NEW YORK — As the coronavirus bears down on New York and the biggest U.S. city becomes the epicenter of the national crisis, state officials are scrambling to augment a health care workforce already stretched to capacity and falling prey to the virus itself.
New York is reaching into every corner of its medical industry for reinforcements, but a new push for retired workers is raising alarms as older populations are among the most susceptible to the disease. And with state rules relaxed, medical and nursing students with little experience are being called into service. Specialty doctors and nurses are being asked to readjust their skills to battle the virus, while many others have been relegated to the sidelines of the battle.
While the wartime footing on which hospitals now find themselves requires a loosening of protocols, some worry the rush may exacerbate the crisis.
“My big concern is you bring in the high-risk group [of retirees],” said Joyce Lemon, a 67-year-old retired nurse. “Anyone who has retired has aged into it or taken a medical retirement. Both [are] groups you shouldn’t be asking to come back into a hospital at this time. If they get sick, they’re using up valuable health care for people you bring in.”
To meet a demand that could, in a few weeks, surge to 140,000 hospital beds at the pandemic’s apex, Gov. Andrew Cuomo has used new executive authority to relax medical licensing and scope of practice standards, shield health care workers from civil liability and require hospitals to increase their capacity by at least half, among other measures. He’s amplified calls for medical professionals in New York and across the country to “enlist” in the state’s reserve workforce that will staff the expected influx of Covid-19 beds and relieve front line workers falling ill to the virus.
More than 50,000 people have heeded the governor’s call for assistance, which Cuomo suggested could eventually turn into an involuntary draft. They include 16,300 registered nurses, 4,000 licensed practical nurses, 2,300 physicians, 2,400 nurse practitioners, 900 physician assistants, 300 nurse anesthetists , 160 respiratory therapists and 8,600 mental health professionals.
But none had been deployed as of Wednesday and it remains unclear when and how that will occur. As of Thursday morning, more than 37,000 people had been infected and 385 died across New York according to Cuomo’s office. The death toll increased by 100 in a 24-hour period.
Art Fougner, president of the Medical Society of the State of New York said the reserve workforce should deploy international medical graduates and newly minted doctors who did not get matched with medical institutions before turning to retirees.
“It has nothing to do with medicine rules now, it has to do with the fact that, gee, a lot of retired people are kind of in that high-risk age group,” he said in an interview.
But putting inexperienced workers in the field comes with its own risks.
Fougner said the loosened regulations have raised “a bunch of concerns with scope of practice,” potential liability issues and other changes included in Cuomo’s executive order — especially if the actions become permanent.
But, he said, “this is an all-hands-on-deck situation; this is not business as usual.”
“We understand this is an emergency … but we need to be watchful and make sure that somebody’s minding the store so that crazy stuff doesn’t happen unnecessarily,” Fougner warned.
Medical schools like Albert Einstein College of Medicine and New York University are turning to the class of 2020 to bolster the workforce. Einstein, a Bronx-based medical school, has asked its students to “resume clinical work as a sub-intern” or work in an ancillary field that doesn’t involve patient care, according to an email sent out to the class of 2020.
“We realize this news is likely startling and potentially anxiety provoking, but we are working with Montefiore leadership to protect the health and safety of those of you who choose to work in a hospital setting,” according to the email obtained by POLITICO.
NYU announced this week that it will allow medical students who have met all necessary requirements to graduate early if they volunteer to work in the NYU hospital system’s internal or emergency medicine department.
Most of the reserve force — especially medical students — are unlikely to be sent to the front lines to treat coronavirus patients, Fougner said.
“I don’t think they’ll be sending an early graduate medical student to do an emergency heart bypass, that’s clearly not happening,” he said.
Randall Moore, CEO of the American Association of Nurse Anesthetists, said the regulatory changes in New York now allow advanced practice providers, like the state’s 1,700 nurse anesthetists, “to care for patients in the most effective way possible” — essentially repurposing their skills to deal with the manifold respiratory issues brought on by the coronavirus without mandatory direct supervision.
“Nurse anesthetists are advanced airway experts,” Moore said. “You can imagine, in a crisis where a shockingly high percentage of people are going to require intubation and mechanical stimulation, nurse anesthetists are going to be a big part of that.”
With nurse anesthetists among the providers most at risk for contracting the coronavirus due to their intubation work, Moore said utilizing a reserve workforce, including the state’s 270 student nurse anesthetists, could help prevent shortages in respiratory care.
“I think that now, more than ever, it’s imperative that we have providers, whether it’s physicians or nurses, in a clinical environment providing care,” he said. “I am supportive of the concept of moving medical students into the workforce, I’m also supportive of moving nursing students, who are in the same boat … into the clinical environment too. This is not the time to allow bureaucracy to get in the way of taking care of patients.”
Many hospitals have furloughed staff that are not directly involved in the fight against coronavirus. The Hospital for Special Surgery, a medical center focused on musculoskeletal health in Manhattan, has canceled all its elective surgeries and procedures and told its staff to stay home. Lenox Hill Hospital, which is owned by Northwell Health, has also furloughed some staff but is continuing to pay their salaries.
Other hospitals are moving their specialty staff into different roles.
NYU Langone Health is using its orthopedic hospital to discharge coronavirus patients, though staff said they are concerned that they will contract the virus when they prepare patients to leave. Lemon said one staffer at NYU Langone Orthopedic Hospital asked the contract administrator: “I didn’t sign up for this. Can I resign, and come back after this?”
The health system did not return a request for comment.
Lemon said using personnel from other specialties has its pitfalls, as well.
“Your specialty may be orthopedic, or it may be neuro, or it may be the mother-baby unit,” Lemon said. “Now you’re being [put] on a medical unit that you’re not familiar with. The [nurses] won’t say no, but it has to be a unit feeling like they could come out on the other side.”