Fewer doctors are choosing to go to emergency care


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Imagine yourself in the emergency department in dire need of urgent care.

If you’re lucky, check in with the triage nurse right away to have your vitals taken, register your complaint, and then send it back to the lobby. It’s been hours, and you may still not have the cure. You are surrounded by other sick people, some of whom have contagious diseases. As the clock ticks, many leave to risk managing the disease themselves. Finally, someone will take you to the treatment area.

Now imagine yourself on the other side. You are a paramedic, nurse, or she one of the countless other providers who contribute to this important care. You desperately want to see a patient who has been waiting for hours, but the department is understaffed due to an epidemic of nurse shortages., It is predicted that 450,000 open positions will be created by 2025. Your ED is full of people who “board” or who need to be hospitalized but are stuck. There are not enough beds to transport the person from the emergency department. This leaves less space to see and treat the currently growing line of people in the waiting room.

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People will lash out at you for their frustration with waiting so long. Your department is bogged down because you don’t have enough people to move people or get things done. You may feel helpless, exhausted, or even grief-stricken.

Now, thanks to COVID, many people recognize the difficulty of working in the emergency department. But many of these problems existed before the pandemic, and things look to be getting worse. A few days ago, on the biggest matchday in history, nearly 40,000 medical students across the country decided to train for the next year after a limited number of spots, a highly competitive process for hundreds of emergency medical I learned how to do Residency positions are now vacant. In two years, the number of applications for the normally highly competitive emergency medical residency has dropped by 26%, leaving 555 vacancies this year.

The emergency doctors and nurses who work with us are suffering more than ever from burnout, depression and deep moral trauma. Some days, we can’t take care of them the way we were trained to. Game day tells us that medical students recognize this. We’ve known for a long time that the emergency department is broken. Management needs to acknowledge this, listen to us, and rebuild the environment so they can treat people quickly, fix problems, and save lives when called upon. there is.

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When I chose this specialty 30 years ago, I knew that the emergency department would be a high patient volume and stressful environment. I knew I would face uncertainty at times. But I liked that paramedics were supposed to be a great equalizer for us to treat you, regardless of race, creed, gender, or ability to pay. I love that it’s an exciting field of medicine that anyone can get into at any time, whether it’s a 60-year-old cardiac arrest patient. Sometimes I studied in medical school, sometimes I tried to help them. I love you for helping me.

But lately my love has waned. In some parts of the United States, especially in states without Medicaid expansion to cover rural areas and the uninsured, my colleagues send out some without a viable option for follow-up after emergency visits. This will affect their health. The initially adrenaline-pumping uncertainty of having to think on our own feet has now turned to staff and resource uncertainty fueling our anxiety.

When dealing with these unrelated things, instead of providing optimal and wholesome clinical care, it turns the idealistic vision I had as a young doctor into a dark and uncomfortable one. Then it causes moral damage. It burns us out and makes us more prone to medical malpractice, racism, depression and career changes. If you believe that you are not, that you have been treated unfairly, or that you cannot make a complaint, this aggravates moral damage and burnout.

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To that end, hospital administrators need to improve their working environment. The people who run our hospitals know better than anyone how well our department works, so they need to involve us in coming up with solutions. Beyond, clinicians reserve inpatient beds for those undergoing non-emergency procedures, those undergoing planned surgery for those who are ill but do not require the emergency department. often do. Our administrators can spread these planned admissions and subsequent discharges over her week, including nights and weekends, to reduce bottlenecks that lead to high hospital occupancy and boarding.

A fully functioning emergency department needs more than a doctor.Hospitals must reinvest profits and devote a significant portion of their budgets to hiring more Nurses and Auxiliary Staff. Nurse-to-patient ratios need to promote quality care, not the bare minimum we often have. I have to.

Our hospital management must seek temporary ways to manage staffing shortages and reduce the burden on physicians, such as clerical records and simplified electronic medical record systems. Because there is some overlap in paramedic and nursing skills, they can work with paramedics to fill some of the growing nursing shortages. Telemedicine can be more widely adopted in triage to conduct medical screening tests, reduce patient wait times, and free up care providers. However, no single solution will work. It must be a dedicated effort on multiple fronts.

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The day after the game was another milestone. The Lorna Breen Health Care Provider Protection Act is named after a paramedic colleague who committed suicide during the pandemic. This law aims to end the stigma surrounding mental health care among medical professionals. .

A shortage of matchdays may not be immediately evident in emergency departments, with some predicting there could be an oversupply of emergency doctors by 2030, but the number of matches has plummeted this year. If it continues, we will eventually face a shortage. After that, many of us burn out and leave. This leaves society with an important and difficult problem. If you go to the emergency room and there are no doctors or nurses left to take care of you, how will we survive?

This is an opinion and analysis article and the views expressed by the author or authors are not necessarily Scientific American.



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