Medical treatment/cost changes due to COVID-19

[Nutria]

A number of places are licensing doctors and nurses who aren’t quite finished training to get them in the field ASAP.

This situation is bad. Like seriously, apocalyptically bad. Everyone who thinks the media is just blowing it out of proportion doesn’t comprehend what is actually happening.

This makes zero sense, given what you wrote earlier:

there have been plenty of lay offs in the healthcare realm also. I know our system has reduced staff and reduced hours in many places. Some staff had hours cut so they are still working in a reduced capacity and have been able to file for partial unemployment benefits to make up the difference.

[disneysteve]

This makes zero sense, given what you wrote earlier:

I get that those quotes sound contradictory, but they really aren't. A dermatologist in Texas or a medical assistant in Kentucky is going to be of no help with a COVID crisis in NY or NJ.

I will be attending a hospital training on Wednesday in preparation for possibly reassigning me to hospital duty in the near future since urgent care volume has dropped to nearly zero (I saw 9 patients yesterday in 12 hours). However, I haven't set foot in a hospital since January 2000, just over 20 years ago. Any hospital-based knowledge I once had is long outdated and left my brain many years ago.

Compare that to someone who is a 3rd year resident right now, actively working in the hospital setting as part of their training. They can easily have their license granted 3 months early and be put to work independently. They're going to be doing it July 1 anyway. They are far better trained to assume that role than I am.

[Nutria]

I get that those quotes sound contradictory, but they really aren't. A dermatologist in Texas or a medical assistant in Kentucky is going to be of no help with a COVID crisis in NY or NJ.

Some laid-off nurse has got to want to temporarily move to NYC for $100/hour.

Any hospital-based knowledge I once had is long outdated and left my brain many years ago.

You've been an Urgent Care physician for years. I'd rather have someone like you treat me than a psychiatrist at the upstairs psych ward.

[disneysteve]

Some laid-off nurse has got to want to temporarily move to NYC for $100/hour.

Sure, and there will be some of that happening. Of course, that requires waiving state licensure and changing some malpractice rules and policies if that person is coming from some other state.

You've been an Urgent Care physician for years. I'd rather have someone like you treat me than a psychiatrist at the upstairs psych ward.

That's very possible. But would you rather have the 3rd year internal medicine resident who works in the hospital 12 hours a day, 6 days a week, for the past 2 years, or the guy who hasn't treated a hospitalized patient or written a hospital order for 20 years?

[Nutria]

But would you rather have the 3rd year internal medicine resident who works in the hospital 12 hours a day, 6 days a week, for the past 2 years, or the guy who hasn't treated a hospitalized patient or written a hospital order for 20 years?

Is this guy who hasn't treated a hospitalized patient or written a hospital order for 20 years a GP/Internist who sees a wide variety of problems, or a urologist who spends his days snipping middle aged vas deferens?

[disneysteve]

Is this guy who hasn't treated a hospitalized patient or written a hospital order for 20 years a GP/Internist who sees a wide variety of problems, or a urologist who spends his days snipping middle aged vas deferens?

Doesn't matter. I would take the resident over myself any day. Hospital medicine is a whole different beast than outpatient family practice. I wouldn't even recognize probably 60% or more of the drugs currently used in the hospital. There are numerous very common lab tests that I know zero about as they didn't exist when I trained or back when I was doing hospital work.

[Thrif-t]

disneysteve is there anything we need to be worried about with my daughter taking a job before she is licensed? She was offered the job informally today. Formal offer coming week of April 13th. I'm nervous for her. I don't know a lot about medicine but I thought there are reasons you can lose your license, would we have to worry about that?

I already told her don't commit to anything until we read over everything. And as luck would have it, my nephew is a nurse at the same hospital so I'm sure he can give us some tips. But I don't want to see her get screwed for some reason?

Oh and just to bring this back around to on topic. I listened to a 4/2 episode of Clark Howard's podcast and one thing he said big insurers were doing is not billing copayments and coinsurance while this was all going on. That's about the extent of the details I remembered from the podcast.

[disneysteve]

disneysteve is there anything we need to be worried about with my daughter taking a job before she is licensed?

She needs to make sure she has all of the proper licensing and credentials and that she is fully covered by insurance. I can't imagine any hospital would allow her to get near a patient if all of that wasn't in place anyway because they would be equally liable.

[Thrif-t]

She needs to make sure she has all of the proper licensing and credentials and that she is fully covered by insurance. I can't imagine any hospital would allow her to get near a patient if all of that wasn't in place anyway because they would be equally liable.

She's not going to have any licensing, she will graduate May 9th and start right away. Well I guess we need to get the details on the 13th I don't know when she will start. She told me she can work and worry about taking her boards later after the pandemic passes, she said maybe in the fall or December(to take boards).

I guess I'll check back with you when she gets a formal offer and I review the paperwork. It scares me to death, being she didn't even get to do all her clinicals or preceptorship. Maybe she is misunderstanding and she'd just be an aide but have a job once she passed her boards? I don't know?? Being young she isn't fearful.

[disneysteve]

She's not going to have any licensing, she will graduate May 9th and start right away. Well I guess we need to get the details on the 13th I don't know when she will start. She told me she can work and worry about taking her boards later after the pandemic passes, she said maybe in the fall or December(to take boards).

I guess I'll check back with you when she gets a formal offer and I review the paperwork. It scares me to death, being she didn't even get to do all her clinicals or preceptorship. Maybe she is misunderstanding and she'd just be an aide but have a job once she passed her boards? I don't know?? Being young she isn't fearful.

A lot of normal requirements have been waived due to the COVID crisis, and it's a state by state thing since licensure is state-run. If her state has waived certain requirements then she should be just fine. Again, no hospital is going to let people start caring for patients if they don't meet whatever the current rules are.

[Thrif-t]

Yep I guess Ohio is actually one of those states that has relaxed their standards. I found this article https://www.toledoblade.com/local/Co...es/20200331092

[disneysteve]

Yep I guess Ohio is actually one of those states that has relaxed their standards. I found this article https://www.toledoblade.com/local/Co...es/20200331092

Yep. Several states are doing similar things.

I know on the doctor side of things, they are allowing retired doctors or those who otherwise let their licenses lapse (perhaps because they were no longer actively seeing patients) to get relicensed but waiving CME requirements and waiving the normal fees. You want a license? Here it is.

One concern I have with the call for help to retired medical professionals is you're reaching out to older people who are automatically high risk, even more so if they have any health conditions. So we're asking the most vulnerable to move up to the front lines. Scary stuff.

[Nutria]

I wouldn't even recognize probably 60% or more of the drugs currently used in the hospital. There are numerous very common lab tests that I know zero about as they didn't exist when I trained or back when I was doing hospital work.

That's interesting, and (to me, at least) unexpected.

we're asking the most vulnerable to move up to the front lines.

Would they be in in the front lines, or back fill for younger people who have been pulled into the front lines?

[disneysteve]

That's interesting, and (to me, at least) unexpected.

There have been a lot of medical advances over the past 20 years.

Would they be in in the front lines, or back fill for younger people who have been pulled into the front lines?

Probably a little of both. If the person coming back from retirement is a former intensivist, it might be a waste to have her doing scut work on a general medical floor, if she's even willing to do so. If, however, the person coming back is a recently retired floor nurse, he would probably be perfectly happy to jump right back into it.

I'm heading to the hospital on Wednesday to start training to do hospital work. We've been assured repeatedly that we will be doing low level tasks in order to free up the hospitalists to care for the more serious stuff. As long as that's true, I'm probably okay. I'll still be totally out of my element but I'll figure it out. This crisis is stressing out everyone involved so we just all have to do our part.

[Nutria]

There have been a lot of medical advances over the past 20 years.

I guess I was assuming that you kept up with the journals, Continuing Ed, that sort of thing.