Why I've Decided to Depart from Emergency Medicine
I'm reaching the end of my journey in emergency medicine, and I've made the difficult decision to leave behind the ambulance bay doors and hang up my stethoscope for the last time. I initially entered this field with the intention of providing critical care to seriously ill and injured patients, but unfortunately, that mission has become nearly impossible to fulfill.
It's essential that I share some of the reasons why I, along with many colleagues, are departing from a profession we once held dear. The repercussions of these issues will inevitably affect you and your loved ones, and it's crucial that we shed light on the challenges we face.
As a trained and certified emergency physician, my shifts begin with a commitment to serve. However, a significant portion of my time is spent addressing cases that extend beyond the realm of emergency medicine. I find myself acting as a podiatrist, dentist, pediatrician, urgent-care provider, nursing home doctor, mental health counselor, primary care physician, and social worker. Despite possessing the skills to handle emergencies, the strained and overburdened emergency department staff and resources often hinder my ability to deliver timely care.
Emergent patients often wait excessively, up to 45 minutes, before their triage and abnormal vital signs are recognized. This delay is a result of the influx of non-emergent cases that take precedence, such as routine check-ups, school-related matters, and minor ailments. Corporations overseeing emergency departments are increasingly catering to these non-emergent cases to boost profitability. Rather than focusing solely on legitimate emergencies, the emphasis has shifted toward accommodating non-urgent visits. Some hospitals have even gone so far as to actively advertise that they can provide round-the-clock convenience for tasks traditionally handled by pediatricians, such as school sports physicals.
The improper utilization of the emergency department, coupled with inadequate staffing, leads to extended waiting times for patients. This situation forces many individuals to spend their entire visit in the waiting room. Meanwhile, administrators, in an attempt to protect themselves, remind us not to violate patient privacy laws while we're working in a crowded lobby. They understand that we lack both the space and time to ensure private updates for every patient. Despite this, their goal of minimizing liability is met, leaving us, the healthcare providers, to shoulder the increased risks and continue striving to provide quality care while adhering to our Hippocratic Oaths.
Some individuals in our field urge us to accept this new norm, highlighting the job security that non-emergent cases bring. This perspective is as illogical as asking fighter pilots to engage in unrelated activities to ensure job stability between missions.
Patient satisfaction has become a central focus to attract non-emergent cases and maximize Medicare reimbursements. However, the surveys used to measure satisfaction are only given to patients who are discharged from the emergency department, many of whom do not have true emergency conditions.
Research indicates a correlation between higher patient satisfaction scores, increased costs, and elevated mortality rates. Additionally, what the patient desires or expects often clashes with proper clinical practice and genuine medical necessity. This places healthcare providers in a dilemma where they must choose between satisfying the patient's wishes or adhering to medical best practices. In some cases, clinician salaries are tied to both patient satisfaction and clinical quality measures. Consequently, physicians facing demands for inappropriate care, such as antibiotics for viral infections or unnecessary CT scans, may opt to provide such care to avoid negative feedback that could impact their careers.
Medical professionals have long refrained from accepting patient gifts due to ethical concerns. Similarly, other industries have significantly increased the emphasis on tipping, but healthcare should not be viewed as a customer service industry. This distinction is particularly crucial in the emergency room setting. If you're uncomfortable with the notion of doctors soliciting tips, you should also be uneasy about their salaries being linked to patient satisfaction.
The number of emergency medicine residencies has surged from 160 to 273 between 2013 and 2022. Projections suggest that there will be an excess of emergency physicians by 2030. Many of these new residencies are not affiliated with universities and offer subpar education. Corporate hospitals have initiated these programs primarily to access funding, utilize inexpensive labor (residents), and flood local markets with physicians to drive down salary costs. Those of us trained before the expansion of these programs are astounded by the inadequate training they provide and the subpar quality of their graduates. However, this oversaturation of the market has reduced career stability and hindered physicians' ability to voice concerns about these issues. Hospitals often inform emergency medicine groups that they are starting residencies, and compliance or replacement is the only option. Consequently, attending physicians who opted for non-academic positions, and are therefore ill-equipped to teach, are tasked with training the next generation. Ultimately, the quality of medical education and care is being sacrificed for the sake of corporate profits.
Emergency departments are grappling with the misallocation of staff and resources, leading to potentially dangerous outcomes. At some point, you or a loved one might experience a life-threatening emergency. Would you prefer an emergency department where patients with minor issues rate doctors highly for excessive attention, or would you rather have resources allocated to those with genuine emergencies? My answer is clear. I can no longer contribute to the degradation of emergency medicine, which is why I've chosen to step away.
The author wishes to remain anonymous.
