Indian Journal of Vascular and Endovascular Surgery

ORIGINAL ARTICLE
Year
: 2020  |  Volume : 7  |  Issue : 4  |  Page : 340--345

Economic impact of Coronavirus disease of 2019 pandemic on vascular surgeons in India


Prem Chand Gupta1, Ishita Joshi2, Pritee Sharma1, G V R K Acharyulu3, Gnaneswar Atturu1,  
1 Department of Vascular and Endovascular Surgery, Care Hospital, Hyderabad, Telangana, India
2 Hospital Administration, Narayana Nethralaya, Bengaluru, Karnataka, India
3 School of Management Studies, University of Hyderabad, Hyderabad, Telangana, India

Correspondence Address:
Prem Chand Gupta
Department of Vascular and Endovascular Surgery, Care Hospital, Hyderabad, Telangana
India

Abstract

Introduction: Coronavirus disease of 2019 (COVID-19) pandemic has affected virtually everyone in every walk of life globally including all health-care services. The economic impact of such disruptions in vascular surgery services on vascular surgeons in India is unclear. This study aims to understand the economic impact of COVID-19 pandemic on vascular surgeons practicing in India. Materials and Methods: A questionnaire consisting of 15 questions was created using Google Forms and circulated through E-mail and WhatsApp groups dedicated to vascular surgeons in practice and/or training in India and was available for 2 weeks. Only vascular surgeons who are currently practicing in India were eligible to participate in the study. Results: One hundred and eighty-four out of 400 (46%) members that are thought to be currently practicing or in training in India participated in the study. 98.91% completed all the questions. 90.2% (n = 166) of the respondents were aged below the retirement age of 60. Thirty-four worked in government job, 89 in private sector on salary basis, and 58 in private sector as fee for service. Seventy-one percent of the respondents (including trainees) reported a negative impact on their monthly income due to COVID-19 pandemic ranging from 10% to 90%. Seventy-six percent of the respondents believed that there will be a further negative impact in the coming few months. Sixty-nine percent claimed that they did not have alternative sources of income. 82.6% were not aware of measures to overcome such adverse economic impact and have not taken any preventive steps or measures. Conclusion: The results of the study show that COVID-19 pandemic had a significant negative economic impact on majority of the vascular surgeons practicing in India resulting in a 50% or more reduction in their income. Skills and knowledge about financial resources, financial resilience, and risk management are needed to prevent or overcome future crisis.



How to cite this article:
Gupta PC, Joshi I, Sharma P, Acharyulu G V, Atturu G. Economic impact of Coronavirus disease of 2019 pandemic on vascular surgeons in India.Indian J Vasc Endovasc Surg 2020;7:340-345


How to cite this URL:
Gupta PC, Joshi I, Sharma P, Acharyulu G V, Atturu G. Economic impact of Coronavirus disease of 2019 pandemic on vascular surgeons in India. Indian J Vasc Endovasc Surg [serial online] 2020 [cited 2021 Jan 28 ];7:340-345
Available from: https://www.indjvascsurg.org/text.asp?2020/7/4/340/304625


Full Text



 Introduction



Virulent strains of viruses emerge periodically causing pandemics such as the Spanish influenza pandemic, Ebola infection, hantavirus pulmonary syndrome, severe acute respiratory syndrome (SARS), and swine flu.[1] Currently, we are witnessing one of such serious and devastating coronavirus disease of 2019 (COVID-19) pandemic caused by SARS coronavirus 2.[2] Identified first in China, it has spread to more than 200 countries, affecting around 27 million people and claiming almost 900,000 lives. The health-care industry in India is facing huge challenges in containing the virus spread, providing necessary support to affected individuals, and catering to the needs of non-COVID-19 health conditions.

On March 11, 2020, the World Health Organization declared COVID-19 a global pandemic. India is a country of 1.3 billion people. Considering our dense population and the rate at which the virus has spread in other countries, our policymakers commenced measured on war footing to curb the spread of disease. Learning lessons from worst-hit countries such as Italy and Spain, India declared a nationwide lockdown[3] on March 24, 2020, to slow down the spread of disease and reduce the burden on health-care infrastructure.

Resultantly, everything came to a halt except essential services. As per the statement released by Chief India Economist of Goldman Sachs on April 09, 2020, the economic growth of India dipped down to 1.6% due to the aggressive lockdown and has worsened further over time. Such steps, taken with the intention of slowing the pandemic peak and reducing the burden on health care, were associated with a significant negative economic impact on several industries and service sectors (Nicola et al.).[4] This economic brunt has been borne by the health-care workers too. In order to cater to the needs of COVID-19 patients, the health-care services have undergone major restructuring. Specialties such as medicine and radiology have started telehealth facilities to cope with the demand of the current situation. However, surgical specialties have taken a big hit due to the fear of intraoperative viral transmission risk, procedural prioritization, restricted access, and staffing issues.

Vascular surgery is a specialized surgical specialty that deals with the diseases affecting the blood vessels and lymphatics. Globally, all types of vascular surgery services such as outpatient, inpatient, elective, and emergency surgery were negatively affected in this pandemic.[5] The economic impact of such disruptions in vascular surgery services on vascular surgeons is unclear. Hence, in this study, we aim to understand the economic impact of COVID-19 pandemic on vascular surgeons practicing in India.

 Materials and Methods



A questionnaire consisting of 15 questions was created using Google Forms and circulated through E-mail and WhatsApp groups dedicated to vascular surgeons in practice and/or training in India [Appendix 1]. The questions were designed to capture the views of vascular surgeons on the economic impact of COVID 19 on their practice. The form was available for completion from April 23, 2020, till May 07, 2020 (2 weeks). Only vascular surgeons who are currently practicing in India were eligible to participate in the study. Data from the completed survey were transferred to an excel sheet and analyzed using descriptive statistics.[INLINE:1]

 Analysis and Results



Out of the 600 registered members of the Vascular Society of India, approximately 400 members are thought to be currently practicing or in training in India. One hundred and eighty-four out of the 400 members (46%) completed the online questionnaire. One hundred and eighty-two out of 184 (98.91%) completed all the questions. Majority of the respondents were aged below the retirement age of 60 (166 out 184, 90.2%). One hundred and sixty-nine out of 184 were men (91.8%). One hundred and eighty-one participants responded to the question regarding place of work, stating that 34 worked in government job, 89 in private sector on salary basis, and 58 in private sector as fee for service. One hundred and fifty-six out of 184 respondents (84.78%) were independent practitioners, having completed vascular surgery training and working unsupervised. These demographics are summarized in [Table 1].{Table 1}

Seventy-one percent of the respondents reported a negative impact on their monthly income due to COVID-19 pandemic ranging from 10% to 90%. Seventy-six percent of the respondents also believed that there will be a further negative impact in the coming few months. One hundred and twenty-seven out of 184 respondents (69%) claimed that they do not have alternative sources of income. The possible alternative sources of income and measures to overcome the economic impact are shown in [Table 2].{Table 2}

The most surprising revelation came from a subgroup analysis of trainees who responded to the survey. Nine out of 28 trainees said that there was a negative impact on their monthly income and further 5 had a possible (maybe) negative impact. Thirty-three percent of the trainees also confirmed that the impact was 50% or more. Nineteen out of 28 trainees think (an additional 6 replied saying maybe) that their income in the coming next few months will be affected by pandemic. Only three were confident that there would be no income loss.

Majority of the respondents (82.6%) were not aware of measures to overcome such economic impact and have not taken any steps or measures to prevent it from happening (156 out of 184, 84.78%). Twenty-eight surgeons claimed that they have taken definitive measures to prevent or overcome such adverse economic impact [Table 2]. Many suggestions were given by the respondents to try to dampen the economic impact of such pandemics on vascular surgeons in the future [Figure 1].{Figure 1}

 Discussion



In India, vascular surgery is a rapidly evolving surgical subspecialty with <500 vascular surgeons in practice for a population of 1.3 billion. The results of this economic survey show that majority of them were negatively affected by the current COVID-19 pandemic. Drawn by the exponential opportunities in private sector and lack of positions in government institutions, majority of the vascular surgeons in India are currently practicing in private hospitals and institutions. While some of the vascular surgeons working in state or central government-run hospitals may be financially immune to external changes, the current pandemic has exposed the economic vulnerability of vascular surgeons in private practice with 88 out of 137 respondents, stating that there was a 50% or more reduction in their income. One hundred and seventy-eight (140 definite and 38 maybe) out of 184 respondents also think that there will be further negative economic impact due to the pandemic.

A key finding of this survey and a point of concern is lack of alternative sources of income for a majority of the vascular surgeons. One hundred and twenty-seven out of 184 respondents (69%) reported a definitive lack of alternative sources of income. Only 41 respondents (22%) confirmed that they have definitive alternative sources of income. The alternative sources of income included pension, other household member/s income (wife/husband/parents), dividends from mutual funds and shares, rental income, and income from alternative/family business such as agriculture.

Majority of the survey respondents were not aware of the measures to overcome the economic impact. Only 28 out of 184 respondents (15.2%) confirmed that they have taken positive steps to overcome the economic impact. Some of the actions taken such as reducing fees to attract patients, reducing personal and institutional expenditure, redeeming mutual funds, and practicing general surgery might be beneficial in the short-term but may not be sustainable in the long term. Online marketing and consultations might help in recruiting and retaining clientele but unlikely help much in the short term due to existing uncertainties and challenges in resuming elective vascular surgery.

As shown in [Figure 1], the respondents have suggested few ways in which the economic impact of such pandemics on vascular surgeons can be prevented or dampened in the future. These suggestions are very relevant in building financial resilience for vascular surgeons. Resilience is “a dynamic process wherein individuals display positive adaptation despite the experiences of significant adversity or trauma.”[6] Relevant to our study, an individual's financial resilience can be described as “the ability to withstand life events that impact one's income and/or assets.”[7] Financially stressful life events could be positive such as birth of a child, negative such as unemployment, health problems, or disability, or mixed such as marriage and divorce. Pandemics, acts of terrorism, recessions, and stock market downturns are other external factors that could affect a wider population. Financial resilience is a multidimensional concept and can be conceptualized across four components, namely economic resources, financial products and services, financial knowledge and behavior, and social capital [Figure 2].[8] It is important to understand and work on all the four components to have good financial resilience.{Figure 2}

Several factors such as monthly income, savings balance, monthly debt repayment, and cost of living expenses influence an individual's ability to cope with financial adversity. These direct money-related matters form the components of economic resources that determine an individual's financial resilience. For example, having access to savings plays an important role in smooth cash flows to meet the cost of living expenses and unexpected expenses.

Access to a bank account, affordable credit, and general insurance form the financial products and service component. It is likely that all vascular surgeons would have a bank account, but access to affordable credit and general insurance may be variable. Although not essential for everyone, these financial products and services form an important component of financial resilience. For example, having an overdraft facility will act as a buffer in the event of unexpected expense but should not be seen as a long-term viable option. If not planned in advance, accessing affordable credit and insurance can be challenging.

The ability to judiciously use economic resources and financial products depends on individuals' financial knowledge and behavior. In this era of complex financial systems, vascular surgeons need to acquire skills and build confidence in identifying appropriate economic resources, financial products, and services that would help them in effectively managing their finances. Financial knowledge and behavior in areas such as savings, credit, investment in equity/mutual funds/derivatives and/or retirement planning depend largely on accessibility to financial information and the ability to process that information.[9]

It is not unusual to seek financial help from friends and family in times of emergency. Similarly, financial help could be sought from voluntary and nongovernment organizations. In times of hardship, there are several financial schemes provided by the government such as income assistance schemes, jobseeker's allowance, and microcredit programs that act as safety nets.[10] These external factors, called social capital, form an important component of financial resilience.

With a response rate of nearly 50%, the current survey highlights the vulnerability of Indian vascular surgeons to unexpected financial crises both at an individual and community level. Although some of the factors such as lack of transportation and restricted access to health-care services are understandable in this pandemic, an in-depth analysis into the precipitating factors will help in preparedness and responsiveness to such events in the future.

 Conclusion



The study shows that COVID-19 pandemic has a significant negative economic impact on majority of the vascular surgeons practicing in India. For many vascular surgeons, their professional income is the only source of income, and disruption of surgical services in this pandemic has caused a 50% or more reduction in their income. Majority of them believe that there will be a further negative economic impact on them but have not taken any major steps to prevent or overcome future crisis. Skills and knowledge about financial resources, financial resilience, and risk management are the need of the day.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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