In March of 2017, I was among various members of AAEM who were invited faculty for the 26th Winter Conference for Emergency Medicine and Critical Care in Karpacz, Poland. We were distressed to learn that emergency medicine is under dire threat in Poland.
When a resident matches into a residency slot at a given hospital or university, they may be one of only one to five residents in the specialty, across all five years of training. Further, at most hospitals, the emergency department director must fill an ambitious clinical duty schedule, so that the residents are strongly compelled to repeatedly, week after week, “take one for the team” and fill unscheduled hours as an independent contractor. The EU has work hour limits, but it is difficult for the resident to decline a chairman’s “request” to work beyond these limits. Some Polish emergency medicine residents spoke of being on clinical duty in excess of 90 hours per week. Is it any wonder that Polish EM residency training programs have such difficulty attracting new classes of trainees, and that the majority of “open” positions in EM go unfilled each year?
And it’s not just about the residency hours. Even after graduation, working conditions in Poland are so bad that many recent residency graduates actually commute to Great Britain to work in their National Health Service, because the working conditions in Britain are so much better.
Reading the previous sentence should give you pause. As you may be aware, British emergency physicians engaged in widespread strike activity earlier this year when health ministry leaders there essentially mandated that British emergency physicians work more evening, night and weekend hours than before, without a commensurate adjustment in pay.
The fact that Poland’s young emergency physicians voluntarily flock to the British system, which has been beset by strikes by its own doctors, puts the ongoing calamity faced by Polish emergency medicine in stark relief.
The elected government in Poland, leading a populace that became accustomed to free healthcare during its Communist era, doesn’t seem to understand that health care workers will become unlikely to willingly show up for clinical duty if they aren’t given a workable system while earning a competitive wage.
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Dr. Judith Tintinalli asks the question, “Do we need to put emergency medicine on the endangered list?”
Dr. Mark Reiter asks the question, “Do emergency physicians need a labor union?”