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When Aimee Paulson, a nurse practitioner, learned in late March she was being temporarily laid off from the private family practice she’d worked at for the last three years, she was disappointed but not surprised. Patient visits in the San Ramon office had gone down by almost 80% as the coronavirus outbreak kept people at home.

She called her patients, many of whom followed her from her previous workplace, and told them she hoped to be back by June.

In the midst of a public health crisis, Paulson and other health care workers are learning they aren’t immune to layoffs, furloughs and pay cuts. It’s an ironic twist to the pandemic: When the health care system seems to need workers the most, it can’t afford to keep them all. A recent survey of more than 3,200 physicians by the California Medical Association, for example, found that 49% of practices have had to lay off or furlough staff.

Now providers and state lawmakers are searching for ways to keep hospitals, clinics and private practices afloat and its workers employed — or face the prospect of a deeper medical jobs shortage months or years from now.

This week, California hospitals are planning to ask the state for $1 billion before June 30 to help with immediate revenue losses, said Carmela Coyle, the CEO of the California Hospital Association. An injection of cash from the state could help hospitals avoid or reduce pay cuts and layoffs, she said. California hospitals so far have received $3 billion in aid from the federal government, she added.

Hospitals have also asked that health insurance plans accelerate payments for claims within 30 days during the pandemic. Currently, claims can take up to 90 days to process, but “we need to move those dollars more quickly,” Coyle said during an Assembly budget hearing on Monday.

Coyle said hospitals have done their best to keep their staff, but furloughs and layoffs have begun. “And that is because 60 percent of hospital spending is for labor,” she told lawmakers.

At the outset of the pandemic, the state asked hospitals to prepare for a surge and make room for about 40,000 more patients at once. “And we did that, we answered that call. We emptied California’s hospitals to make way. That means canceling surgeries and procedures and more,” she said. “But as we begin to assess the damage, the toll is enormous.”

In late April, Gov. Gavin Newsom allowed hospitals to resume some elective surgeries, which is the bread and butter for many facilities. But some hospitals, especially smaller ones or those in rural areas, are already in a deep hole.

Meanwhile, clinics and doctors’ offices continue to struggle with a drop in revenue as patients are advised to avoid non-emergency in-person visits.

This week, the Legislature’s Latino Caucus sent a letter to the Newsom administration also warning that many of the state’s health centers will not be able to remain open much longer “without significant financial support from the state.”

Laying off and furloughing staff is a “recipe for disaster,” said Stephanie Roberson with the California Nurses Association. Last month, for instance, about 150 registered nurses in San Jose and San Diego were temporarily laid off because of department closures and the cancellation of elective procedures, Roberson said.

Her organization has been protesting these layoffs. On Thursday, another union, SEIU-United Healthcare Workers West, will be protesting a 20% pay cut at Stanford Health Care.

“It is a weird dichotomy,” said Joanne Spetz, associate director of research at the Healthforce Center at the University of California, San Francisco. The labor challenge for health systems, she said, is that not all positions transfer smoothly into surge preparedness. A nurse in a primary care office or one who specializes in orthopedic care, for example, perhaps wouldn’t be the best fit to care for a coronavirus patient on a ventilator, she explained.

“So you have furloughs happening in community health centers and in certain departments of hospitals, while at the same time there is concern about a surge and we’re hearing these calls for things like a health corps,” she said.

In late March, Gov. Gavin Newsom announced the California’s Health Corps, whose members would tend to coronavirus patients in alternate care facilities. But that surge in anticipated volume hasn’t occurred and these facilities across the state remain mostly empty. Out of the approximately 94,000 people who have applied to the state’s backup medical reserve, 551 have been accepted into the program.

Of these Health Corps members, 233 are on call to staff the Sleep Train Arena, the former Sacramento Kings playing venue which was prepped for up to 400 patients with mild or moderate cases of COVID-19. As of Tuesday, only five patients were being treated there. Workers are taking turns as needed, according to the state’s Department of Health and Human Services. The rest are being used to staff nursing homes that need temporary or emergency support.

Democratic Assemblyman Jim Wood of Healdsburg said it makes more sense to look at laid off workers first for Health Corps jobs, rather than hire people who need to be retrained and recredentialed. “My rationale is they’re going to go on unemployment, and then we turn around and pay someone else,” Wood said.

The California Department of Health and Human Services confirmed that currently laid off workers are not prioritized for these jobs. Hiring is based on need and geography, according to the agency.

Paulson, the nurse practitioner, applied to the state’s Health Corps and was recently offered a position at a clinic in Berkeley. She didn’t take it. On Wednesday, she returned to the San Ramon practice after her employer qualified for a Paycheck Protection Program loan. She’ll be working partial hours until patient visits pick up again, she said.

Others may not be as fortunate. Assemblyman Wood said he believes the pandemic is “going to be a breaking point for some offices and clinics.” He said he is concerned about the loss of primary care doctors, especially in rural districts like his that already struggle to attract and retain them.

“This will hasten the retirement of some folks, or the closing of practices,” he said.

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