Young physicians belong on the battlefront

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In the last month, we have seen surgeons and shrinks alike leave the comfort of their suburban perches in order to fight on the front lines of the coronavirus war in America. While it should be inspiring to watch retired physicians return to the field to engage in the battle of their lifetimes, we should be wincing—the odds of suffering severe complications from COVID-19 are demonstrably greater amongst the older and more seasoned, those most likely to have picked up a comorbidity or two along the way. The moment has never been more ripe for younger and less attached doctors to heed the call of serving in what might be the defining pandemic of their careers.

I’m here to say, I’ve done it. As a physician anesthesiologist who has previously been on assignment for Doctors Without Borders in a resource-depleted region fraught with conflict, I’d like to say there’s little I haven’t seen. But now, after four weeks of staffing COVID intensive care units and emergency response teams throughout New York City, I struggle to distinguish between the exhaustion of a distant war-zone and the fatigue I see in state-of-the-art medical facilities.  In some ways, my past experience treating war-wounded Syrian refugees mentally prepared me for my most recent journey where I dropped the comforts of life in California, booked a one-way ticket to the Big Apple, and secured emergency credentialing at multiple hospitals in the global epicenter of the virus outbreak. But in other ways, the campaign against COVID-19 is its own brand of horror, and I find myself worn down overseeing emergency intubations and debating the ethics of ventilator distribution, whether or not to initiate cardiopulmonary resuscitation, and how to help patients die with dignity when they are nearing end-of-life.

That said, I am invigorated because I know I am the right person for what this evolving pandemic demands. My training is fresh, and at 33 years of age, I stand in favorable odds if (or when) I contract the virus myself. But, as I administer care shoulder to shoulder with veteran doctors in their 60s and 70s who are at tremendous risk, I wonder, what will encourage more young colleagues to temporarily uproot and migrate to outbreak hubs as needed?

Although I have placed patients in their 20s on life-support, the risk increases with age and less robust physiology. Imagine our health care workforce dwindling further; with a national shortage of physicians already plaguing the system, this unprecedented pandemic will only exacerbate medical needs. Also, global trends have revealed that as the curve flattens in one region, a peak is rearing to spike somewhere else. Young physicians should prepare to mobilize as the need arises.

In the age of COVID, the doctrine of utilitarianism can help guide our decisions, indicating we are virtuous when our actions benefit the majority. By keeping our older physician workforce healthy, we indirectly care for the masses, albeit in a less hands-on capacity. For instance, patient access to telehealth services was recently expanded, allowing remote medical care and eliminating packed clinic settings.  The battlefield where direct patient care is needed, however, remains open for young and newly-minted doctors.

Protective equipment remains scarce, but if we are inadequately armored on a collision course, should it not be the individuals who can better tolerate the insults of the virus—i.e., the young? National debate rages about how to equitably distribute scarce resources such as ventilators and dialysis machines, but the physician workforce is arguably the most vital resource requiring immediate redistribution. After all, what good is a ventilator without an expert to judiciously implement it?

By mobilizing to the frontlines, younger doctors are not abandoning their health systems back home, many of which have been shuttered for noncritical business. The nationwide postponement of elective surgeries now leaves many physicians with time at their disposal, perfect for providing service in surge cities. Relocating does not mean the conversation on the home front comes to a halt: we can be a resource to help keep the health care engine running by briefing colleagues back home regarding COVID preparedness.

I urge fellow young doctors to recall the day we received our white coats and held our stethoscopes, signifying adherence to our Hippocratic Oath commonly known for the precept “first do no harm.” During these unprecedented times, we cannot sit idle while health systems exceed capacity, while our colleagues become sick and unable to treat, and while COVID-19 continues to ravage communities. Young physicians in this pandemic are vital, and we belong on the battlefront.

Ajit Rai is an anesthesiologist and interventional pain physician and can be reached at his self-titled site, Ajit Rai MD.

Image credit: Shutterstock.com

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