Fewer physicians are choosing emergency medicine (2023)

train inemergency departmentin dire need of attention.

If you're lucky, you'll quickly check in with a triage nurse who will take your vitals and record your complaint, before being sent back to the lobby. Hours pass and chances are you still haven't received treatment. You are surrounded by other patients, some withcontagious diseases. As the clock ticks on, many peopleto leave, you run the risk of facing your illness alone. Eventually someone takes you to the treatment area, but you wait, again surrounded by what appears to be utter chaos, until finally, sometimes hours later, a distressed doctor comes to you.

Now imagine yourself on the other side. Are you an emergency physician, a nurse or one of themany other providersthat contribute to this intensive therapy. You really want to take care of the patient who has been waiting for hours, but the department is understaffed due to the large dispersionnursing bottlenecks,to create designed450,000 vacantuntil 2025. Your ED is full of people "boarding" orhas to be allowedtaken to the hospital but arrested: not enough beds are available to get this person out of the ER. This leaves less room to view or deal with the growing queue in the waiting room.

people bring you downFrustrationabout your long waits. Your department is at a standstill because you can't outsource people or get things done because there aren't enough people. You feel helpless, exhausted and even sad.

Nonetheless,thanks to covidmany people know thatwork challengesin an emergency room. But many of these issues predate the pandemic, and things seem to be getting worse. A few days ago, in the biggest game in history, around 40,000 medical students from all over the country found out where they would playnext formative yearsAfter an often very competitive process for a limited number of openings, hundreds of emergency medicine assistant positions have opened. In two years, applications for typically competitive emergency medicine residencies dropped by 26%, leaving 555 places open this year.

The doctors and emergency nurses who work with ussuffer from exhaustion, depression and profound moral damageMore than everBefore. When people come to us, some on the worst day of their lives, we cannot care for them as we were taught. Match Day tells us that medical students recognize this. we've known for a long timeEmergency rooms are broken. We need our administrators to recognize this, listen to us, and rebuild our environment so that we can treat people quickly, solve problems, and, when asked, save their lives.

When I chose this specialty 30 years ago, I knew the ER would be a busy, high-stress environment. I knew that at times I would face uncertainty. But I loved that emergency care was supposed to be a great leveler: a safety net where we treat you regardless of your race, creed, gender, or ability to pay. I loved that it's an exciting field of medicine - anyone and anything can get in at any time, whether you're a 23-year-old gun victim or a 60-year-old cardiac arrest patient, and you'd have to do whatever I want . I already learned in medical school, in addition to some, apply to try to help them. I've loved it over the years, it's helped some of our most vulnerable people get the care they couldn't get anywhere else.

But lately my love has waned. In some parts of the United States, particularly inrural areasand states withoutMedicaid extensionTo cover the uninsured, my colleagues had to send some after their emergency room visits with no viable options for aftercare. It affects your health outcomes. The uncertainty of having to think fast that initially fueled our adrenaline morphed into a manpower and resource uncertainty that now fuels our fears.

When we delve into these secondary issues, that idealistic view we had as young physicians becomes dark and uncomfortable, instead of providing ideal and robust clinical care. To believemoral suffering, then moral damage. It burns us, which makes us vulnerable.medical errors,Racial prejudice, depression.and career changes. If health professionals havebad relations with leadership,they don't feel supported by their organization, believing that they are being treated unfairly or that they cannot communicate their grievances aggravates moral damage and exhaustion.

To do this, hospital administrators must improve our work environment. The people who run our hospitals need to involve us in finding solutions because we know better than anyone how our department works. In addition to the ER, doctors often reserve inpatient beds for people who don't have emergency procedures or surgeries scheduled for sick people who don't need the ER. Our admins candistribute these scheduled recordingsand their subsequent downloads throughout the week, including evenings and weekends, to alleviate congestion that leads to high levelshospital occupationFees and restoration.

A fully functioning emergency room needs more than just doctors. Hospitals need to reinvest profits and spend a critical portion of their budget on recruitmentadvancenursesand support staff. We need a nurse-patient relationship that promotes quality care and not the minimum that we usually have. Otherwise, they will have to pay better and make emergency care safer for nurses.they go, and then doctors cannot do our job as effectively.

Our hospital leaders must temporarily find ways to manage staff shortages and ease physicians' workload, includingSchreiberand simplifiedelectronic medical record systems. You can work with doctors to help fill some of our growing nursing shortage, as doctors and nurses have some overlapping skills. We can assume widertelemedicinein triage for medical triage to reduce patient waiting time and relieve providers. However, no solution will work alone. It must be a committed effort on many fronts.

The day after the journey marked another milestone: the one-year anniversary of the Lorna Breen Health Care Professionals Protection Act, named after our emergency medicine colleague who committed suicide in the pandemic and aims to protect themental health stigmaamong medical professionals.

While the deficit on game day may not be apparent in emergency roomsimmediately, and some people predict apotential oversupplyof emergency physicians by 2030, if this year's decline in the number of emergency physicians continues, we will eventually face a shortage. Many of us will get burned. This raises an important and difficult question for us as a society: How will we survive when you walk into an emergency room and there are no more doctors or nurses to treat you?

This is an opinion and analysis article and the opinions expressed by the author or authors do not necessarily reflect those ofamerican scientist.

ABOUT THE AUTHORS)

    Janice Blanchardis a professor in the Department of Emergency Medicine at George Washington University and an associate faculty member of the Fitzhugh Mullan Institute for Healthcare Workforce Equity at the George Washington University Milken Institute School of Public Health. He received an M.D. and an MPH from Harvard University and Ph.D. from Pardee RAND Graduate School. The opinions expressed are my own.

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