Emergency medicine workforce study in israel: 2003

Abstract

Study objectives: Emergency medicine was officially recognized as a specialty in Israel in 1999. In November 2003, the first class of 9 Israeli trained and examined emergency physicians were certified as specialists. We undertake this survey to assess current staffing of emergency departments (EDs) in Israel and attempt to estimate the need for emergency physicians in the future. Methods: A survey instrument was sent to all ED directors in general hospitals having EDs in Israel. The ED directors were informed that the information would be kept anonymous and only used in the aggregate. We asked questions relating to ED staffing by number of physicians, type of specialty, resident or specialist, and differential staffing by time of the day and week. In addition, we inquired as to the census, structure, hospital resources available, and size of the ED. Results: We had a response rate of 96% (23 of 24 hospitals). There are 59 certified emergency medicine specialists working in EDs in Israel, caring for a total of 1,872,500 visitors annually. A minority are residency trained. There are currently 37 emergency medicine residents enrolled in 19 programs in Israel. Emergency care is otherwise given by specialists and residents in other fields and by nonspecialist physicians. Presence of emergency medicine specialists is not evenly distributed by hospital type or time of day. During the day shift at large hospitals, there is an average of 2.25 emergency medicine specialists and another 4 specialists of other types on duty. From midnight to 8 am in large hospitals, there is an average of less than 1 specialist of any kind (typically not emergency medicine) on duty in the ED. Evenings and nights in most EDs, care is given by nonspecialists (residents in various specialties and others nonspecialists) working 16-hour shifts. The shortage of emergency physicians is greatest in medium-sized hospitals (average ED census 88,000 visits per year) where there is an average of only 5.3 full-time physicians (of all types) employed, which is in contrast to large hospitals (average ED census 104,000) where there is an average of 9.3 full-time ED physicians (of all specialties). Nineteen of 23 responding hospitals have been recognized as potential training sites for emergency medicine residents. Conclusion: The recognition of the need for emergency medicine as a specialty in Israel by the medicopolitical establishment has not as yet translated into care of emergencies by emergency physicians for most patients. It is apparent that to adequately staff the existing EDs in Israel around the clock full time, there is a need for a large increase in the number of emergency specialists. This increase will require a policy emphasis on funding positions for emergency medicine staff and a concentrated effort directed at emergency medicine resident education.