No-Work-From-Home Policy During The Covid-19 Pandemic
And The Wrath Of Corporate Medicine *** Original Artwork by physician artist Dr. Judith Hong ***
Nearly 8 weeks after enduring unfortunate organizational behavior, I gathered enough courage to leave a medical directorship role. My transgression? Raising concerns over the organization’s no-work-from-home policy during the new COVID-19 pandemic.
For context, I serve as a clinical director for an outpatient mental health clinic within a community healthcare organization.
When I joined the organization, there were no standardized, outpatient mental health services. By leading hospital task forces, obtaining 6-figure grants and designing hospital-wide education strategies, I was closely involved with creating a subspecialty clinic that would care for the mental health needs of a vulnerable population. Within a short period of time, the clinic was full. I share this not to be boastful, but to shine light on the callousness of corporate healthcare.
For a long time, I noticed certain “organizational splitting behavior”. From one day to the next, administrators dangle praise and dispensability in response to complacency or dissent, respectively. Knowingly, I continued my work until a time came when our principles were just too far apart.
At the beginning of March of 2020, I advised leadership of the need to expedite a telehealth solution, amid pandemic warnings. I voiced personal challenges with having immunocompromised family members and limited childcare options. There was no response for a while.
After the release of emergency provisions from the Center for Medicare Services (CMS) and from the U.S Department of Health and Human Services (HHS), I was allowed to see my patients remotely. Clinic volumes increased and our no-show rates plummeted. When I tried advocating for other mental health team members (e.g psychotherapists) to see patients remotely, I was reminded of the new no-work-from-home policy. I was educated on employee equity and asked not to speak with employees about these matters. I found out that our patients (at risk population for COVID-19 complications) were still being seen face-to-face for their routine, psychotherapy visits. This was already late April, 2020 with a fast-approaching local peak, no universal masking and severely limited testing. To this date, patients are still being seen face-to-face for these visits.
At this point, I politely suggested that employees were scared (I see many as patients). The no-work-from-home policy based on employee equity seemed to be sending a message of “if one is at risk, then we all need to be at risk”. I pointed out that such blanket policy may be posing unnecessary exposure. I explained that some employees with limited “frontline skills”, but who are still essential are most helpful if they could work remotely during the peak. After all, bringing our droplets into the center to provide face-to-face, routine, mental health visits is not the type of solidarity asked by public health officials. Again, no response.
Five weeks after my original request, I was told in a celebratory tone that an institutional video-chat account and smart tablets were approved. The fine print? I had to use the tablet on campus. No routine clinical care (not even phone calls) could be done from home. The rationale du jour was “brand consistency.” Suddenly, employee equity was not catchy enough. The policy explicitly raised concerns over background noise, such as dogs barking. The rationale kept shifting with cyber-security and HIPAA taking a more central role, depending on who you asked.
With such little, science-based logic, I declined to use a portable tablet, on-campus, during the peak of a pandemic when my specialty can be easily tele-ported. Expectedly, my dissent resulted in a parade of phone calls from administrators, all with inflated titles. I was sent articles written by their own leadership on how the “fear epidemic” is going to endanger us all faster than COVID-19.
After this, I explained that training and duty called for sacrifice, but not without calibrating risks at every step of the way. Moreover, peer shame with “fear-demic” articles should not be part of the equation. I continued to give examples; My husband is an anesthesiologist. He cannot intubate via video-chat. If he doesn’t intubate, the patient dies. If the patient dies, someone loses a family member and my husband is out of a job. The risk of him staying at home is high in terms of lives lost, professional stance and job security. Considering his specialty and our household circumstances, he needs to be in the operating room. I even tried to speak the administrator’s favorite tongue; like business, I explained, we could transfer risk, eliminate it, mitigate it or accept it. In our home, we mitigated our risks; my husband wears PPE when he works and “disinfects” in a designated “hot zone” in the garage. We updated our life insurance and trust and, we stopped having grandparents care for our kids. In our two-physician household, the remaining parent (me) can still practice medicine and homeschool our kids with thoughtful planning. Again, no response.
After several days, I became aware of behind-the-scenes arrangements for a quick replacement. All without fanfare. My new patients were given to someone else. Referring physicians came under the impression that “the psychiatrist declined to see patients”. I was reminded by an administrator that my contract stated “on site.” I was told they cannot accommodate for my “daycare issues.”
At this point, I reiterated my continued availability to care for my patients. Given unforeseeable circumstances, I offered accommodations to fulfill my contractual duties and reminded them that the document was drafted before a global crisis. For example, for “brand consistency,” I secured a space without any external distractions during normal business hours. For Cyber-Security and HIPAA, I purchased a secure router to be used with the institutional tablet and the institutional, video-chat account. All of this with a standard, telemedicine consent form. A system like this goes above and beyond the expectation of the emergency HIPAA provisions released by HHS in March, 2020. All of these accommodations were declined.
Our values were just too far apart, so I submitted a request to place the contract “on hold.” After a week of silence, they proficiently asked if my request was a resignation. While I knew this would absolve them of the burden of a wrongful termination, I was too tired and demoralized not to agree. They offered instead a “mutual agreement” to end the contract “sooner than stipulated.”
The moral of the story is... complacency with corporate medicine comes with an enormous moral cost. Courage comes with the risk of losing our jobs. I chose courage.