What is it like to be a Swiss EM Doctor?
In Switzerland, the title of EM doctor may describe different roles: It may be an internal medicine or surgery specialists with additional qualification in emergency medicine who works in an ED. Or, it may be an anesthesiologist who accompanies paramedics to provide preclinical emergency care. Some do both. For me, working at a medium-sized urban hospital, it means spending each day closely working with a team of nurses and residents trying to solve medical puzzles and providing primary care.
3 things that are going well in EM in Switzerland:
Swiss EDs are well equipped with readily available diagnostic tools, including MRIs and specialist consultations. Follow-up specialist consultations usually take place within a short time span, as required by guidelines.
EM is seen as an attractive occupation among young residents. It is an incredibly interesting field with varying working hours, which is why – luckily – positions available at EDs can usually be filled. However, this is threatened by less attractive working conditions that have emerged post COVID-19.
Collaboration between hospitals usually works well: If a there is no availability in-house, or patient needs care that is only available in a different hospital, we work together to transfer patients to wherever care can optimally be provided.
3 things that are hard:
Currently there is a concerning shortage of (mostly nursing) staff, which results in a severe lack of in-hospital care availabilities. This has worsened after the COVID-19 pandemic. We now engage daily in long searches for an available hospital bed elsewhere for a patient in need, which binds resources and results in stress for everyone involved.
While there is a diploma for EM, it is not its own specialty. This results in greatly varying skills and backgrounds of EM physicians, and weakens the position of EM in cooperation with other disciplines. This has even resulted in interdisciplinary EDs being shut down and medical emergencies being directly referred to specialists.
The increasing shortage of family doctors, the growing population, and the shifting understanding of a medical emergency in the public leads to staggering increases of emergency consultations each year. We continually expand resources to accommodate this increase, but it still leads to longer wait-times and over-filled EDs.
Description of 2-4 solutions underway
There are continuous political efforts on multiple levels to establish EM as its own specialty. Recruiting initiatives of family doctors and nursing staff look promising: We just passed a political initiative to improve working conditions for nurses. Family doctors have been working closely with universities to create interest in the profession among medical students.