Advanced career emergency physicians

Rodrick Lim, Riyad B. Abu‑Laban, Rafiq Andani, Brittany Cameron, Jim Christenson, Si‑Cheng Dai, Zumil Damji, Sara Gray, Constance LeBlanc, Jill McEwen, Judy Morris, James Stempien, Louise Rang, Douglas Sinclair, Leadership and Wellness Committees, Canadian Association of Emergency Physicians

Emergency medicine is tasked with the delivery of immediate and life-saving care to patients facing health crises, and frequently functions as a gateway to the entire healthcare system. Emergency physicians in the advanced stage of their career bring not only a wealth of clinical experience and diagnostic acumen but also a rich repository of leadership skills, including communication, crisis management, and institutional wisdom. Moreover, with the current critical human resources shortage in emergency medicine, the value of their continued participation in the workforce is even more pronounced.

As physicians age, the physiologic changes and physical demands of clinical emergency medicine, shift work and resulting circadian disharmony, with increasing patient volumes, can be especially challenging. This has resulted in individual Canadian emergency medicine groups establishing approaches or adaptations based on the principle that mitigating these challenges can help promote career longevity [1]. By providing advanced career emergency physicians work flexibility, a pathway can be ensured to strategically support their continued workforce engagement, thereby extending their career longevity and impact, while acknowledging and celebrating their contribution to the field of emergency medicine [3].

Many industries adapt roles in the workplace after a specified age or number of years of service, including first-responders and pilots [4, 6]. The American College of Emergency Physicians recommends workload modifications for physicians in their “pre-retirement years [2],” but does not explicitly define this term. It is also important to acknowledge that the timing of “advanced career” may be individual. Career spans can vary depending on factors other than age, including gender [5], health status, and disability.

Emergency groups may need to incorporate a flexible and context-specific approach to optimally define “advanced career.” The definition of advanced career emergency physicians should rest with individual groups. Reaching agreement on how to define this category requires dedicated group discussions. Factors to consider may include group demographics, local scheduling practices, shift differentials, and shift/site variety. Some options for this definition are age (eg. age over 55), years of practice (eg. at least 15–20 years) or a combination metric (eg. age+years of practice>/=70).

Advocacy by the Canadian Association of Emergency Physicians (CAEP) for clinical work adaptations for various groups is underpinned by several important principles, including equity, wellness, and respect. In relation to this statement, providing flexibility in clinical work for advanced career emergency physicians not only acknowledges the significant contributions they have made in Emergency Medicine but also represents a critical component of addressing the human resources shortage in a manner that is both sustainable for them and beneficial to individual groups, patients, and the healthcare system overall.

CAEP recommends emergency physician groups establish a policy to support the clinical work of advanced career emergency physicians, to ensure continued participation of these valued and experienced colleagues in the workforce, while supporting the principles of physician wellness and safe patient care. Physician groups should work together to design and implement policies based on the following adaptations wherever possible and according to the conditions of each group. These policies should take into consideration work burdens on non-advanced career physicians, resources available, shift coverage demands. and the unique needs of individual advanced career physicians:

Shift scheduling

• option for advanced career emergency physicians to opt out of night shifts and shifts associated with significant disruption of circadian rhythm;

• consider scheduling additional time off for recovery after night shifts for those who continue to work night shifts.

Shift acuity and complexity

• option for advanced career emergency physicians to opt out of shifts identified as high acuity or resuscitation intensive.

Shift duration

• shortening the duration of shifts and schedule fewer consecutive clinical shifts wherever possible;

• consideration of the creation of a formal “split shift” pool to support EPs interested in working half shifts.

Strategies to mitigate group consequences of these adaptations, to achieve satisfaction for group members of all career stages, which may include

• more weekend day shifts in lieu of overnight and/or late evening shifts;

• adjustments in the value/remuneration of resuscitation and complex acuity shifts;

• individual education plans to ensure resuscitation skills and knowledge are maintained by physicians who opt out of high acuity or resuscitation practice.

Consider recognizing exceptional career contributions.

Declarations

Conflict of interest - There are no conflicts of interest to declare from the authors.