Bay Area Hospitals Shift Workforce to Free Doctors for Coronavirus Duty

At the same time hospitals in California are racing to secure more beds, ventilators and masks to care for a surge of coronavirus patients, they are also scrambling to prepare — and preserve — their workforce so they don’t run out of doctors, nurses and respiratory therapists, too.

With health care workers among those most likely to become sick and need weeks off from work to recover or be quarantined, hospital and government officials are calling older doctors out of retirement, asking part-time staff to go full time and moving surgeons and anesthesiologists out of the operating room and into the intensive care unit and the emergency room.

“Anesthesiology in a lot of other countries is called anesthesia and intensive care medicine,” says Dr. Jeffrey Swisher, an anesthesiologist who specializes in liver transplants at California Pacific Medical Center in San Francisco. “Every anesthesia machine in an operating room is a ventilator as well.”

Instead of intubating patients for surgery, he and his machine will be repurposed for coronavirus duty in the ICU. It’s similar with other departments, now that all elective surgeries have been canceled.

“Orthopedic surgeons who would normally be doing hip replacements or knee replacements will be asked to come in and serve as emergency room doctors, taking care of the usual emergency room business,” Swisher says.

So while the regular ER doctors are taking care of COVID-19 patients, the orthopedists can tend to the folks coming in for car accidents, heart attacks and drug overdoses.

“Because remember, we all did internships,” Swisher says. “We all did our rotations in medical school and you don’t forget this stuff, it’s like riding a bike in a lot of ways. We might be a little rusty at it.”

Instead of surgery, these doctors are spending their days in training sessions.

But these measures still may not be enough. Researchers believe prolonged exposure to the virus itself puts doctors at higher risk of becoming seriously ill, and hospitals need to plan more time off for front-line health care workers, says Dr. Ashish Jha, professor of global health at the Harvard T.H. Chan School of Public Health.

“Our best understanding of the high rates of infection is really because of a combination of inadequate PPE,” he says, referring to personal protective equipment like masks, gowns and gloves, “and fatigue and just long, long work hours. People start getting tired and they just end up being a little bit less vigilant and can make mistakes.”

This is especially worrying, he says, “because it creates a cascade where once health care workers start getting sick, everybody else has to work more hours, which increases their risk.”

Preventing this vicious cycle is going to be difficult. At San Francisco General Hospital, doctors who have a health condition that puts them at risk of becoming particularly ill from COVID-19 are encouraged to stay home. Current contingency plans for filling the gaps as others become ill generally involve other physicians working more hours.

“People are volunteering their extra time to be part of the backup system, should residents get sick,” says Grace Taylor, a third-year resident doctor in the ER.

“We're talking about changing the length of people's shifts,” she adds, to allow residents to work longer than the current 80 hours per week limit.

Administrators say they are trying to be mindful of overtime for shift workers like doctors and nurses. “We do everything we can not to mandate overtime,” says Susan Ehrlich, CEO of SFGH. “We only do it in the most extreme of circumstances.”

At Sutter hospitals, Dr. Swisher says they are actively thinking about how to reduce contact with COVID-19 patients.

“Clearly limiting exposure is important,” he says. “We try to do that by limiting peoples’ actual presence and rotating people out and make sure they can rest.”

But, he adds, they haven’t figured out exactly how to do that yet.