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EM resident Tom Strandberg rides a “bike” used for rapid transport within the hospital. “The hospital is quite big. Some doctors bring their own mini scooters just for transport within the hospital.”
work week
36 to 40 hours per week (junior & senior staff alike)
vacation Five weeks per year
sweden
less than 1%
by Katrin Hruska, MD
is a cause of death four times more common than traffic accidents
Though still a supra-specialty, EM training continues to build on the gains of the past decade.
I
t is a constant struggle to develop and implement a new specialty like emergency medicine (EM). There are multiple stages to go through and several obstacles to overcome. Interestingly, these seem to have been more or less the same all over the world. Nations who started early with EM have reached further, but it has not been hassle free for anyone. To begin with, it takes a highly dedicated group. In 1999, in Sweden, such a group of people founded what would become, in 2002, the Swedish society for Emergency Medicine. Training programs in EM were started in a few enthusiastic hospitals in 2000-2001, but it was not until 2006 that EM was recognized as a specialty. To many aspiring emergency physicians’ disappointment, the National Board of Health and Welfare chose to recognize EM as a supraspecialty, making it necessary to train in a base specialty as well. All specialty training programs take at least 5 years. The EM specialty training does not have a set time frame, is goal-oriented, and it is estimated
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that you need 2–3 years of training after completing your base specialty. Any clinical specialty is approved as base specialty, even psychiatry, but to fulfill the curriculum requirements would of course take longer with a less relevant base specialty. Internal medicine, family medicine, and anesthesiology are popular base specialties. Most residency programs now offer 7 years of integrated training in the base specialty—for convenience, mostly internal medicine and EM. This causes great frustration since a lot of time is spent in internal medicine wards learning things that are not really needed in the ED. Swedish emergency departments have traditionally been staffed by junior doctors and residents from the different departments of the hospitals. Most hospitals are still divided by specialty into at least a medical and a surgical unit, but several have separate units for cardiology, neurology, ENT, and infectious diseases. More hospitals have realized the advantage of having doctors working in the ED on a
Fall 2010 // Emergency Physicians International
of all invasive Staph Aureus infections are MRSA
suicide
regular basis and have started some sort of EM training program. Most have started out with a group of junior doctors and consultants from internal medicine, surgery, orthopedics, and anesthesiology to supervise them. There are also consultants, who have worked in their respective fields for many years, who have decided to become EM residents themselves. All these emergency physicians-to-be initially rotated their shifts between the different units, then gradually covered more and more shifts. In a few hospitals the emergency physician unit has gained overall responsibility for the ED, but there are still no hospitals that don’t have to rely on doctors from other specialties to cover part of their shifts. To date in Sweden there are around 30 certified EM specialists and close to 200 residents, training in 16 different hospitals. The biggest challenge is to secure the standard of this training, especially in hospitals where there are only a few residents and no specialists. Hopefully there will soon be enough specialists to convince The National Board of Health and Welfare to acknowledge EM as a base specialty. With the current practice it takes at least 7 years of training, after an 18-month internship, to quality as a specialist in EM. Patience and perseverance are crucial characteristics for emergency physicians, who, ironically, might have chosen this profession because they like the thought of finishing their work at the end of the shift and starting out with a clean slate the next day. But, again, this seems to be a common feature around the world.
Bouncebacks: New Findings from Sweden In a 2010 analysis, 50% of non-urgent ED and unscheduled primary care visits resulted in a repeat health care contact within 30 days. Of those patients:
9% originating from unscheduled primary care visits led to a secondary ED visit 16% originating from non-urgent ED visits resulted in a repeat ED visit Backman AS, Blomqvist P, Svensson T, Adami J. Health care utilization following a non-urgent visit in emergency department and primary care. Intern Emerg Med. 2010 Aug 19. [Epub ahead of print]