Barbara Hogan MBA
President, European Society of Emergency Medicine
I believe the number of patients seeking emergency care in Europe will increase again in 2016 in the majority of countries. Simultaneously, the squeeze in state healthcare spending is likely to continue.
Emergency medicine leaders will also face the challenge of retaining their teams of physicians in an increasingly tough working environment.
Patient numbers in emergency departments have been rising steadily in most of Europe and I expect this trend to continue. Family doctors generally no longer provide care out of normal working hours or at weekends. Cuts in healthcare spending make it more difficult to get appointments with specialist physicians in many countries.
This gap in European healthcare has to be filled by emergency departments. The people of Europe are getting older and need ever more care. The emergency department is where elderly patients turn to.
Increasingly, elderly people are in homes for senior citizens. Many such homes have no medical care or no care in the evening or weekends. Instead their business plan is to send elderly people they are paid to look after into an emergency department if they fall sick.
Emergency departments, like the police, have the duty to be available at all times and have to deal with the problems society wishes to ignore but which are a daily reality.
Alcohol abuse among young people continues, with hard drinks like vodka and gin only a little more expensive than beer in many countries. Alcohol abuse, especially in big European cities, is becoming an ever-greater problem for us.
Drug abuse continues and the number of homeless people living on the streets is an issue that society often ignores. In 2016, emergency departments will again have to deal with these patients. Alcohol and drug abuse can also be linked to violence, with attacks on emergency physicians and nurses a sad feature of emergency medicine especially in large cities.
Meanwhile, the period between Christmas and the new year has become an unofficial holiday in Europe, with huge numbers of medical practices and treatment clinics closed. Emergency departments increasingly provide the primary medical care for millions of European people in this period.
The hundreds of thousands of refugees arriving in Europe also need medical care. It is the emergency department that must often take on the enormous burden of providing medical care for these people.
Increasing patient numbers in emergency departments mean waiting times are a top political and media theme in many countries. Physicians are likely to receive even greater pressure to treat more and more patients with zero errors.
Introduction of the specialty physician in emergency medicine will be vital in those European countries that are still refusing to introduce this essential qualification. Work must be intensified to introduce the emergency specialty in the face of a hostile and even abusive attitudes among other medical specialties in some countries.
Emergency department staffing will continue to face the challenge of what I call the move to the West. Physicians in West Europe are attracted to the higher pay received in the United States. The new freedom of employment among Eastern EU countries mean physicians in Eastern Europe are moving to higher paid jobs in West Europe, leaving staffing gaps in their home countries.
Against this background, a critical challenge facing emergency medicine leaders in 2016 will be retaining staff.
New concepts need to be developed to share the burdens of shift work at nights, weekends and public holidays. Pay must reflect the special demands physicians in emergency departments face.
But efforts must also be made for emergency physicians to gain more respect for their work, which is too often belittled and even insulted by other medical departments in hospitals.
Training is also vital, and is a special challenge in countries where resources are tight or the emergency specialty is not recognised.
It is one of EuSEM’s aims to become a source of information to answer any question raised about emergency medicine, so making a concrete contribution to training. We want to become a matrix providing the answers to questions about clinical and pre-clinical emergency medicine needed by physicians in training and undergoing further training in their roles, and to help them in their daily work.
We want to provide answers about scientific medical questions but also to questions about organisation and management of emergency medicine. This will include working methods in emergency departments, personnel requirements, economics and budgets.
To help achieve this aim we have set up a series of EuSEM working groups to examine a range of themes such as research, education and training, professional working methods, pre-hospital emergency medicine and for young emergency doctors.
EuSEM has also developed and implemented the European Board Examination in Emergency in Medicine (EBEEM) for physicians in emergency medicine. This exam aims to create a uniform high standard in emergency medicine in every European country, benefitting both physicians and patients.
EuSEM also organises education, training and preparation courses for the EBEEM exam.
Healthcare managers need to re-think their attitude towards emergency medicine. Emergency departments can move from being only an access point into the hospital and a cost centre to being a centre of excellence for process-based medicines.
Emergency departments can play a strategic role in generating and steering the patient flow in hospitals, this work will continue in 2016.