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EPs Are Thinking about Their Exit

2023; Lippincott Williams & Wilkins; Volume: 45; Issue: 6 Linguagem: Inglês

10.1097/01.eem.0000942488.74906.8b

1552-3624

Madison Spencer,

Global Health Workforce Issues

Figure: EPs, emergency medicine, career, COVID-19, salary, survey, contract management groups, health care, hospitalsFifty-three percent of EPs are having second thoughts about their career The COVID-19 pandemic revealed systemic issues and did a number on EPs' physical and mental well-being, leading many to say they are contemplating leaving the specialty, according to responses we collected in our 2022 EMN salary survey. Most EPs (64% of respondents) said their institution had been supportive in implementing precautionary procedures and providing appropriate resources during the COVID-19 pandemic, but many mentioned the lack of PPE, ED beds, and staff as ongoing issues. One doctor said, “My job did not provide the emergency medicine physicians and staff with N95s and threatened us with ‘corrective actions’ if we wore our own that we purchased.” There was a notable difference in how EPs felt about this depending on where they worked. Twenty-two percent of those employed by contract management groups said their facilities could have done better, as did 17 percent of those in independent groups and 12 percent employed by hospital and health care systems. But 40 percent of locum tenens EPs said their institution didn't offer enough support to help them do their job safely. The opinions were more diverse when we looked at how EPs feel about the additional benefits their institution offered, such as better pay, extra vacation time, and free mental health counseling, to help them cope with the increased demands of the pandemic. A large number of physicians (47%) strongly or somewhat strongly agreed that their institution had done enough in this regard, 20 percent were neutral, and 33 percent were unimpressed with the level of support they received. One EP wrote, “My employer has actually taken resources away and tried to reduce pay. They took away the ability to earn overtime.” Many of those who clocked more hours with patients fell into this latter group. Fifty percent of those who saw patients for 30 to 40 hours a week said they were not appropriately compensated or given enough resources to deal with the extra stress. Coping with COVID Satisfaction with workload also seemed to be tied to how positively or negatively EPs viewed the perks and assistance their institution offered. An overwhelming 64 percent of physicians who said they were very happy with how much they worked said they were given sufficient incentives and support. On the other hand, 57 percent of those who said they were somewhat dissatisfied with their workload said that was not the case. We also noticed that more CMG employees were discontent with the level of financial and emotional support from their institution—42 percent—compared with EPs who worked elsewhere. Twenty-eight percent of those employed by independent groups and 22 percent of those employed by hospital systems said their institution did not provide adequate support. More than half (53%) of our respondents said they had to take on responsibilities outside the scope of their jobs. One physician wrote, “I have become a janitor, tech, phlebotomist, nurse, chaplain, and mental health supporter. But I did it from the bottom of my heart. My patients are first!” Lack of Support Another EP shared that nurses were furloughed during the pandemic, and they had severe nursing shortages for about a year to the point where physicians were cleaning patient rooms and begging for oral meds to dispense. Now they are employing high-cost, low-accountability travel nurses and dealing with extensive ED boarding. Increased workload and ongoing lack of personnel support were common issues that many EDs encountered during the pandemic and with which they still struggle. This comment summed up the challenges that many shared in the survey: “Expectations on patients-per-hour went up; pressure to make money for the corporation went up; staffing, support, and beds went down. What's not to love?” These challenges had a direct impact on the physician workforce: Forty-seven percent of EPs said they were reconsidering their career in EM as a result of the working conditions and demands during the pandemic, and 67 percent reported feeling more exhausted mentally and physically from their job since the start of the pandemic. These sentiments were prevalent even among those who reported high satisfaction with their workload: Fifty-three percent were having second thoughts about their career, and 64 percent said they feel more tired as a result of their work. One EP said, “I'm leaving clinical medicine as a result of the unsustainable expectations and burdens placed on emergency medicine as a direct result of the pandemic as well as the systemic strain and inadequate resources across the system revealed by the pandemic. In lieu of significant systemic and increased support, I suspect the frontline workforce will shrink at an alarming pace as individuals flee the field for a more sustainable career.” Next month: Part 5: We'll cross-reference EPs' salaries, gender, age, employer, and position with career satisfaction. We are also publishing all of the salary survey articles ahead of print in our enews. Sign up for the enews (totally free!) at http://bit.ly/EMNenewsSignup. MS. SPENCER is a freelance writer in New York City. Share this article on Twitter and Facebook. Access the links in EMN by reading this on our website: www.EM-News.com. Comments? Write to us at [email protected].