is anti-VEGF retina injections. Our main OR does around 100 cases a day. March 19, there were two cases.
We have taken any physician older than the age of 68 years and are not allowing them to see patients for any reason. There are six people affected. We have about 100 ophthalmologists in the practice, and on any given day, only 10 are seeing patients. We have seven ODs in the practice, and they are not working at all.
Our biggest problem is we have had to close three offices because a staff member was exposed to someone at home with COVID-19 and we were forced to move to another office. The only offices that are open have retina capability.
We have had to furlough many of the staff. Partners are not taking a paycheck, and associates are continuing to be paid based on productivity, which is not a lot.
We are continuing health insurance for all.
Our management is doing an exceptional job, and they could write a book about how to respond to a crisis.
As a managing partner, I have an update twice a day with our management leadership, and we keep our lines of communication open with physicians and staff through frequent emails and personal calls when needed.
New York is exploding with new cases, and there is a sense of dread as hospitals are being overrun with new cases. Keeping the subways, theaters and schools open so long was in my opinion a bad decision that is now affecting the entire population.
We are taking draconian steps, but I believe they are necessary, and we are confident we will come out the other side stronger than ever, but there is a good deal of pain right now. Most importantly, none of our staff or physicians has tested positive yet.
In summary, this is a time of concern in ophthalmic practices and the key to our success is to limit exposure and continue our vigilant action plan to stay abreast of CDC and local department of health guidelines as they are released. My best to my colleagues is to stay home as much as you can with your family.
Steven Silverstein, MD
Kansas City, Missouri
Steven Silverstein
Had you asked me 1 week ago about life, health care and my practice in Kansas City, Missouri, I would have told you that it is business as usual. However, as each of you know, the unchartered circumstances are changing hourly. We have decided to remain open and accessible to patients. We will practice every manner of precaution and have given our staff the option of either maintaining proper hygiene or staying at home. If they choose to remain at home, they can use PTO or time off without pay, and their job will be secure.
In the end, we are in the health care business. I would not ask my patients nor my staff to face risk I am not prepared to accept for myself.
This is yet another, albeit more virulent, virus, but a virus just the same, and I am concerned about the precedent this will set for future, more virulent strains.
I wish each of you and your families good health and happiness.