Exhausted emergency rooms on verge of collapse amid protracted doctor shortage

Shorthanded emergency rooms are on the verge of collapse, forcing emergency patients to spend hours on the road searching for hospitals for treatment. Some urgent patients have had to sit and watch their symptoms worsen — with nowhere else to go.

Paramedics and medical staffers take care of an emergency patient at an emergency room at the National Medical Center in central Seoul on Wednesday. [NEWS1]

Shorthanded emergency rooms are on the verge of collapse, forcing emergency patients to spend hours on the road searching for hospitals that can admit and treat them. At worst, some urgent patients have had to sit and watch their symptoms worsen — with nowhere else to go.

A patient in his 70s, who suffered an earlier stroke, faced a medical emergency after falling into a semiconscious state as his blood-oxygen level dropped at a rehabilitation hospital outside the greater Seoul area. Emergency rooms at nearby general hospitals refused to admit him, citing a lack of available beds. With no other options, he had to stay in the rehabilitation hospital and died two hours later.

Such cases are not limited to rural areas.

In July, another patient who collapsed in a convenience store in Seoul died in an ambulance while hopping between 14 hospitals. A repair worker who was hit by a moving train car at Guro Station in western Seoul had to wait nearly 16 hours to receive orthopedic surgery as he bounced between three hospitals in Seoul on Aug. 9.

The current emergency patient care crisis results from a prolonged medical vacuum that began when junior doctors resigned en masse in February. The void also overburdened the remaining doctors, mostly senior doctors with board-certified specialties in emergency medicine.

Although the Health Insurance Review and Assessment Service said the country added 118 emergency doctors with board certifications in the second quarter of this year, the number of active doctors in the field sharply dropped after some 525 junior doctors working at emergency rooms resigned.

As of last month, 55 junior doctors remained in emergency rooms across the country, according to a report from the JoongAng Ilbo on Wednesday.

Doctors who have consistently practiced emergency medicine said they were at a tipping point regarding their continued services in emergency rooms. They are taking sick leave or submitting resignations.

The report said Ajou University Hospital, which functions as a regional emergency center in the southern Gyeonggi area, is about to see a massive drop in the number of emergency doctors from 21 to 12.

At Konkuk University Chungju Hospital in North Chungcheong, seven senior emergency doctors stated their intention to quit last week. Chungbuk National University Hospital temporarily shut down its emergency room when two doctors went on sick leave on Aug. 14.

“Emergency room management has reached its limit as six doctors have been taking extra shifts days and nights for several months since junior doctors left the hospital,” an official from Chungbuk National University Hospital said.

A medical professor at Hallym University Kangnam Sacred Heart Hospital’s emergency medicine department said he recently resigned as he was “physically exhausted.” He said he has “tolerated an intense workload as his vacancy would result in extra burden on his colleagues,” despite suffering from a chronic ailment himself.

Having a single on-duty emergency doctor in each regional emergency medical center has become the “new normal,” the report said.

The report said that treating a single emergency patient is usually more demanding because more human resources and efforts go into their treatment than 10 patients with lighter symptoms.

“Now, a single emergency doctor handles treatments that used to be done by five to six doctors, including junior doctors,” said Prof. Kim Su-jin, head of the regional emergency medical center at Korea University Anam Hospital, noting that only one on-duty doctor usually serves at its emergency center at night.

The hospital has eight board-certified emergency doctors.

“If several patients with critical symptoms arrive at the emergency room around the same time, doctors cannot treat other patients,” Prof. Kim said.

Kim said her biggest concern “lies in the possibility of emergency doctors experiencing burn-out syndrome during the Chuseok season,” when many patients are expected.

“If the current situation persists, more hospitals will likely fail in running and managing their emergency rooms.”

Health Minister Cho Kyoo-hong announces public health and emergency medical measures at the government complex in central Seoul on Wednesday. [YONHAP]

On Wednesday, a presidential official said there are “no changes in the presidential office’s stance regarding the proposed measure to delay the admissions quota hike in medical schools.”

The quota hike prompted thousands of discontented junior doctors to walk out in February.

Instead, the Ministry of Health and Welfare announced new measures on the same day to alleviate the nationwide emergency medical crisis. It decided to keep over 4,000 local clinics open between two weeks before and after the Chuseok holiday season.

It also promised to run over 29 emergency rooms that only admit patients in critical condition.

This set of measures appears aimed at allowing emergency rooms to focus on treating urgent patients by directing and sending patients with mild symptoms to community doctors and local clinics.

Yet, the effectiveness of the financial incentives remains in question.

“Even though the hospital offers high salaries to emergency medicine doctors and professors, the slots have remained empty for several months,” an official from a general hospital in Seoul said, noting that the bigger problem is that doctors “avoid essential medical fields.”

BY SPECIAL REPORTING TEAM [lee.soojung1@joongang.co.kr]