Economic implications of the COVID-19 pandemic on the plastic surgery community.

Dear Sir,

In light of the ongoing COVID-19 pandemic, the American Society of Plastic Surgeons (ASPS) has released a statement urging the suspension of elective, non-essential procedures. This necessary and rational suspension will result in detrimental financial effects on the plastic surgery community.

Given the simultaneous economic downturn inflicted by public health social-distancing protocols, there will be a bear market for elective surgery lasting well past the bans being lifted on elective surgeries. This effect will largely be due to the elimination of discretionary spending as individuals attempt to recover from weeks to months of lost earnings.

As demonstrated during the 2008–2009 recession, economic decline was associated with a decrease in both elective and non-elective surgical volume. Private practice settings performing mostly cosmetic procedures were particularly vulnerable to these fluctuations and demonstrated a significant positive correlation with GDP.

The surgery community must prepare for the economic impact that this pandemic will have on current and future clinical volumes. These effects are likely to be more severe than the previous recession as surgeons are currently indefinitely unable to perform elective surgeries, coupled with the immense strain on hospital resources at this time. Given this burden, elective surgery cases may be some of the last to be added back to the hospital once adequate resources are restored.

While surgeons are temporarily unable to operate, they do have the potential to use telehealth in order to arrange preoperative consults and postoperative follow-up appointments. This could be accomplished in private practice settings with the use of telehealth services such as Teladoc Health, American Well, or Zoom, which allow for live consultation with patients without unnecessary exposure of patients or providers to potential infection. The main limitation of these types of appointments is the lack of an in-person physical exam, so providers have found that billing based on time spent with the patient is more effective with this tool. This could generate revenue and facilitate future surgical cases after the suspension of in-person elective patient care has been lifted.

Several strategies should be considered by the elective surgery community to minimize financial losses. Many financial entities have changed their policies in order to support small businesses. Examples include the Small Business Administration offering expanded disaster impact loans and deferment of the federal income tax payments by three months to July 15. Another option employers may leverage is temporarily laying off of employees so that employees can apply for and collect an expanded unemployment package by federal and state governments thereby reducing the payroll burden on stagnant practices with no cash flows and providing employees with a steady source of income during the pandemic. The employer's incentive to do this may be reduced with the potential suspension of the payroll tax on employers and loan forgiveness to employers who continue to pay employees wages.

Once elective procedures are again permitted, plastic surgeons that have retained a reconstructive practice should make a strategic business decision to increase reconstructive surgery and emergent hand surgery bookings as historically these procedures are less fluctuant with the economy. Other options to maintain aesthetic case volume include price reductions or temporary promotions. However, it is important that these be adopted universally in order to minimize price wars between providers.

As physicians, it is principle that surgeons practice nonmaleficence and minimize non-essential patient contact for the time being. However, this time of financial standstill should be used constructively to prepare for the financial uncertainty in the months to come.

Declaration of Competing Interest

None