Recently, a senior nurse at a large hospital went to the emergency room with dizziness and headache after going to work, but lost consciousness and collapsed. As a result of the examination, he was diagnosed with cerebral hemorrhage, and despite neurosurgical intervention, hemostasis did not occur, so surgical treatment was required. At that time, both neurologists at the hospital in charge of the operation were on leave, so they were eventually transferred to another hospital for surgery, but the nurse died.
When it became controversial that the hospital was transferred to another hospital because it was the largest hospital in Korea, the Ministry of Health and Welfare conducted an on-site investigation into the hospital to see if there was any problem with the on-call and leave system. We checked whether there were any problems with the transfer and delivery, but it was judged that there was no problem.
A lot of controversy arose as the medical environment that could not save an employee who had collapsed due to a brain hemorrhage became known at a large hospital. There were various ways of looking at this case and solving the problem. Some argued that the medical school quota should be increased because the absolute number of doctors was insufficient. There were also claims that
Personally, I don’t think the above claims make sense to some extent, but they can’t explain everything. There are claims to increase the quota of medical schools because there is a shortage of doctors in the field of emergency medicine, but increasing the number of doctors does not guarantee that they will go to the field dealing with emergency medicine. Even now, surgery, thoracic surgery, and neurosurgery, which deal with emergency patients, are not filling the training quota because no one wants to do it. It is difficult to think of applying to these departments simply by increasing the number of medical schools.
The argument that the low-price policy in the essential medical field is the cause overlooks the fact that professors currently working at university hospitals have the same salary system regardless of medical income. However, there may be differences in performance-based pay based on medical treatment revenue, but the difference is not high. Also, if the number of patients is absolutely large, even if it is losing money due to low water prices, the hospital increases the number of specialists it needs. Therefore, I think that the current health insurance low-cost system itself is not the most important issue.
– Two-thirds of cardiologists, 7 to 15 on-call days per month
Personally, with the recent development of medical technology, diseases that were previously treatable only by surgical methods are gradually moving to less invasive, faster recovery and better prognosis, such as interventional treatment. As the number of patients requiring surgical treatment has drastically decreased under this circumstance, hospitals have focused on increasing the number of doctors performing interventional treatment while keeping the number of doctors performing surgical treatment to a minimum.
Under this circumstance, young doctors are focusing on interventional treatment that is easy to learn and requires less time and effort and is easier to get a job than surgical treatment, which is difficult, difficult to learn, and difficult to get a job. At the same time, what I personally think is the most important is the change of thinking of the younger generation. The younger generation attaches great importance to war labels. Such a work label means that you are guaranteed time to do what you want to do when you are working, and to do what you want to do when you are not working. not kept This is because emergency patients who occur at night as well as on weekends and holidays ravage the lives of doctors.
It is no exaggeration to say that for cardiologists like me, they are at the forefront of the collapse of this war label. Acute myocardial infarction has a golden time, so treating the patient as soon as possible greatly affects the patient’s prognosis. Therefore, it is recommended that patients with acute myocardial infarction visit the emergency room and perform the procedure within 90 minutes. This means that an on-call cardiologist should always be ready so that they can be contacted and arrive at the hospital as quickly as possible. In this situation, on-call cardiologists must always have their cell phones around, not only at night, but also on weekends and holidays, and it is impossible to drink alcohol or travel nearby.
The problem is that these watch days range from as little as a week to as much as 20 days per month. In 2022, the Society for Cardiovascular Intervention conducted a survey on on-call duty for members. The number of days waiting for on-call for emergency procedures was 7 to 10 days per month in 50.4% of cases and 11 to 15 days in 17.7% of cases. In other words, two-thirds of them are on call 7 to 15 days a month. Nevertheless, the rewards for these efforts and hard work are little or no.
According to the above survey, the hospital does not provide any financial compensation for on-call watchkeeping, and only when receiving an on-call, it is compensated a little in the name of transportation expenses. 15.3% and 37.7% received 50,000 to 99,000 won. 21.0% of the respondents answered ‘no’ at all.
Another thing to consider is that these doctors cannot rest the next day, even if they participate in emergency patient care or surgery at night or late at night. In other words, even if the operation was performed overnight the night before, the procedure or outpatient procedure scheduled for the next morning should be performed as it is. Also, I can’t go when I want to because I have to go on vacation according to the watch schedule. And when you go on vacation, you have to look at the person who is on the watch instead. And even if you do your best, if the results are not good, it is easy to get sued. Due to the current situation, young doctors are increasingly reluctant to major in essential subjects such as thoracic surgery, neurosurgery, and surgery, which treat emergency or critically ill patients, and are flocked to dermatology, ophthalmology, rehabilitation medicine, and radiology departments with relatively good work labels. is the reality
Some say that doctors should have a mission to care for sick patients. It’s true, but you can’t live with a sense of mission alone. Your own life is also important. Will the word YOLO (you only live once, YOLO) become popular? It seems that social interest and discussion are needed to understand how to deal with the current situation, and to understand the change in treatment and generational thinking caused by such medical technology. If these problems are not addressed, no matter what policy is introduced, the number of essential doctors treating emergency and critically ill patients will gradually decrease.
In addition, in the case of life-related essential departments, although the number of patients is very low or the number of patients is small, it seems that the hospital should consider how to maintain the appropriate number of doctors. Hiring these people is costly for the hospital. But if it doesn’t work out, hospitals will be hesitant to hire enough of these doctors.
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