Facial Plastic Surgeons Respond to COVID-19, Part II: Taking Care of Patients and Staff
With calls to cancel all elective procedures and widespread stay-at-home orders in place, COVID-19 has dramatically upended the practice of facial plastic surgery in the US and abroad.
Here, two American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) board members discuss what they are doing to face these unprecedented challenges.
Group Vice President of Education, American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS)
Facial Plastic Surgeon, California
"I am a solo private practice Facial Plastic Surgeon in San Francisco. While the COVID-19 outbreak has caused a serious disruption to my practice, I have faith that we will be able to return successfully to normal business once deemed safe to re-open by our public health leaders. The immediate challenges are difficult but they are short-term. Like others, I have suspended surgery (all of mine are elective), re-scheduled in-person appointments, and transitioned to virtual consultations. These measures have helped. But what I feel has been the most important priority during this time of fear and uncertainty is to provide a sense of security to my employees and maintain engagement and support of my patients. Eventually, the pandemic will pass and restrictions will be lifted. To me, it is most important that these personal relationships remain strong through this time.
Employee trust. I made the decision to retain all of my staff during our shut-down with no furloughs or pay reduction. I expect this to be about a 2-month period of time when all is said and done. I have applied for the Federal Payment Protection loan to help with this. I pledged to them that I would do all I can to protect them through the shut-down. It has taken me a long time to develop a team of outstanding workers and I view my support of them now as a long-term investment which I expect will be paid back to me in loyalty and hard work. For the time being, they are all working remotely on various projects which will add value to the practice. Although we conduct meetings remotely now, we continue to feel the team unity which carries us forward.
Patient engagement. Communication is key here. Even though there is a lot of uncertainty, it is important that patients know we are available to support them, answer questions, and that we will be ready to resume treating them when it is safe to do so. At the start of our shut-down, I reached out by email to our entire patient database providing clear channels of communication to my office staff, my nurse, and me. I also acknowledged to them that during these difficult times, it prompts one to reflect on what is truly important—and that for me it is the privilege to take care of my patients.
Despite the outbreak, I feel incredibly lucky to be in the position I am in. First and foremost, my family and friends near me are safe and healthy and the COVID curve has flattened here, thanks to early measures initiated in Northern California. I have fantastic staff who are committed to me, relatively low overhead, and a specialized practice (rhinoplasty and revision rhinoplasty) which will likely withstand some economic downturn. My heart goes out to those less fortunate during the outbreak. The challenges I face in my practice seem small compared to the suffering faced by many."
Paul J. Carniol, M.D., F.A.C.S.
President Elect, American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS)
Facial Plastic Surgeon, New Jersey
"In New Jersey the COVID-19 struck us early and with significant impact. When we were already seeing effects of the infection, while in some other geographical locations they were not yet seeing the effects. On March 16, 2020 we “closed” our office for all elective procedures and office visits. By doing this we could support our community as possible to deal with this unprecedented pandemic.
In our facial plastic surgery practice, we treat a variety of issues. In addition to cosmetic patients, we also treat some trauma, some cancers, and some congenital disorders. We immediately canceled all of the cosmetic and congenital patients. By its nature, trauma is not predictable by type and extent. Some injuries need relatively immediate care. We have been responding to these as needed. For lesser injuries we have been treating these in our office if possible so that they do not have to go to the overstressed emergency room. Dr. Eric Carniol has been treating the vast majority of these.
The next more challenging issue is the management of cancer patients. The course of any one neoplasm has a certain amount of unpredictability. It should follow the usual course but as we all know that is not guaranteed. We are trying to follow by telemedicine and the patient’s impression for the slower growing ones. As telemedicine techniques and technology are new, we are all still on a learning curve. However, the more aggressive tumors, i.e. invasive melanomas cannot be delayed for months and will need to be treated during the pandemic. These are also “grey zone” decisions as to which tumors to treat and we wrestle with them.
As a volunteer with the local Office of Emergency Management (OEM) we contacted the local director and asked how we could assist. We brought them any supplies that we were able to share while keeping a lesser amount for our office as we would be treating trauma as described. We are on call for the local OEM services as needed.
Another important issue, especially with no income, is how do we manage our staff? Our staff has been with us for years and as possible we try to manage our staff as an extended family. Considering this we have continued to pay our employees even though they are not working.
We have applied for the Paycheck Protection Program. If this is significantly delayed how will we manage our employees? This is a challenge we will face if needed."