Abstract
Objective A nationwide strike that took place from August 21 to September 7, 2020, which was led by young doctors represented by residents and interns, resulted in shortages of manpower at almost all university and training hospitals. This study aimed to identify differences in the process and outcomes of emergency department (ED) patient care by comparing the performance over about 2 weeks of the strike with that during the usual ED operations. Methods This retrospective observational study evaluated ED flow and performance during the junior doctors' strike and compared it with the usual period in a single tertiary-care academic hospital. The outcome variables were defined as ED length of stay, crude mortality, and hospital mortality and adjusted for demographic and clinical parameters. The effect of the doctors' strike on hospital mortality adjusted for demographic and clinical variables was investigated using logistic regression. Results A total of 1,121 and 1,496 patients visited the ED during the strike and control periods (both 17 days), respectively. The care usually provided by four or six physicians, including one specialist, was replaced with that by one or two specialists at any one time. During the trainee doctors' strike, EM specialists managed patients with fewer consultations. However, the proportion of patients who underwent laboratory and radiologic tests did not change significantly. The median ED length of stay significantly decreased from 359 minutes (interquartile range, IQR: 147–391) in the control period to 326 minutes (IQR: 123–318) during the strike period (P < 0.001). The doctors' strike was not found to have a significant effect on mortality after adjustments with other variables. Conclusion During the junior doctors' strike in 2020 in Korea, EM specialists efficiently managed the care of emergency patients with higher levels of acuity without compromising the survival rate, through fewer consultations and faster disposition.
Highlights
Doctors have gone on strike to express their opinions in the same manner as members of other professions [1,2,3,4,5]
Since the start of the strike, only six specialists worked on three shifts, with one or two of them working at the same time. e emergency department (ED) physician workforce’s timetables during the usual and strike periods are presented in Figure 1. e structure of human resources in other groups in the ED remained the same, composed of nurses, nursing assistants, emergency medical technicians (EMT), and administrative staff. e scope of the ED doctor’s work included history taking and physical examinations, bedside procedures, prescriptions of laboratory and radiologic tests, request for consultations with other specialists, and the acquisition of informed consent
1,037 cases in the strike group and 1,384 cases in the control group were included for analysis (Figure 2). ere were no significant differences in age or sex between the study and control groups
Summary
Doctors have gone on strike to express their opinions in the same manner as members of other professions [1,2,3,4,5]. In 2020, a nationwide strike was launched to protest the plan regarding a medical school for public health in Korea It was led by young doctors represented by residents and interns and resulted in shortages of manpower at almost all the university hospitals and training hospitals [11], with medical students participating by boycotting class activities. While most clinics and community hospitals did not take part in the strike, most resident physicians, who are key personnel in universities and training hospitals, were absent from essential services such as emergency departments (EDs), intensive care units, operating theaters, and Emergency Medicine International hemodialysis units throughout the strike Owing to their absenteeism, for approximately 2 weeks, the faculty and attending physicians were the only doctors providing elective and emergency care in academic hospitals. Concerns about possible decreased quality in medical care and an increase in mortality arose, considering the preexisting difficulties posed by the outbreak of the coronavirus disease (COVID-19)
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