America's coronavirus epidemic has placed an outsized burden on the country's health care providers, with many medical professionals on the frontlines risking their own safety to care for patients with Covid-19. That danger is particularly great for America's older medical workers, whose age puts them at a higher risk of developing a severe case of or dying from Covid-19—and now, many are choosing to retire early, close their practices, or change the way they work, the Washington Post's Marlene Cimons writes.

How Covid-19 will impact the clinical workforce

Physicians shift their employment plans in light of Covid-19

According to Cimons, in a survey of more than 3,000 U.S. physicians released earlier this year by the nonprofit Physicians Foundation, 4% of respondents said they would not return to work because of personal health concerns, and 28% said they had "serious concerns" about contracting the novel coronavirus. Another 47% said they were moderately concerned about catching the virus, Cimons writes.

The survey also found that 8% of respondents said they had permanently closed their offices, Cimons reports, though she notes that the survey did not ask those respondents why they had closed. According to Cimons, 72% of all respondents said they had lost income because of the epidemic.

The survey's findings highlight that health care professionals' reasons for changing their employment plans amid America's coronavirus vary, as do the types of changes they've made. Here are the approaches that some providers have taken—and why—in their own words.

'I've never been that scared'

According to Cimons, Michael Peck—a 66-year-old anesthesiologist working part-time in the Maryland suburbs of Washington, D.C.—on April 3 worked a 12-hour shift, during which he intubated severely ill patients with Covid-19 who were being placed on ventilators. Although Peck was wearing personal protective equipment (PPE)—a gown, gloves, and a mask—during the shift, "he was terrified," Cimons writes.

"I've never been that scared," Peck told Cimons. "When it was over, I said to myself, 'This is crazy. I'm done.'"

According to Cimons, Peck already had "semiretired," choosing to only work part time. However, April 3 "was his last [day] on the job," Cimons writes.

"The environment was frightening," Peck told Cimons, even despite the fact that Peck had access to PPE. "It wasn't so much when I was wearing the stuff, as when I was taking it off," he said. "I thought: 'Why am I doing this? Why run this risk?'"

'I like what I do. But I'm not going to risk my life to do it.'

Meanwhile, Louis Korman—a 73-year-old gastroenterologist working in Washington, D.C., and Chevy Chase, Maryland—stopped providing endoscopies and colonoscopies in March because of the coronavirus, Cimons reports. Cimons notes that both procedures "are invasive," and Korman thought performing the procedures "was risky for him because anesthetized patients often cough, and the tubes can pick up potentially infectious materials."

Korman told Cimons, "You are putting yourself into a prolonged exposure to an aerosolized environment."

Now, Korman uses telemedicine to see patients, and then refers his patients to his younger associates when hands-on services are needed. He's contemplating retiring, however, like two of his colleagues in their mid-60s did this summer, Cimons reports.

Korman told Cimons that treating potentially infectious patients during the epidemic "takes a real emotional toll, … [n]ot just to [him]self, but also to [his] family." And when he considers how his age puts him at an increased risk of developing a severe case of Covid-19, "it's scary stuff," he said, because "[t]he mortality increases exponentially with each decade."

Overall, Korman told Cimons, "I like what I do. But I'm not going to risk my life to do it."

'There were weeks when we'd see maybe three patients'

Stephen Rockower—a 70-year-old orthopedic surgeon in Rockville, Maryland—also recently retired, "albeit reluctantly," Cimons writes.

Rockower told Cimons, "I absolutely would've kept going at least in some fashion or other if not for" the epidemic. He explained, "We went from seeing 15 to 20 patients in a half-day to maybe one or two. There were weeks when we'd see maybe three patients. People were afraid to come in."

Rockower said he began seeing some patients via telemedicine, which he described as "okay" but difficult. "[Y]ou can do some things—but it's really tough to examine somebody. You can say: 'Bend over and touch your toes,' or 'Put your hand over your head,' but there are things that have to be done in person, for example, feeling if the skin is warm to see if there is an infection."

Rockower said his experience with telemedicine overall "was not very satisfying," but his decision to retire was driven more by economics and his family's concerns for his health.

"I wasn't too worried, but my kids were," he told Cimons, who reports that Rockower's daughter is an ED nurse and his son is a physician.

"They are on the front lines treating [Covid-19] patients. I kept going into the office, and they didn't like that. They didn't even want me to leave the house," Rockower said.

'I'm not going to stop doing my job'

Separately, Gary LeRoy—a family physician in Dayton, Ohio, and president of the American Academy of Family Physicians—has said conducting appointments mostly via telemedicine could be harmful for some patients, and it's important that some providers continue on with their work.

According to Cimons, LeRoy's practice switched "from all in-person visits to nearly all telemedicine" amid the epidemic. But LeRoy said the switch has placed him at a disadvantage when it comes to caring for some patients.

"I begin my examination from the moment I lay eyes on you, the way you walk, the way you dress," LeRoy said. "If I look at you only from the neck up, it doesn't allow me to really see you. Why are you limping? Why do you look so pale? I had one patient who looked fatigued. It turned out she had a partial heart block, and needed a pacemaker. The fact that I was sitting there looking at her [in person] probably saved her life."

LeRoy said health care providers can rely on their training to mitigate their risks. "[W]e've been well trained in universal precautions. We know how this stuff spreads and how to take care of ourselves," he said, adding, "I'm not going to stop doing my job."

Still, LeRoy said he also worries about his personal risk from treating patients in person amid the coronavirus epidemic. "I hear individual physicians who say, 'I'm older, I have a chronic health condition, I value my life too much to risk dying from this thing,'" he said. "It does make you think about your own survival, that you aren't invincible" (Cimons, Washington Post, 10/3).