Fresh Blood in the Emergency Department

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Author: Henry Knott, Becky Maxwell / Code: CC23, CC4 / Published: 12/11/2014

Health Education England recently announced recruitment of trainee doctors into emergency departments has increased to its highest level this year. 340 junior doctors will be joining emergency departments, an increase of 102 from last year [1]. For the first time in years the numbers have increased rather than got worse. This is great news, and goes some way in implementing two of the ten College of Emergency Medicine priorities for resolving the crisis in emergency medicine [2]. Not dissimilar to a haemorrhage,
we need to continue to restore the volume as well as stem the bleed.

priorities

Box 1. 10 priorities for resolving the emergency crisis. [2]

Im now in my 3rd week of being a doctor, and I am chomping at the bit at the thought of getting into the emergency department. I hope by voicing my views on emergency medicine (EM), recruiters will have a flavour of the things to advertise in order to attract others.

I cant believe EM isnt the most competitive field to work in, what isnt there to like? What could be more rewarding than helping people in life crisis on a daily basis, being the calm head of reason amongst the panic? Aneurin Bevan envisaged a health service available to all. The idea of serving the masses was a huge pull for me in choosing medicine as a career and I cant think of a more accessible department to work in than through the open doors of the emergency department.

For me EM offers the unique opportunity of practicing medicine in its rawest form, often being the first to assess and implement management for the plethora of presentations that enter the department, with nothing but a history and clinical signs to work with. I havent always wanted to follow this career path, while on elective in a Malawian paediatric oncology unit I was torn between paediatrics and oncology, while I was holding a Sims speculum in theatre I wanted to be a gynaecologist, while consoling a young female who wanted to take her own life I wanted to be psychiatrist, and it goes on. I have at some point wanted to follow a career in every specialty I have studied. Fortunately the emergency department will incorporate all of these, the master of all trades and the jack of none!

What do my peers think of EM? Admittedly a small sample size of 11 foundation year doctors at my current trust, four are considering EM as a career and seven are keeping well clear. Variety is the biggest pull. Nearly all are excited by the idea of being able to treat a variety of presentations, others like the opportunities to work in the different areas of the emergency department, and get involved in pre hospital care.

What puts them off? Nearly all said poor work life balance and the hours, they perceive these long antisocial hours to extend into consultancy, and they are put off by the stress and pressure of the four-hour breach time, which they perceive to undermine patient care. A controversial view, may be explained by not knowing the emergency department before the advent of the four-hour breach? Perhaps to your surprise, there was no mention of inappropriate A&E attendances, coincidently consistent with the colleges claim that this figure is near 15% rather than the claimed 40% [3]. Another unpopular view was the lack of continuity of care, however one contradicted this and relished the idea of leaving their patients at the end of a shift!

I understand the recent boom in numbers is thanks to the initiation of run through training and new entry routes. This suggests having to re-apply during training and frequently having to relocate put doctors off, and perhaps some warm to the idea of EM later in their training.

Continuing to embrace the military style of advertising through demonstration of the excitement, variation, and opportunities of EM, and addressing the perceived work life balance and stress will continue the momentum of EM recruitment. I know personally my enthusiasm for treating whatever comes through the emergency department doors far outweighs any of the negatives highlighted above.

References:

  1. 1.Lintern S. Exclusive: Emergency medic recruitment hits highest ever level. HSJ. Aug 2014.
  2. 2.College of Emergency Medicine. 10 Priorities for resolving the crisis in Emergency Departments NHS England. URL: http://www.collemergencymed.ac.uk/Shop-Floor/Policy/10%20priorities%20for%20Emergency%20Medicine. Accessed August 2014.
  3. 3.Peter Locke. Clifford Mann, Small wooden boxes wanted. BMJ 2014;349:g5380

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