How Rothman Orthopaedics is addressing COVID-19 & why essential orthopedic surgeries must continue: Q&A with Dr. Alan Hilibrand

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Alan Hilibrand, MD, is vice chairman for academic affairs and faculty development for the department of orthopedic surgery and co-director of spine surgery at Rothman Orthopaedic Institute in Philadelphia.

Here, Dr. Hilibrand discusses how Rothman Orthopaedics is addressing the spread of the novel coronavirus and the importance of essential orthopedic surgeries to continue during such a challenging period. 

Question: How has Rothman Orthopaedics pivoted to address the spread of COVID-19 over the past week?

Dr. Alan Hilibrand: Our hospitals, like most places, are now performing essential surgeries only. Our office hours are being transitioned to telehealth and telemedicine visits and we are updating and rolling out our telehealth capabilities. Initiatives that we've developed in the past are now being brought forward. As a practice, we believe that this is going to be a capability that will stay with us after the novel coronavairus is behind us. Anyone who can work from home works from home and staff who need to be here are only in to the extent they need to be. 

Q: What in-person appointments is the practice seeing at this time?

AH: In-person appointments are dropping off but there are certain patients that we still have to see.  Acute and postoperative patients have to be seen. There are some patients who may need to be seen because of some complexity in their problem that requires a physical examination. A lot of follow-up patients who have had surgery and nonsurgical patients who are doing fine can be dealt with over the phone. Even if there's a need for updated imaging, that can all be reviewed online.

Q: On a more personal note, how has your day-to-day changed over the past week?

AH: I would like to say that I'm going to have more free time but unfortunately it doesn't work out like that because there are so many things that we have to do to change the practice to accommodate the situation that I still find myself on conference calls, going through and responding to emails and meeting with people from the hospital or within our practice — at a six-foot distance — to discuss issues as they arise. So, the pace is a little slower but the hours that I'm not with my family as of this week has not gone down. However, I do believe that will change substantially next week.

Q: How do you see next week playing out for you and your practice?

AH: Well next week was supposed to be the American Academy of Orthopaedic Surgeons Annual Meeting so my schedule was light because I was going to be there. Personally, I have very little on my schedule — I have a couple of essential operations that I'm performing on one of the days and I have a small number of patients with urgent issues that I'm seeing on another day. These are patients who need to be seen at a certain point after their spine surgery or patients with an acute problem that needs to be seen sooner than a month from now.

Q: As a larger group, the financial impact may not be as severe as some physicians in smaller private practices. How will this pandemic impact Rothman Orthopaedics in the coming weeks? 

AH: We know that there will be a dramatic drop off in revenue. That's not going to happen right away but it will in the next two months. When operations resume there will be a lag time before revenues follow. Our first priority has always been to protect our employees — to protect them from getting the virus and also to protect their jobs. Thankfully as a large organization that doesn't carry any debt, we believe that we can weather this storm and protect our employees but things will be difficult. Inevitably, all of us will see much less income. From top to bottom, all physicians, management and employees.

Q: What's one key point to remember about orthopedic surgery as elective procedures across the country are being postponed?

AH: One key point to remember is this: While people think about orthopedic surgery as elective surgeries like having a hip or knee replaced or an ACL reconstructed, there's a lot of essential surgery that orthopedic surgeons do, like fixing tendon ruptures and fractures, taking care of infections and patients who have significant neurologic deficits. These services need to continue to be provided. We can't just all go home and not provide services to patients who need them. The challenge of this pandemic is for us to be able to do all those things safely and not put undue stress on a healthcare system that may face substantial burdens to provide other types of care in the next month.

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