Health executives on challenges emergency departments are facing

The healthcare industry is facing a wide variety of challenges—and solutions aren’t always straightforward. Each month, Modern Healthcare asks leaders in the field to weigh in on their approaches to the sector’s thorny issues.

Dr. Christopher Kang, president of the American College of Emergency Physicians, and Dr. James McCarthy, executive vice president and chief physician executive, Memorial Hermann Health System, discusses what’s troubling providers at emergency departments.

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What do you see as the most critical workforce issue in emergency medicine?

Dr. Christopher Kang: While we don’t necessarily have a shortage of emergency physicians, unfortunately they’re now ranked as one of the [worst] specialties for burnout and unhappiness in their careers, mainly because of the working conditions they’ve endured. One issue is the number of tasks they’re constantly being assigned—data entry, administrative work, logistics—rather than spending more time evaluating and communicating with patients.

Dr. James McCarthy: Physician staffing has been more stable than nurse staffing. … We faced tremendous challenges in filling shifts for a while. We’ve weathered a lot of that, but the result has been a massive turnover in nurses over the last three years. It’s a very different workforce than it was previously, and that turnover creates unique challenges in terms of preserving our culture and our processes.

Violence against healthcare workers has made headlines in the past few years. What’s the current trend in EDs?

Kang: The COVID-19 pandemic exacerbated the problem. We’ve seen a swing in perceptions of caregivers and healthcare delivery. It used to be that hospitals were sanctuaries and safe spaces; now we’ve seen a 50% to 75% increase in verbal and physical assaults on ED staff. … Part of it is frustration over long wait times for care, but part of it is also a loss of some civility.

McCarthy: I would say that workplace violence is the number-one concern of our staff. We hear this routinely when we go round. The episodes of violent outbursts towards our employees from patients and family members is higher than it’s ever been. … We just completed a two-year review of our workplace violence protocols and are continuing to drive what we consider best practices, including de-escalation training for all employees.

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What’s another ongoing issue in the nation’s emergency departments?

Kang: It’s boarding patients. This is a source of increasing frustration and moral injury for all of the department staff, but it’s also a manifestation of the problems we have with the entire healthcare delivery system. These are patients who have been evaluated and diagnosed and are supposed to be admitted or transferred, but there is no capacity for them outside of the ED.

McCarthy: Burnout continues to be a challenge. … We’ve launched a physician well-being initiative in which we have partners helping folks lead healthier lives, getting them the tools and resources they need to lower their stress. We’ve also piloted a physician well-being index, which is a tool that Mayo Clinic developed that allows doctors, in a very confidential way, to answer questions and get an assessment of their burnout risk.

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