How has the resurgence of the pandemic affected your urology practice?

Nina Davis, MD, FACS

“Pandemic 2 is far worse. The only good news is that we planned for this originally, so we have options for delivering care. Our intensive care unit [ICU] is 100% full, so we turned our recovery room into another ICU. Luckily, we haven’t had to go to the next level and set up a ward in the auditorium.

The [US] Air Force came to help with things that don’t require medical skill—like screening guests at the door.

Pandemic 2 really locked us up. It’s much worse than before. Individuals were coming back to the office; now they’re retreating home to do patient care.

A lot of us—oncologists particularly or ones, like me, who do female medicine—must examine patients. I can’t do much surgery because mine is mostly elective.

Patients started coming out with the vaccine but now they’re retreating. It’s difficult to get individuals to follow up.

Many elderly patients aren’t computer literate, so they can’t do virtual visits. I won’t do new patients on the phone. You can’t form a therapeutic relationship over the phone—I’m sorry. Face-to-face, there’s more opportunity to establish a connection.

During emergencies like this, the VA [Veterans Affairs] reaches out and takes civilian patients. The VA provides tertiary clinical care when the university can’t.

I treat patients with multiple sclerosis [MS]. During the first phase, we had no losses. The MS population did awesome. Now, however, we’re getting secondary cases; I’ve had people hospitalized. It makes me sad because they’re doing everything right. Now, they’re evidently quite susceptible to Delta [variant] and we’re almost 100% Delta in this state. It spread fast because we have so many unvaccinated.”

Nina Davis, MD, FACS

Portland, Oregon

Yousef Salem, MD

“The resurgence hasn’t affected us too much here in Virginia. Because of precautions, we aren’t getting hit as hard.

One impact is the hospital’s seeing a staff shortage, especially nurses. Our hospital system went out of the country to hire nurses from different countries because they can’t get enough here.

It affects us because it’s hard to find staff for the right job. We have high turnover. It’s hard to find somebody with experience. We hire somebody, train them, and after a few months some of them are overwhelmed by the work and leave. Then we must do it again. Health care is hard because you have contact with patients. That increases your risk.

Urology is a bit different because patients come in for a specific need. They have symptoms that simply cannot wait—a staph infection, bleeding, or stones. Those patients really can’t delay.

Patients who need medication for ED or other medication refills don’t have to come in. Their needs are met without risking exposure in the office.

We are affected financially, however, because much of what urologists do are procedures, like cystectomies. Telehealth appointments aren’t as beneficial to the practice because often patients are charged based on time spent and the complexity of the visit. We lose a lot of revenue because we’re not doing a cystoscopy- or urodynamics—all of which make money, maybe 30% to 40% of practice revenue. We had to stop doing them, so practice income is affected.”

Yousef Salem, MD

Alexandria, Virginia

Jacob McCoy, MD

“Nashville is getting hit really hard. Fortunately, or unfortunately, we got hit hard the first time. We learned a lot, so we were able to quickly transition back to telemedicine where appropriate. We also canceled our more elective cases when it got bad.

Vanderbilt [University Medical Center] had to do strategic redeployment of providers of all specialties to help accommodate overflow intensive care units [ICUs], and critical care doctors who are caring for patients with COVID-19.

I’m more likely to get with patients who are following up for routine care over the phone or our online portal instead of them coming in.

Patients are more wary of undergoing surgery. I’ve had several who decided to hold off until COVID-19 is under better control.

ICUs are overwhelmed, between providers getting sick themselves or the number of patients they’re caring for. They’re asking other providers to assist in the ICU, just to have manpower.

We’re continuing with high-priority patients with cancer, important or life-threatening cases, but the truly, purely elective cases are being held off.

We look at it on a day-to-day basis. It’s not just a blanket shutdown. We look at the census; talk to the surgery board; look at how many and types of beds are available. The day before surgery, we coordinate with all the surgical specialties, shutting down a room, cancelling cases as necessary, if staffing’s unavailable.

Patients in the community may hesitate to go to Nashville because of the larger population and the way COVID-19 is. They prefer to stay in their smaller town or in the country.”

Jacob A. McCoy, MD

Nashville, Tennessee