key: cord-0940178-3h0kzd6m
authors: Romeo, Marco; Gonzalez-Peinado, David; Duran, Hector
title: Will private plastic surgeons survive the pandemic? Analyzing the impact of COVID-19 on private practice
date: 2021-03-10
journal: J Plast Reconstr Aesthet Surg
DOI: 10.1016/j.bjps.2021.02.004
sha: 359b7d5eac02d3ddd12a473d495c2b06cce4b1f1
doc_id: 940178
cord_uid: 3h0kzd6m

nan

On December the 31 st , 2019, a pneumonia of unknown origins detected in Wuhan, China, was first reported to the WHO Country Office. After that, the initial outbreak escalated into a global pandemic. Until May 2020, 5.27 millions cases of COVID-19 have been reported, including 340.000 deaths, affecting 210 countries 1 .

Different measures have been taken by these countries to prevent the spread of the virus (such as social distancing), and Emergency Status was declared worldwide.

Public and private hospitals started to change protocols to treat both outpatient and inpatient settings, including suspension of elective surgeries and presential consultation being postponed 2,3 .

How will these changes affect private plastic surgeons' life? Most of the studies are focused on hospital environment, none of them on private practice. We tried to determine how the pandemic has affected the life, job and economy of private plastic surgeons.

A 30-question anonymous survey entitled: "COVID-19 impact on plastic surgeon's private practice" was sent via the online system SurveyMonkey® only to Board Certified Plastic Surgeons around the World.

The questionnaire analyzed: 1) Current private practice setting; 2) Changes in surgeon's practice;

3) Forecast of consequences in own's practice due to the suspension of activity.

The survey was sent between the 28 th of March and the 16 th of April 2020, when awareness about the pandemic was rising.

The Scientific Community actively replied, 205 out of 300 surgeons (69%) across 34 different countries replied to the survey.

Most of the working time of our participants is dedicated to private practice and the income of 65% of them comes only from private practice.

The spontaneous interruption of the activity before authorities ordered the lock-out showed a responsible reaction of the medical community around the globe. 90% of surgeons stopped their activity in March; 68.7% for self-initiative, 27.7% for authority regulation and 3.6% stopped for other reasons, such as patient's cancelation, Figures 1-2. 72% of the surgeons were able to offer telemedicine, which reflects the image of a modern surgeon (quite appreciated by patients) and reduces the distance between patient and physician.

Unfortunately, there are some potential risks too. The most relevant problem is related to privacy since most of the platforms that allow video-communication do not fulfill the privacy requirements of most countries, exposing the surgeon to legal consequences.

Considering the socioeconomic aspects related to plastic surgeon, there is a great variation in the monthly income of the participants (17% reported an income of less than 5000€*, 33% between 5000 and 10.000€, 26% between 10.000 and 20.000€, 24% more than 20.000€).

When asked if they believe that COVID-19 caused a global economic problem, the surgeons gave a unanimous affirmative answer (98%).

As the pandemic forced to stop non-essential medical activities, most plastic surgeons decided to keep their staff at the original salary (73%) even when most of them (85% of the participants) received no support from their government.

Maintaining salaries with no income is also a difficult situation that becomes eventually unsustainable. 47.3% of our participants considered that they could stand this situation between 4-8 weeks, 15.7% less than 4 weeks and 37% more than 8 weeks.

Only 23,9% of them have a family member that could provide economical help during this situation and only 5,85% of our participants' insurances cover their lack of income during a pandemic. Even though, most of the participants (61.5%) did not consider working or returning to work (if they had done so before) in a public institution as an emergency economic measure. a serious clinical condition. Only 4% indicated that they have treated COVID-19 positive patients, but only 4 of them knew that the patient was infected before being in contact with the patient.

In conclusion, as any other private activity, plastic surgeons suffered the social and economic consequences of the pandemic. The practice will not be the same in the mid-term with the need of introducing safety and preventive protocols prior to surgery; this "new normality" will change our reality forever. Our fragilities have been exposed, but we have a chance to evolve to a more flexible and digitalized healthcare, reducing costs and improving services to our patients. 

COVID-19 situation update worldwide , as of 22

Epidemiological curves Geographic distribution of COVID-19 Geographic distribution of COVID-19 cases worldwide , as of 22

Current impact of Covid-19 pandemic on Spanish plastic surgery departments : a multi-center report

Manejo quirurgico de pacientes con infeccion por COVID-19. Recomendaciones de la Asociacion Espanola de Cirujanos