COMMENTARY

Docs Asked to Join the COVID Frontline Without Pay

Alok S. Patel, MD

Disclosures

May 20, 2020

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Politicians have compared the COVID-19 pandemic to a war and physicians to soldiers, but no branch of the armed services asks soldiers to risk their lives without compensation or adequate protection.

Several physicians I spoke with are being asked to join the COVID-19 frontlines and work for decreased or no pay. Dr Ryan Barnett, an anesthesia intensivist in California, completed his residency at Mount Sinai Hospital in New York. He reached out to the hospital, offering to fly out to assist in the COVID-19 unit. He was told that his help would be appreciated but he would not be paid.

"It didn't even cross my mind that they would expect me to work on the frontline without reimbursement," he said. "I had to think about the fact that I'd be leaving my primary job, be gone for weeks or possibly months, then be quarantined after that, all with student loans to pay." He decided not to go.

Others Are Offered Pay While We Are Asked to Work for Free?

An email sent out by NYC Health + Hospitals and New York City Medical Reserve Corps, asking for physician volunteers, was shared by physician groups across social media. My initial thought was, If patients need doctors, we'll be there. This isn't about money; this is a crisis. Then I started reading through all of the comments on social media, and I began to understand and share in the widespread frustration.

Several of us noticed that staffing agencies were advertising temporary nursing and lab-tech positions with exorbitant compensation. Links and screenshots of highly lucrative job offers for other healthcare workers circled social media and rightfully frustrated physicians. Nurses, respiratory therapists, physician assistants, and nurse practitioners were being offered $5000 to $13,000 per week, with benefits including food stipends, transportation reimbursements, and housing. In some cases, they specified "luxury lodging." Yet doctors are being asked to work for free?


 

It's a striking contrast that many have told me serves as an aggravating reminder that physicians' altruism and sense of duty gives administrators leverage for manipulation.

I speak for many of my physician colleagues when I say that we did not go into our fields for the money. Neither did nurses, respiratory therapists, lab technicians, or any other healthcare professional. So why is it acceptable for the same hospital to fulfill contracts for all of them while expecting physicians to volunteer?

Social Media Outcry

The more stories I heard, the more the glaring disparity sunk in. One physician anonymously reported on Twitter that, while volunteering at a New York City hospital, he asked about housing options and was told that he should find his own lodging or stay with friends.

https://twitter.com/Covid19Docs/status/1246483911728697346

Another physician emailed the administration at a New York City hospital to let them know that she was happy to work "anywhere she was needed, as a supplemental medical attending." All she asked for was reasonable financial compensation and a guarantee of PPE. She has yet to receive a response.

I hope the tide turns, especially for newly graduated residents. I feel the need to emphasize that the median medical school debt is $200,000 and the average resident takes home an average annual salary of $61,000.

After all of my preliminary research into the ambiguous economic factors at play, one question still bothered me: How is not paying physicians even an option when the average NYC hospital CEO takes in a seven-figure salary?

Hospital executives should prove that they are team players by better financially supporting their staff. Hopefully, many look to Shore Medical Center in New Jersey, Beth Israel Lahey Health in Massachusetts, TriHealth in Cincinnati, or Stormont Vail Health in Kansas for inspiration. Leaders at all of those hospitals have taken pay cuts to support their staff and aid in COVID-19 efforts.

What Do the Staffing Agencies Have to Say?

Krucial Staffing was one of the agencies that listed several of these job offers on Facebook and Twitter. I was curious about how they and others were able to offer such high rates to nurses, which included crisis pay of $3500 to $10,000 per week. That is substantially more than what most registered nurses in the United States make on average in a typical month.

https://twitter.com/KrucialStaffing/status/1250374192572379136

I spoke to Krucial Staffing founder and CEO Brian Cleary, who is himself a registered nurse, about how his company was able to procure these deals. He said New York City Emergency Management coordinated negotiations with the hospitals, which agreed to the rates. According to Cleary, "You have to take care of people and create an enticing offer to get them to show up for disaster staffing."

When asked the names of the hospitals that agreed to the contracts, he told me that they were all handled through NYC Health + Hospitals, the same group that sent out the email asking for unpaid physician volunteers. He was aware that doctors were being asked to volunteer and added, "I've had physicians reach out to us asking if they could take any of these contracts. It's not something we could do because of insurance."

I commend the healthcare professionals who took advantage of these contracts and flew out to assist in this crisis. Nonetheless, an ongoing lawsuit accuses Krucial Staffing of not giving their recruited nurses adequate PPE or properly preparing them for their roles.

All Members of the Healthcare Team Deserve Compensation

Granted, some hospitals are losing revenue and cutting pay for staff. I spoke to Dr Amy Cho, an emergency physician and cofounder of Grassroots Emergency Medicine, about it. "It's a cruel irony that there won't be hazard pay or reimbursement for our tireless efforts and instead there will be a pay cut."

Cho's comment is a stark reminder of how complicated hospital staffing is and how much louder doctors' voices need to be. "It is critical that physicians speak out with clarity, confidence, and moral authority. We are on the frontlines and we are experts."

I talked with several other physicians who are working for free alongside nurses and respiratory therapists who are being compensated. Everyone agreed that all members of the healthcare team are vital and deserve compensation and, in some cases, hazard pay. Yet, for so many doctors, it is the hazard without the pay.

Physicians' first and foremost commitment is to our patients. This is a well-known and often exploited truth. Hospital leaders galvanize us with words like "war," "calling," and "battle." So we march on, Hippocratic Oath in hand, our moral obligations superseding all else.

We need to remind the higher-ups that physicians aren't martyrs or soldiers. I'm personally not sure if this should come in the form of more advocacy, unionization, or contracts with staffing agencies, but we have to take action. Otherwise, I fear that there will always be the option for hospitals to take us for granted.

Dr Alok S. Patel is a pediatric hospitalist, television producer, media contributor, and a digital health enthusiast. He splits his time between New York City and San Francisco. Alok hosts The Hospitalist Retort video blog on Medscape.

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