‘I do not want to be spat on, punched or kicked’: Exodus of emergency physicians accelerating

As anti-vaxx protests continue in front of hospitals across Canada, emergency physicians are saying enough is enough and leaving their profession behind.

According to the Canadian Association of Emergency Physicians, a staffing shortfall has been in the making for years but the challenges of the pandemic have doctors exiting the profession at an accelerated pace, leaving hospitals already struggling with nursing shortages in yet another staffing crunch.

In December, Kari Sampsel, an emergency physician in Ottawa, took a leave of absence after 20 years in the profession. “The unsolvable problems are getting worse and worse, and no one is coming to help us fix them,” she says.

While Sampsel cites the ever-increasing pressures of crowding, boarded patients and lack of mental health and primary care services as reasons for her departure, it is the feeling that she and her colleagues are undervalued by patients, the hospital and the health-care system that ultimately has driven her out.

“The level of vitriol, abuse, frustration and anger that is hurled at us from all corners is untenable,” says Sampsel. “I do not want to go to work to get spat at, punched or kicked. I don’t expect to be called a hero, but not being treated like a human being is a deal breaker.”

Alan Drummond, Co-Chair of Public Affairs for the Canadian Association of Emergency Physicians, says the shortage of emergency physicians has been building for a decade. In 2016, a report by the Collaborative Working Group on the Future of Emergency Medicine in Canada estimated a workforce deficit of roughly 1,500 emergency physicians by 2025. In other words, Canada would be missing more than 20 per cent of its necessary workforce to staff emergency departments across the country.

That timeline seems optimistic now. Drummond says the exodus has accelerated during the pandemic and signs of serious trouble began this summer. Every province was hit with emergency department closures due to staffing shortages of both nurses and physicians.

The level of vitriol, abuse, frustration and anger that is hurled at us from all corners is untenable.

 “Initially, it was smaller departments (in rural areas), and now it is larger departments in sizable communities,” says Drummond, adding that he attributes the physician departures to low morale and feeling like “expendable cogs in a wheel.”

Sampsel says emergency departments are an “afterthought” in health care and pandemic decision-making, “the health-care system’s punching bag.”

Sampsel and Drummond’s experiences on the ground are mirrored in a January research survey in which more than 60 per cent of 416 emergency physicians reported high levels of burnout.

Kerstin de Wit, the senior author of the survey and an emergency physician at Kingston Health Sciences, says what troubles her most is that younger physicians and female physicians completing the survey reported the highest levels of burnout. Since emergency departments are increasingly staffed by doctors in these demographics, says de Wit, “we may not have enough emergency physicians to do the job.”

The results of the survey resonate with Sampsel. “The enjoyment of work is gone. In the resuscitation room we’re all in plastic, yelling through baby monitors, and you can’t hear anything. So many of our colleagues have left, and with all of the system pressures, younger people are saying, ‘Am I going to do this for 30 years? Absolutely not.’ ”

Recently, a controversial editorial published in the Canadian Journal of Emergency Medicine stated that emergency medicine in Canada is a lost paradigm. It sent shock waves across the specialty because the authors argue the Canadian health-care system is far too dependent on emergency departments to provide unscheduled care. Instead, the department should only care for patients with the most emergent conditions.

Emergency departments are an “afterthought” in health care and pandemic decision-making.

As part of their justification, they cite Canadians as having the least access to primary care, specialists, surgical procedures and imaging among peer OECD countries and the highest rate of emergency department utilization per capita. And, they argue, emergency departments are picking up the slack of a “broken system;” to fix it, emergency departments’ care should be limited to patients with “acute injuries, emergencies and lifesaving care in keeping with the specialty’s original intent.”

In other words, the authors seek to obliterate the notion that every doctor’s office voicemail can instruct patients to “go to your nearest emergency department.”

While Drummond agrees emergency physicians are fed up with many health-care providers who refuse to see patients in-person, resulting in patients showing up in the emergency department with “time sensitive conditions where the time window has passed,” he says limiting visits only to those with high acuity is unrealistic and would not serve the health needs of Canadians.

“We do a good job of stopgap measures. We are able to be responsive to people who need us, whether it be people who can’t access primary care or mental health services, socially disadvantaged patients, people who need to escape violence, or those who have just left hospital or had surgery.”

However, Drummond, Sampsel and the editorial authors all agree, emergency physicians must be at the table when health-care decision-makers reflect on the pandemic and plan for the future.

“We all now recognize the fragility of the system,” Drummond says. “We must be part of that discussion. As the safety net of the system, we need to be engaged with the process and must be actively listened to.”