Australia’s emergency departments have become so overcrowded and chaotic that stress and burnout are pushing increasing numbers of doctors to consider abandoning the speciality, which threatens to exacerbate an existing crisis.
A new report from the Australasian College of Emergency Medicine (ACEM) revealed close to two in five emergency doctors plan to leave the profession in the next decade. Even when physicians close to retirement are excluded, one in five respondents aged under 50 still said they were “likely” or “very likely” to quit – a rate that has doubled in less than 10 years.
Most cited unsustainable workplace conditions as a reason for wanting to quit. In addition, almost three in four emergency physicians planned to cut their hours. Some 60 per cent of doctors surveyed said the demands of work interfered with their home and family life. Over half of them reported work-related burnout.
EDs have a different role in the healthcare system than they did last century, but the system has not kept pace with the massive changes. Overcrowding, which can lead to “bed block” – has turned EDs into glorified waiting rooms, with people stranded in corridors, in chairs and in ambulance bays.
ACEM president Dr Peter Allely said he expected the situation to worsen because overcrowding had become so normalised its impact on staff and patients was not being properly addressed. “It’s the moral injury that we face day to day of not being able to give the best possible care because we don’t have the space,” he said.
There was a bright spot: violence and aggression towards doctors surfaced as an emergency department occupational hazard some 16 years ago, but the survey found instances of discrimination, bullying, harassment and sexual harassment by other staff had halved since 2019. However, two in five clinicians still reported experiencing verbal abuse or physical aggression from a patient or carer in the past year.
The problems facing EDs may be worse, but they are not new. Problems caused by insufficient staff and long wait times for transfers sound eerily similar to the findings of a 2008 inquiry into the NSW hospital system by Peter Garling, SC.
He recommended more beds and diverting patients not thought to need urgent care away from EDs to reduce overcrowding. But the Australasian College of Emergency Medicine report released today shows little progress has been made.
Australia’s health system has long been the envy of other countries, but its reputation for being universally accessible is failing. The federal government has successfully encouraged the uptake of bulk-billing by GPs but some patients, particularly those on low incomes, have little alternative other than to attend EDs, thereby causing longer delays for patients with far more serious conditions who need urgent treatment.
Any solutions will certainly require improved hospital capacity and better co-ordination between federal and state governments. Both levels of government say they are working to address the problems.
EDs play such a critical role in Australians’ lives that routine understaffing makes absolutely no sense. The potential flight of ED specialists must be addressed as a matter of urgency.
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