Minnesota medical retirees get back to work during COVID-19 pandemic

Mac Baird is enlisting with retired doctors and nurses across the country as they rush to support the front lines of medicine.

Despite being at an age that puts Baird at risk of contracting COVID-19, the 71-year-old family physician wants to help Minnesota's health care system as it struggles with the biggest public health crisis in a century.

"If we get waves of very sick patients, we're going to need all the active clinicians probably doing the more serious work," Baird said. "And people like me can do things around the edges.

"I would be careful, of course," he said. But, he added, "I don't like sitting around not doing anything to help."

Retired health care workers have been part of the COVID-19 response in states like California and New York, and they could soon become a bigger part of the plan in Minnesota, as well.

Gov. Andrew Cuomo in New York reached out to retirees in March as part of a broader push to fortify his state's health care workforce. Last week California Gov. Gavin Newsom announced the creation of a new California Health Corps that would supplement the existing health care workforce with public health professionals, medical retirees, medical and nursing students and members of medical disaster response teams.

In Minnesota, utilizing help from willing retirees is one of several strategies the state is considering to supplement the health care workforce so it can handle an expected patient surge, said Jan Malcolm, the state health commissioner, during a conference call with reporters on Tuesday.

The idea might seem confusing when some health care providers are being asked to work fewer hours due to the shutdown of elective procedures across the state, Gov. Tim Walz acknowledged during the call. But he added: "Many of those, if not all those health systems, are retraining as many of those people as possible" to help with the expected surge, as well.

More than 20 retired and semiretired physicians have inquired with the Minnesota Medical Association about how they can contribute to the pandemic response.

The Minnesota Hospital Association told lawmakers last week that retired doctors and nurses should be able to renew licenses to help out by providing telemedicine. The Minnesota Board of Medical Practice has talked with lawmakers about whether there's a need for the Legislature to create a special pathway for returning retirees to practice. But Ruth Martinez, the group's executive director, said by e-mail, "We have not, at this time, identified the need for such an expedited process."

For nurses, licensure refresher courses are available for retirees, but completing the clinical component is complicated by the coronavirus pandemic.

"Many health care facilities are no longer allowing nurses with a permit to participate in clinical [work] at their sites due to concerns about the spread of COVID-19," Shirley Brekken, executive director of the Minnesota Board of Nursing, said via e-mail. "It is important to realize that many of the nurses who have retired may be in the high-risk group due to their age."

Beyond "virtual visits," where caregivers use online video tools to communicate with patients, retirees could play an important role with providing end-of-life care, said Dr. Brad Benson, the chief academic officer at M Health Fairview and professor of medicine at the University of Minnesota. With the severity of illness in a small minority of coronavirus patients, Benson said, the sobering truth is that some will have a very low likelihood of survival.

"Having those conversations upfront — I think the wisdom and experience of our retired physicians often puts them in a good position to do this," he said.

Palliative care is one place where Dr. Steven Miles thinks he could help out.

There's clearly going to be a group of patients, he said, for whom intensive care either hasn't worked or is not an option they want to pursue. With the right resources in place, they would become hospice patients who are dying of the virus, said Miles, 70, who is a professor emeritus of medicine and bioethics at the University of Minnesota.

Hospice medicine isn't simply about end-of-life decisions, it also involves special management of pain, breathing and bowel movements, Miles pointed out. With COVID-19, palliative care could last up to an average of two weeks if a person refuses life-prolonging care altogether.

Patients and their families won't accept the prospect of disconnecting from a ventilator, Miles said, if they are discharged with no treatment for pain or shortness of breath. Retirees might use webcams and other forms of monitoring to watch a patient's breathing patterns and ask about pain, but Miles expects that face-to-face conversations with families would be needed.

"Bravery is not being afraid to be afraid," Miles said, quoting a saying from journalist Marie Colvin. "I'd do it in a heartbeat."

Dr. John Goeppinger is already pitching in. On a Tuesday evening in March, he was parked outside C.A.R.E. Clinic in Red Wing, Minn., providing advice from the front seat of his car to nurse practitioners and physician assistants who occasionally walked outside for a consultation or to get the doctor's signature on a prescription.

Goeppinger retired from medical practice in 2013, but he has volunteered for several years with the clinic, which tries to be a resource for people in Red Wing who lack good access to health care. Whereas he previously volunteered at the clinic about once per month, Goeppinger is now increasing his hours to help with the COVID-19 response.

Medicine from the parking lot is an experiment he launched last month out of concern for the infectiousness of the coronavirus. Goeppinger is 71. Whether working from his car, or his home office, Goeppinger also is providing care directly to patients over the phone.

"These are unusual times — they're exceptional times," he said. "I feel good, I'm healthy and I'm thankful. And I'll do what I can."

Dr. Mac Baird opted to maintain his medical license when he retired two years ago as chief executive of University of Minnesota Physicians, the nonprofit that represents academic doctors at the U. After contacting the Minnesota Medical Association a few weeks ago about volunteering, Baird thinks he'll soon be helping out at the C.A.R.E. Clinic in Red Wing.

The switch to virtual visits that's now happening across health care due to the coronavirus is long overdue in primary care, Baird said. It's a good fit with the sort of medicine he can practice. About seven years ago, bone marrow treatments for leukemia weakened Baird's immune system, which meant he had to give up his part-time work seeing patients.

Returning to medicine isn't a decision that Baird takes lightly. He talked it over with his wife for a week and recognizes that health care workers are in a risky position right now, particularly with reported shortages of everything from gowns to proper masks.

But as he talks about the challenges, Baird speaks with the calm authority of a doctor who was chairman of the U's family medicine department for 15 years. The situation of retired doctors and nurses helping out reminds him of documentaries he has seen about old soldiers pitching in during World War II.

"I think they had the same motivation," Baird said. "We want to help. And if there's some risk involved, we accept that as we're older."