Mass Redeployment: Experience from an early COVID-19 hotspot
By Anna Flattau MD MSc MS
March 31, 2020 — Across the country, family medicine departments have undergone or will imminently undergo mass redeployment of their physicians and staff due to the COVID-19 epidemic. Our institution, Montefiore Medical Center, is located in the Bronx, NY, an area with the misfortune to be an early hotspot with a raging epidemic of this infection.
The medical center is achieving a truly extraordinary transformation to massively expand hospital, emergency department, and critical care capacity, including a state mandate to increase beds by 50%. To staff for this tsunami of COVID-19 cases, the entire medical center has undergone redeployment, including our Department of Family & Social Medicine which has so far:
- Tripled its family medicine hospitalist coverage
- Contributed to emergency department shifts
- Minimized in-person primary care staffing
- Created a hard-working telemedicine team of physicians whose age or medical conditions put them at higher risk from direct patient contact, in a system that had no prior telemedicine capabilities
- And seen our palliative care program step up to provide hospital-wide support.
Handling Family Medicine Redeployment During COVID-19
As the surge in patient volume hits new areas in our country, family physicians in any medical center will certainly be redeployed.
This will be done either by the department, or through a central reassignment process. In our context, by planning proactively, our department has so far been able to shape our own redeployment in a way that maximizes the abilities of our doctors and meets our providers’ preference to stay together as family medicine teams.
If I had one piece of advice for departments who have not yet undergone redeployment, it would be to realize early on that the unimaginable is happening
Doing so will help you maximize the psychological safety of your teams through planned restructuring and clear, frequent communication.
In this emergency situation, where every day feels like years, one week’s run time can make a huge difference in improving the design of redeployment strategies, communicating well and repeatedly with the team that consists of every individual in the department, and promoting a sense of orderliness in a deeply disrupted environment.
In the days preceding the need for mass redeployment, our sense of reality was shattered dramatically, repeatedly, as the epidemic’s reality came sweeping upon us in serially worsening waves every few hours. Multiple times within a single day, our entire understanding of our world was morphed into what was previously unthinkable, and difficult to accept and understand.
Adapting to new realities at dizzying speed is hard cognitive and emotional work that the human brain struggles to accommodate. But it is necessary to force oneself through this process to grasp the context of redeployment design and to communicate clearly with faculty and staff in a rapidly changing paradigm.
Panic is even more contagious than COVID-19.
Having a common understanding of current reality and a plan in place for redeployment is one element in helping to keep everyone grounded despite high baseline anxiety and a radical shift in expectations.
Redoing Redeployment
In the course of this highly accelerated planning process, we needed to redo our department’s redeployment plans several times as we came more and more fully to the realization that most attending physicians and all trainees would be redeployed into acute care.
Our earliest plans now seem laughably innocent.
Initially we thought we were going to rotate our attendings through the inpatient service — this is now patently absurd, as all departments are all hands on deck for the foreseeable future. At the very first, we hoped to protect some specific learning experiences for fellows and residents — but for the course of the pandemic, every trainee in our institution is now fully assigned to hospital-based work.
Our department usually runs two family medicine hospital teams, and we were proud of ourselves when we created a third team. Ten days later, we had six teams. We shifted almost literally overnight to telemedicine in primary care, with a skeleton crew on-site and a firehose of telephonic work for physicians who work remotely while covering four extra patient panels each.
Trauma-Informed Management
There are many realizations that are difficult to absorb: that we will be having endless end-of-life conversations with shocked families; that we will lose professional colleagues; that our primary care patients, whom we care about very much, will not all survive; that some of us will lose family members; that our state and country will struggle with limited ventilators.
This situation is repeatedly traumatizing to everyone involved, and there is definitely a need for ‘trauma-informed management’ for the foreseeable future.
Creating solid plans, empowering leadership throughout the department, and maximizing psychological safety in what is inherently a deeply challenging experience for our profession and our society.
Family medicine is at its core a versatile specialty designed to meet the needs of our communities, and this process is an example of how we can rise to the occasion, as we always do, even in this most difficult of times.
Anna Flattau MD MSc MS is a practicing family physician and the Vice Chair for Clinical Services in the Department of Family & Social Medicine at the Montefiore Medical Center, Bronx, NY.
