Surgical Subspecialties during the COVID

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  • Bonez
    Member
    • Apr 2016
    • 212

    Surgical Subspecialties during the COVID

    How are the surgical subspecialists holding up during Coronavirus? Our state just opened up for "elective surgeries" last week, but the hospitals had furloughed the majority of OR staff and the ramp-up is slow (some hospitals not re-opening normal block time for who knows how long). I haven't gotten a paycheck since the end of March and don't expect to get one until July probably..
  • uksho
    Member
    • Aug 2018
    • 990

    #2
    Originally posted by Bonez
    How are the surgical subspecialists holding up during Coronavirus? Our state just opened up for "elective surgeries" last week, but the hospitals had furloughed the majority of OR staff and the ramp-up is slow (some hospitals not re-opening normal block time for who knows how long). I haven't gotten a paycheck since the end of March and don't expect to get one until July probably..
    Depends:
    Academic/employed/pvt practice
    Also, on specialty
    Trauma/ICU: Busy
    Vascular: still seem busy
    Plastics( especially cosmetic ): not so
    Bariatric: no cases
    Surg Onc: still seem busy
    Ophthal: I think they were also doing only emergency cases.
    Urology: I don't know

    Obviously apart from trauma/ICU, I don't think anyone is near their normal volumes.

    Hospitals depend on these cases for survival, so hopefully we can ramp up soon, but I doubt, with all the restrictions and fear.Even in the places they are opening, either there is a slower turn over due to cleaning, restriction of 50% volumes, pts scared to come to hospital or loss of insurance.
    This is just an unfortunate situation for everyone. Hope you soon get busy enough.

    Comment

    • wa2106
      Physician
      • Nov 2017
      • 497

      #3
      Oncologic surgery has held up just fine. Usually 60% of my practice, last 2 months basically 100%.

      Good to be diversified.

      Comment

      • ACN
        Moderator
        • Jan 2016
        • 1426

        #4
        Ortho: back to 90%+

        Comment

        • HandFellow
          Member
          • Jan 2016
          • 477

          #5
          full speed until middle of march. Hit the breaks real hard for 2 weeks and saw a lot of post ops and fractures. Gradually started figuring things out in April and looked at my total billing for the month of April, before insurance adjustments, and my billing was around 70% of a typical month. I expect to be more of less back to normal this month based on current volume.
          Distributions for the month of March and April were about 50% of normal, but I had a long vacation right before the shutdown.
          Fortunately having ownership in a surgery center has made it easy to start doing surgeries again now that restrictions have been lifted.

          Comment

          • Cubicle
            Other Professional
            • Sep 2019
            • 1494

            #6
            My hospital does a lot of cardiothoracic cases. They're back to their typical case load.
            General is approaching 80% pre-shutdown volume.
            Ortho is slow but just like before.
            Vascular is slow.
            Plastics is slow.
            Breast & OB are massively down still.

            "Bring us cases!!!"
            "Can I start at 7?"
            "No."
            " ... "
            $1 saved = >$1 earned. ✓

            Comment

            • Nysoz
              General Surgery
              • Oct 2017
              • 1866

              #7
              Luckily I never missed a paycheck or had a decrease in pay despite being pretty slow for a few weeks. Still put in ports and did cancer related cases with the various urgent/emergent cases.

              Elective outpatient cases started about 1-2 weeks ago now I think and we're about 80% back to normal. Elective cases requiring inpatient stay isn't quite allowed yet, but starting soon.

              Comment

              • ENT Doc
                Physician
                • Jan 2017
                • 5766

                #8
                Hard to say right now. And I think that’s the case for most private practice surgical subspecialties. If you think your volumes are good now look ahead the next few weeks or month. We stacked a lot of people into this part of the month from late March and most of April. Referrals declined because no one was going in or seeing patients. So we didn’t “bank” a month or two of patients. Sure, filled a week or so but nothing like it would be normally. I think we’re going to be busy for a week or two then hit a lull as we realize the decline in third next available and reduced referrals (because of loss of insurance, fear, referring providers not seeing people fully). This is going to take a while to get back to normal. Culture of patient populations will drive volume too. I have a strong suspicion that a lot of blue collar workers are ready to come in, mask or not, regardless of age. Will be interesting to see if that plays out in my practice location compared to others in my practice who have less blue collar workers. I think the Medicaid increase we’ll see will necessarily drive lower revenues, which I don’t think people are thinking about.

                Comment

                • TheDangerZone
                  Physician
                  • Dec 2018
                  • 692

                  #9
                  I agree with above. We are back to 80% of pre COVID volume in clinic and 90% in OR, but working through a backlog of postponed cases. Loss of referrals from primary providers is a clear possibility.

                  We should have a clearer picture of the “new normal” in a month or so. Don’t get me wrong, not complaining about being back to work but current production in many cases may be skewed.

                  Comment

                  • BruinBones
                    F.I.R.E. Surgeon
                    • May 2018
                    • 318

                    #10
                    Rural, Hospital employed Ortho. Was down to 30% of normal in office and 10% of normal for surgeries past 2 months.
                    Now back to 75% and 50%.
                    General surgery here seems to be bouncing back about the same rate as mine.

                    Comment

                    • bonebrokemefix
                      Physician
                      • Apr 2017
                      • 85

                      #11
                      For the employed subspecialists, have they continued to pay you at Pre covid rates? Any concessions for RVU targets or other production metrics?

                      Comment

                      • endo4jc
                        Member
                        • Nov 2018
                        • 175

                        #12
                        Ortho: never changed as my practice is call based. The elective folks are ramping up.

                        Comment

                        • BoneDoc32
                          New Member
                          • Jun 2019
                          • 6

                          #13
                          Ortho here: Clinic volume is approximately 60% of pre-covid. Surgical volume now 120% of pre-covid volume due to more time available for surgery.

                          I expect my RVU's to increase for the year (even with the down month of April). A 30% paycut is planned for 3-6 months starting in July... Go figure...

                          Comment

                          • Tim
                            Member
                            • Sep 2018
                            • 19558

                            #14
                            Originally posted by BoneDoc32
                            Ortho here: Clinic volume is approximately 60% of pre-covid. Surgical volume now 120% of pre-covid volume due to more time available for surgery.

                            I expect my RVU's to increase for the year (even with the down month of April). A 30% paycut is planned for 3-6 months starting in July... Go figure...
                            Curious, the rationalization of your compensation cut would be to recoup losses of the hospital/healthcare group?

                            Comment

                            • BoneDoc32
                              New Member
                              • Jun 2019
                              • 6

                              #15
                              I'm an employed hospital group. I don't necessarily want to get to far into this topic (I have previously posted about it). All physicians were given a 10% reduction. We have a quality bonus (this is really a 10% with holding which is redistributed based on quality metrics. I was also due for a 10-15% raise.

                              To re-coup losses for the hospital the following was instituted:

                              9 physicians were laid off (mostly older / lower production) (2 in the my department)
                              Furloughs for lower tier staff
                              No bonuses (this is 10% for an entire year)
                              No raises (I was due 10-15%) for 3-6 months.
                              10% reduction in current salary for 3-6 months.

                              Based on our compensation model the COVID period actually falls out of this time frame. It is based on a 1 yr RVU collection which ended in January 2020. The salary is readjusted in July. Technically this should not have affected compensation until July 2021. One of my partners also gave notice and there was no effort to retain him. None of these changes are set to occur until July, so I will sit back and see how things play out.


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