The Canadian emergency medicine (EM) community is overdue for cultural change and reflection on clinical adaptations to support the longevity and wellness of “advanced career” emergency physicians, according to a commentary by UBC Department of Emergency Medicine (DEM) faculty members.
“Clinical adaptations for advanced career emergency physicians: an approach to support practice transition”, was recently published in The Canadian Journal of Emergency Medicine (CJEM).
“Emergency medicine is a relatively new specialty in Canada, with our first trainees starting their residency in the early 1980s,” said Dr. Riyad B. Abu-Laban, lead author and Professor, UBC Department of Emergency Medicine. “With this cohort now into their 60s, they face the task of forging their transition from professional practice with minimal precedent or policies for guidance.”
An Advanced Career Working Group (ACWG) was established by the Vancouver General Hospital and UBC Hospital emergency group in 2020, consisting of eight physicians who were tasked with making recommendations to mitigate challenges for advanced career emergency physicians. The ACWG undertook a literature review, a Canadian environmental scan, an anonymous values survey of their emergency department group, and an anonymous perspectives survey of emergency physicians over age 55 to research possible adaptations.
Emergency physicians face many clinical challenges, including short, high-stakes patient interactions, significant cognitive load, innumerable interruptions, shift work, and an increasingly untenable work environment. These challenges may increase and be compounded by physiological changes from aging, which can include increased fatigability, visual and auditory decline, reduced tolerance of circadian disharmony, decreased manual dexterity, and neurocognitive changes.
The CJEM commentary identifies several recommendations the ACWG reached, including options for emergency physicians over age 55 to opt out of night shifts and/or high-acuity shifts, supporting the ability to work half shifts, and provisions related to overall shift duration and continuing education.
“You could use the analogy of a light switch when considering the advanced career phase of an emergency medicine physician’s career, and whether it’s an on/off or a dimmer,” said Dr. Abu-Laban. “Does every emergency physician have to make an all or none decision, and soldier on or retire abruptly? Or can they dial things down by stopping nights, working shorter shifts, working in less high-acuity areas, or even augmenting their work with clinical contributions in other areas of emergency medicine like providing virtual care on the provincial 8-1-1 line?”
Age-related discussions and adaptations are more common in other medical disciplines, including anesthesiology and surgery, as well as other high-stakes fields where age-related patient physiology differences can be impactful, such as aviation.
The commentary ends with a call on the Canadian Association of Emergency Physicians to undertake the development of a position statement on advanced career emergency physicians.
“There is no position statement on this topic in Canada, so my hope is that our work will encourage other emergency department groups to consider the issue, and encourage the development of a national position statement,” added Dr. Abu-Laban.
Fellow UBC DEM co-authors include Dr. Nicholas G.W. Rose, Dr. David Migneault, Dr. Erin Fukushima, Dr. Kerry E. Walker and Dr. Jill McEwen.