Interesting article in the BMJ this week about the crisis in recruitment and staffing in UK emergency departments. You can read the text here. Written by an independent journalist it seeks solutions to the current difficulties in attracting trainees into the speciality and in retaining those already here.
Sadly I don’t think the article achieves its aims as there are few solutions here, just an identification of the problems. The idea of deliberately working trainees into the ground is clearly absurd, but we have to recognise that it’s a really tough job. You won’t find the EM trainees in the mess, the coffee bar or even sitting down much. Shifts are fast paced, hard work and peppered with potential risks as a result of the varied and continuous patient flow.
Whilst there is no doubt that EM has concerns about recruitment it is up to those who work in the speciality to get the message out that this is actually a really great job. Whilst we clearly cannot ignore the difficulties the speciality faces it should be balanced with the positives and the benefits of the role. So whilst the article focuses on the negatives what about the positives? The varied practice, teamworking, clinical engagement, management, teaching, education and life long learning were somewhat missed.
There are obviously issues around work intensity in EM as compared to other careers, similarly the work/life balance puts a lot of people off in their early careers but can be of great benefit as families arrive or if you want to do things during the normal working week (I ride bikes).
So if we have a problem then we have to talk about it.., let’s call it therapy for the career. If we don’t recognise the problems and talk about them then perhaps we will not solve them, but there are clearly risks in doing so!! I guess these are typical of some of the responses which were a bit disheartening as these are exactly the sort of people we want to engage with and encourage to join the team.
@Benjih1 It's not the best advert for attracting talent is it 'we will work you til you almost drop'!I loved my A&E rotation tho.— Andrew Dawes (@andrew_dawes) December 11, 2012
So in answer to Ben and Andrew, I think you make a fair point. Indeed it is one we have made before here on St.Emlyn’s this year. Check out the original blog post on EM careers here. Andrew states that he really enjoyed his EM and that is not at all uncommon, but it does not translate into a career choice in the same way that it does in other foundation and undergraduate experiences. In the previous article we did look for solutions to and suggested the following….
What then can we do? A starting point would be to recognise the additional disruption that training in EM causes to the individual and their family. The UK Government is consulting on the idea of differential pay depending on where you work. Perhaps the time is now for us to give additional reward to the hard working trainees in emergency medicine. Perhaps that might convert some of my enthusiastic and brilliant trainees to stay in a speciality where they love to work, and one in which they feel rewarded for doing so.
….we thought it to be fairly controversial at the time and the BMJ were aware of this and other suggestions about how we can encourage people into EM. In case they were forgotten…
- 1. Value the trainees.
- 2. Engage, teach and learn with the trainees.
- 3. Promote and role model great clinical behaviours and show what a good EM doc does.
- 4. Differential pay and service benefits to represent work intensity.
- 5. Develop and promote robust exit strategies. Make it possible for docs to switch careers after 10-15 years in EM (not everyone can do this until 68 years of age).
- 6. Learn from industry about rotas and work patterns (annualised hours, sabbaticals, progressive shift patterns etc.)
Ultimately it is up to us to ensure that our trainees are not worked into the ground and that they feel valued and engaged with what can and should be a fantastically interesting and intellectually rewarding career. If I were to invest in one thing then it would be in supporting and training our junior docs. Through this we can show that they are valued (and they are REALLY valued) which might translate into great colleagues of the future.
So EM stands at a tipping point in the UK. If we cannot recruit we cannot progress, but we need to progress in order to recruit. Quite where that balance lies at the moment I do not know but as consultants we should do our very best to make sure that we tip in the right way.
To quote Mike Clancy (via @_nmay) on the matter….
"EM is a great specialty practiced under adverse conditions."— Natalie May (@_NMay) December 5, 2012
@CEMpresident Future of EM #APEM2012
Just my personal thoughts – and in my own words 😉
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9 thoughts on “A career in Emergency Medicine part 2 (b)”
I switched from medicine to EM And haven’t looked back since. EM is a fantastic speciality that is all too often surrounded by bad press and negativity. EM demands hard work and delivers incredible rewards, and for this reason I agree that it’s time to accept that we as trainees are different from trainees in other specialities, as the expectations from us are greater. It would be really nice to be valued further through teaching opportunities, and work-life intensity to be reflected in the pay,(like this very much!). A lot of us are considering taking time out of programme to gain further experiences abroad- it would be an attractive retainer to offer an in-programme training option to work abroad for 6/12 months??
I know a lot of people take time out of program to work abroad (some don’t come back), or to get subspeciality training.
Do you think that is something we should promote through flexible training programs?
Totally agree. Great to see that top of the list is: “Value the trainees”. Ahead of the important monetary and rota issues. This kind of appreciation from the top down is very important I think
Agree, common sense really as they are the future of the speciality.
Bravo Simon. Recognizing the intensity is key. Everything (mostly!) about EM is great but it cannot be practiced in the same way as other specialties.
Sometimes we are as guilty of not recognizing this as the pay masters I think. Money is only one aspect but important.
Yes I feel I would benefit from a more flexible training programme, for example, it would be great if there were opportunities for further experiences abroad (rural, trauma, pre-hospital, third world, MSF etc) between ST4-6. At the moment it seems the chance is lost if not taken between ST3-4. These experiences make us well rounded, calm and confident trainees and can only be beneficial to our career and personal development, so I feel they should be actively promoted throughout training.
EM is a universally diverse and dynamic specialty, we should promote this to attract more to join the team!!
Interesting points. There is certainly a significant step up in terms of responsibility between ST3-ST4. I wonder if one the reasons people leave at ST3 might be the (perfectly reasonable) anxiety of taking on the ST4 role which is often a step up in terms of overall departmental management and the supervision of more junior trainees.
In ‘Value the trainees’ – Should we be doing more to protect the junior doctors from the open hostility from senior nursing staff? One the most common problems complaints from junior trainees is clashes with the nursing hierachy. We often brush over this as ‘part of the ED process’ and side with the long term members of the ED team – but this lack of manners/professionalism is not tolerated elsewhere in the hospital.
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