Ophthalmologists must persevere
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The COVID-19 pandemic is now into its 10th month of impact on U.S. ophthalmologists and their patients.
We have experienced three waves of cases since March. The first wave peaked at about 37,000 cases a day in April and resulted in a near-complete shutdown of nonemergent eye care. Cataract surgery case volumes were down 96% in April, and even those practices that stayed open, like ours in Minnesota, were at 15% to 20% of usual clinic volumes, managing urgencies and emergencies only. The recovery was fortunately V-shaped and especially rapid for ophthalmology, but the typical practice lost at least a full quarter’s worth of revenue.
By July, most of us were back at 80%-plus of pre-pandemic clinic and surgical patient volume, but another surge peaked in July at nearly 90,000 cases a day, more than two times the peak case volume in the spring. Most of us in private practice were minimally affected by this second surge of cases, and with careful patient screening, extensive use of personal protective equipment, increased clinic and OR cleaning, and reduced participation of family members in patient visits (the parking lots became a busy waiting room), we experienced a return to near-normal patient volumes. In our practice, we learned to manage the same volume of patients per hour in both the clinic and ASC. The main impact was a significant increase in overhead to cover patient screening, PPE use by staff and patients, and increased cleaning after every patient encounter required to ensure patient, employee and doctor safety. There was also a more difficult to measure but tangible decrease in staff and provider morale.
We got through the second surge, thinking we might have seen the worst of it. But we were wrong. As I write, there is a third surge in COVID-19 infections that, at press time, has resulted in more than 200,000 reported cases a day, 2.5 times the second surge peak and five times the first surge peak — and every day there is an increase in reported cases.
In our private practice clinics and ASCs, patients continue to seek eye care and we continue to provide it, but in some institutional and hospital outpatient department-based practices, ICUs are filling up again and elective cases are being managed downward. Our national infectious disease experts are warning us to plan for a difficult winter, as the COVID-19 pandemic is magnified by the winter increase in influenza and common cold viral infections. Health care providers at all levels and their patients are burdened with multiple personal and professional stresses, and morale is down as burnout increases. It is estimated that as many as 8% to 10% of senior physicians will either see their practices fail or voluntarily retire from practice. Fortunately, we have several promising vaccines about to be released, and our hospitalist and ICU colleagues have learned how to manage the most severe cases with a lowered fatality rate per 1,000 cases.
This past year has been the most challenging I have experienced in my 50 years in medicine. I am stressed, my colleagues and employees are stressed, the companies that support our field are stressed, our professional societies are stressed, and our patients and their families who we have dedicated ourselves to care for are stressed. My personal commitment, while doing all I can to stay safe and well myself, is to dress up and show up every day, doing my best to lead by example, and as always, my family, my friends, my staff and my patients’ best interests remain my highest priority.
Sadly, the COVID-19 pandemic is likely to get worse this winter, but it will not last forever. Now is the time to rise to the challenge, plan wisely and execute one’s personal and practice plan carefully. Finally, as Churchill famously said in the dark days of World War II in England: “This is the lesson: never give in, never give in, never, never, never, never.” This is a time when simple steady persistence and perseverance will trump most other attributes.
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