The moment the Associated Press declared Joe Biden the winner of the 2020 presidential race, I tapped on the window of the doctor’s room and pointed out the headline on my computer screen to my resident. We shared a high-five through the glass, then he went on to see his next patient.
Now that Biden has been inaugurated, and is several weeks into his term, I can’t say that much for me, in my life as a doctor who treats COVID-19 patients, has changed. Certainly, waking up every morning and knowing there’s someone at the helm who takes the pandemic seriously is an enormous morale improvement. The country has rejoined the World Health Organization; it is absurd that we ever left. The staff at the hospital where I work has had the opportunity to be vaccinated, but this happened during (if perhaps in spite of) the Trump presidency. Even as COVID-19 numbers go down worldwide, and in my ER, much of the damage done by Donald Trump will be hard, if not impossible, to undo. We are still experiencing Trump’s mishandling of the pandemic. Biden cannot reverse unwillingness to wear masks, distrust in public health authorities, or national exhaustion from stay-at-home orders that were not effectively used to get ahead of the virus.
People have spent the past year highly attuned to my profession, and our current lack of resources, but the truth is things have always run on a shoestring. I’ve been an emergency physician for 15 years, and now under four presidents. Sometimes I cannot believe the conditions under which we function. Not for lack of promises. Health care has often been front and center of the political conversation, from the opioid epidemic to universal health care, to exorbitant prescription drug pricing. But there has been little significant reform that improves working conditions of doctors and therefore the quality of care we can deliver. There hasn’t been a shift in support for a public health infrastructure that helps patients not need that care in the first place. Some of the major problems that plague us—including those that set us up to have such a disastrous time in a pandemic—seem unlikely to be fixed by the new administration.
A normal start to the workday for me involves walking through a very crowded waiting room. I often worry that a sick patient will wait out there for hours and then die. Even before the pandemic, our ER was sometimes too full (often because the hospital was overcrowded) to see patients in a timely manner, let alone to spend time carefully considering their needs and treatment plans. We’re all now familiar with the burnout doctors and nurses are experiencing from the pandemic. Before the coronavirus, we were discussing the “moral injury”—a term borrowed from war—that comes with rushing to move through patients too quickly. While I’m glad that the Affordable Care Act is likely to be safe now, it has had little impact on the number of visits to emergency departments, even though at the outset we hoped that it would give people better access to primary care and thus reduce emergencies. Health care costs continue to be prohibitive for many even with insurance. Unless there are more drastic changes in the way health care is delivered and financed in this country, the constant awareness that I am part of an industry that bankrupts half a million people a year is unlikely to be mitigated by Biden.
Every single day at work throughout my career, one key drug or another that I use in the ER has been in short supply or unavailable. In the richest country in the world, with the most complicated health care system, we cannot pass legislation to ensure that there is enough salt water available in hospitals to hydrate the dehydrated and resuscitate the critically ill (this shortage is a surprisingly complicated and long-standing problem). Americans are now hypertuned to the lack of medical masks available during an ongoing emergency. Trump tried to cover up the shortages by calling them fake news, but he didn’t create the complicated manufacturing and supply chain issues that are at the root of our lack of drugs, salt water, and now masks. If we couldn’t solve the drug shortage problem in the first 15 years of my career, I’m also not hopeful that we will solve the PPE issue anytime soon. My hospital has “enough” PPE, but we are still reusing N95s designed for single use and running low on some supplies. A year into this, and 250 years since the Industrial Revolution, and we have not been able to organize a steady supply chain for essential supplies.
Over the course of my career, the gun violence crisis has only gotten worse. While the victims of gun violence make up a very small part of my practice, they take up a large part of my brain, emotionally. The most memorable moments of my career in a negative way, prior to the pandemic, have often involved gun violence. It was during Trump’s presidency that I declared dead a toddler shot by his slightly older sibling; but will that become less likely under Biden? No federal law governs keeping guns locked up, and only one state, Massachusetts, has a law whose enforcement would have prevented that death. Two pieces of gun legislation passed during President Barack Obama’s two terms, and both relaxed, not tightened gun control. I fear that the American political process makes it likely that Biden’s presidency will not be very different. Political compromise could not be wrought to make the world just a tiny bit safer for children, even after Sandy Hook, at the expense of gun owners’ Second Amendment rights.
I remain a cynic—but a hopeful one. I think we could see the effects of the Biden administration on health care in the twilight of my career. The restoration of National Institutes of Health and other scientific grant funding, something that Trump made cuts to during every one of his four years in office, will hopefully result in cures for some diseases we already contend with, as well as quicker responses to future pandemics. The restoration of funding for global health initiatives—and a general recognition that America is not its own isolated planet—will make us more prepared for future pandemics, which I am certain are lurking. (Although this is dependent on securing funding from Congress, it seems more attainable and less polarized than gun control). Climate change could have catastrophic effects on our health; Biden seems set to make climate change a priority and I have hope that this will mitigate the damage. We have rejoined the Paris Agreement, and Biden’s agenda on climate change promises to both blunt its effects as well as make us more resilient against them. To me, as an emergency physician, this means many things—fewer emerging infectious diseases, fewer victims of climate catastrophe, and hopefully a cleaner, healthier, safer world. I’m taking the long view. In the meantime, while my workdays might be the same, I’ll continue to feel a sense of relief that the person in charge wears a mask as he goes about his.