Imagine-se noemergency departmentin desperate need of intensive care.
If you're lucky, you'll be quickly checked by a triage nurse who takes your vitals and records your complaint, before sending you back to the lobby. Hours pass and chances are you still haven't been treated. You are surrounded by other patients, some withcontagious diseases. As the clock ticks on, many peopleto leave, risking controlling his illness on his own. Eventually, someone takes him to the treatment area, but it's only a matter of waiting again surrounded by what appears to be total chaos before, sometimes hours later, a hurried doctor comes to see him.
Now imagine yourself on the other side. Are you an emergency physician, nurse or one of themany other providersthat contribute to this critical care. You desperately want to see the patient you've been waiting for hours, but the department is short-staffed due to thenursing shortage,designed to create450,000 open positionsuntil 2025. Your ED is full of people "boarding" orneeds to be admittedto the hospital, but they are stuck: there are not enough beds to get this person out of the ER. This leaves less room to see or handle the growing queue of people in the waiting room.
People attack you forfrustrationabout your long waits. Your department is at a standstill because you can't get people out or get things done because there aren't enough people. You feel helpless, exhausted, and even heartbroken.
For now,thanks to covid, many people are aware of thechallenges of workingin an emergency service. But many of these problems existed before the pandemic, and things seem to be getting worse. A few days ago, on the biggest Match Day in history, when around 40,000 medical students from all over the country found out where they would have theirnext formative yearsAfter an often ultra-competitive process for a limited number of slots, hundreds of emergency medicine residency slots have become vacant. In two years, the number of applications for the normally crowded residencies in emergency medicine has dropped by 26%, leaving 555 places open this year.
The emergency doctors and nurses who work with us aresuffering 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 are taking notice. we've known for a long timeemergency departments are broke. We need our administrators to recognize this, listen to us, and rebuild our environments so we can treat people quickly, fix what's wrong, and, when called upon, save their lives.
When I chose this specialty 30 years ago, I knew the ER would be a high-volume, high-stress environment. I knew that at times I would face uncertainty. But I loved that emergency care was supposed to be a great equalizer - a safety net where we treat you regardless of your race, creed, gender or ability to pay. I loved the fact that it was an exciting field of medicine: at any time, anyone and anything could walk in, whether it was a 23-year-old shooting victim or a 60-year-old cardiac arrest patient, and I would have to use everything I learned. in medical school, something else, to try to help them. I've loved that over the years I've helped some of our most vulnerable people get care they couldn't get anywhere else.
But lately, my love has turned damp. In some parts of the United States, particularly inrural areasand states withoutMedicaid Expansionto cover the uninsured, my colleagues have to send some away after their emergency visits with no viable follow-up options. It affects your health outcomes. The uncertainty of having to think fast that initially fueled our adrenaline morphed into an uncertainty of personnel and resources that now fuels our anxieties.
When we deal with these weird things, instead of providing optimal, robust clinical care, we turn that idealistic view that we had as young doctors into a dark and ugly one. createmoral suffering, then moral damage. It burns us out, making us prone tomedical errors,racial prejudice, depressionand career changes. When health professionals havebad relations with leadership,they don't feel supported by their organization, believe they are being treated unfairly or are unable to communicate their grievances, this aggravates moral damage and wear and tear.
To do this, hospital administrators must improve our work environments. The people who run our hospitals need to involve us in finding solutions because we know how our department works better than anyone else. In addition to the emergency room, doctors often reserve inpatient beds for people with non-emergency procedures -- surgeries planned for people who are sick but don't need the emergency room. Our admins candistribute these planned admissionsand subsequent downloads throughout the week, including evenings and weekends, to reduce bottlenecks that lead to highhospital occupationfees and shipping.
A fully functioning emergency room requires more than just doctors. Hospitals need to reinvest profits and dedicate a critical portion of their budget to recruitingadvancenursesand auxiliary staff. We need nurse/patient ratios that promote quality care, rather than the bare minimums we usually have. They have to make emergency care better paid and safer for nurses, otherwiseare gone, and then doctors cannot do our job as effectively.
Our hospital leaders must explore temporary ways to manage staff shortages and ease physicians' workload, includingscribesand simplifiedelectronic medical record systems. They can work with EMTs to overcome some of our growing nursing shortage, as EMTs and nurses' skills overlap. We can adopt more widelytelemedicinein triage to perform medical tests to reduce patient waiting time and free up providers. However, no solution will work alone. It has to be a dedicated effort on several fronts.
The day after the game marked yet another milestone: the one-year anniversary of the Lorna Breen Healthcare Professional Protection Act, named after our fellow emergency physician who committed suicide in the pandemic, which aims to eliminate thethe stigma of mental health careamong medical professionals.
While the Match Day shortfall may not be apparent in emergency departmentsimmediately, and some people predict apotential oversupplyof emergency room physicians by 2030, if this year's drop in mailings continues, we will eventually face a shortage. Many more of us will go away, burned. This leaves us, as a society, with an important and difficult question: How will we survive if you go to an emergency room without doctors or nurses to take care of you?
This is an opinion and analysis article, and the opinions expressed by the author(s) are not necessarily those ofamerican scientist.
ABOUT THE AUTHORS)
Janice Blanchardis a professor in the department of emergency medicine at George Washington University and an affiliated 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.