Tel Aviv Medical Center, Department of Emergency Medicine, Tel Aviv, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
West J Emerg Med. 2024 Jul;25(4):584-592. doi: 10.5811/westjem.18541.
Emergency medicine (EM) was recognized as a specialty in Israel in 1999. Fifty-nine of the 234 (25%) attending physicians working in emergency departments (ED) nationwide in 2002 were board-certified emergency physicians (EP). A 2012 study revealed that 123/270 (45%) of ED attendings were EPs, and that there were 71 EM residents. The EPs primarily worked midweek morning shifts, leaving the EDs mostly staffed by other specialties. Our objective in this study was to re-evaluate the EP workforce in Israeli EDs and their employment status and satisfaction 10 years after the last study, which was conducted in 2012.
We performed a three-part, prospective cross-sectional study: 1) a survey, sent to all EDs in Israel, to assess the numbers, level of training, and specialties of physicians working in EDs; 2) an anonymous questionnaire, sent to EPs in Israel, to assess their demographics, training, employment, and work satisfaction; and 3) interviews of a convenience sample of EPs analyzed by a thematic approach.
There were 266 board-certified EPs, 141 (53%) of whom were employed in EDs full-time or part-time. Sixty-two non-EPs also worked in EDs. The EPs were present in the EDs primarily during weekday morning shifts. There were 273 EM residents nationwide. A total of 101 questionnaires were completed and revealed that EPs working part-time in the ED worked fewer hours, received higher salaries, and had more years of experience compared to EPs working full time or not working in the ED. Satisfaction correlated only with working part time. Meaningful work, diversity, and rewarding relationships with patients and colleagues were major positive reasons for working in the ED. Feeling undervalued, carrying a heavy caseload, and having complicated relationships with other hospital departments were reasons against working in the ED.
Our study findings showed an increase in the number of trained and in-training EPs, and a decrease in the percentage of board-certified EPs who persevere in the EDs. Emergency medicine in Israel is at a crossroads: more physicians are choosing EM than a decade ago, but retention of board-certified EPs is a major concern, as it is worldwide. We recommend taking measures to maintain trained and experienced EPs working in the ED by allowing part-time ED positions, introducing dedicated academic time, and diversifying EP roles, functioning, and work routine.
急诊医学（EM）于 1999 年在以色列被认定为一门专业。2002 年，全国 234 名急诊部（ED）主治医生中有 59 名是经过董事会认证的急诊医生（EP）。2012 年的一项研究显示，123/270（45%）名 ED 主治医生是 EP，并且有 71 名急诊住院医师。EP 主要在周中上午轮班，导致 ED 主要由其他专业人员配备。我们在这项研究中的目标是在最后一次 2012 年的研究 10 年后，重新评估以色列 ED 中的 EP 劳动力及其就业状况和满意度。
我们进行了三部分的前瞻性横断面研究：1）一项调查，发送给以色列所有的 ED，以评估在 ED 工作的医生的数量、培训水平和专业；2）一项匿名问卷，发送给以色列的 EP，以评估他们的人口统计学、培训、就业和工作满意度；3）对方便抽样的 EP 进行采访，采用主题方法进行分析。
有 266 名经过董事会认证的 EP，其中 141 名（53%）全职或兼职在 ED 工作。还有 62 名非 EP 也在 ED 工作。EP 主要在工作日上午轮班在 ED 工作。全国有 273 名急诊住院医师。共完成了 101 份问卷，结果显示，在 ED 兼职工作的 EP 工作时间较少，收入较高，工作经验较长，而全职或不在 ED 工作的 EP 则没有。满意度仅与兼职工作有关。与患者和同事建立有意义的关系、工作多样化以及获得回报是在 ED 工作的主要积极原因。感觉被低估、工作负担过重以及与其他医院部门关系复杂是反对在 ED 工作的原因。
我们的研究结果表明，受过培训和接受培训的 EP 数量有所增加，而坚持在 ED 工作的董事会认证 EP 的比例有所下降。以色列的急诊医学正处于十字路口：选择急诊医学的医生比十年前多，但保留董事会认证的 EP 是一个主要问题，这在全球范围内都是如此。我们建议采取措施，通过允许兼职 ED 职位、引入专门的学术时间以及使 EP 的角色、功能和工作常规多样化，来维持在 ED 工作的受过培训和经验丰富的 EP。
