Richmond Bryan K, Dean L Scott, Farrell Timothy M
37297 Department of Surgery, West Virginia University, Charleston, WV, USA.
20205 Health, Education and Research Institute, Charleston Area Medical Center, Charleston, WV, USA.
Am Surg. 2020 Aug;86(8):916-925. doi: 10.1177/0003134820945203. Epub 2020 Sep 14.
The coronavirus disease 2019 (COVID-19) pandemic dramatically altered the delivery of surgical care.
Members of the Southeastern Surgical Congress were surveyed regarding system adjustments, personal impact, and productivity losses. Subgroups were analyzed for disproportionate impact across practice models (academic/employed/private), practice communities (urban, suburban, rural), and practice case-mix categories (broad general surgery, narrow general surgery, specialty practice, hospital-based practice).
135 respondents reported that 98.5% of surgeons and 97% of hospitals canceled elective cases. Practices and hospitals reduced staffing dramatically. Telemedicine was utilized by most respondents. Hospitals variably implemented system changes, developed tests, and set up diagnostic centers. Most surgeons anticipated resumption of practice and hospital activity by July 1, 2020. More than one-quarter reported worsened financial status and personal well-being. Interestingly, family/personal relationships were improved in more than one-third. Most surgeons anticipate reduced year-end case volumes, clinical productivity, and salary. In subgroup analyses, academic surgeons were more likely than employed and private-practice surgeons to use telemedicine and to work in hospitals with in-house COVID-19 testing. Private-practice surgeons expected decreased financial status, case volumes, relative value units (RVUs), and salary. More rural surgeons anticipate reduced salary than urban and suburban surgeons. Surgeons in narrow general surgery practice reported more furlough of employees than specialty surgeons, hospital-based surgeons, and broad-based general surgeons. Narrow-practice surgeons and specialists were more likely to report RVU reductions and improved family/personal relationships.
The COVID-19 slowdown affected surgeons throughout the southeastern United States. Variations between different practice models, communities, and case-mix categories may help inform surgeons in the future.
2019年冠状病毒病（COVID-19）大流行极大地改变了外科护理的提供方式。
对东南外科大会的成员进行了关于系统调整、个人影响和生产力损失的调查。对不同执业模式（学术/受雇/私人执业）、执业社区（城市、郊区、农村）和执业病例组合类别（广泛普通外科、狭义普通外科、专科执业、医院执业）的不成比例影响进行了亚组分析。
135名受访者报告称，98.5%的外科医生和97%的医院取消了择期手术。执业机构和医院大幅减少了人员配备。大多数受访者使用了远程医疗。医院以不同方式实施了系统变革、开展了检测并设立了诊断中心。大多数外科医生预计2020年7月1日前恢复执业和医院活动。超过四分之一的人报告财务状况和个人幸福感恶化。有趣的是，超过三分之一的人报告家庭/个人关系得到改善。大多数外科医生预计年终病例量、临床生产力和薪资会下降。在亚组分析中，学术外科医生比受雇和私人执业外科医生更有可能使用远程医疗，并在设有内部COVID-19检测的医院工作。私人执业外科医生预计财务状况、病例量、相对价值单位（RVU）和薪资会下降。与城市和郊区外科医生相比，更多农村外科医生预计薪资会降低。狭义普通外科执业的外科医生报告的员工休假情况比专科外科医生、医院外科医生和广泛普通外科医生更多。狭义执业外科医生和专科医生更有可能报告RVU下降以及家庭/个人关系改善。
COVID-19导致的放缓影响了美国东南部的外科医生。不同执业模式、社区和病例组合类别之间的差异可能有助于为未来的外科医生提供参考。
