“I’m scared that December is coming.”
A first-year resident at an internal medicine department said he often recalls a medical mishap that claimed the lives of infants at Ewha Womans University Mokdong Hospital two years ago. He feels it could happen at his workplace, too.
In December 2017, the pediatric department of Ewha was in charge of the neonatal intensive care unit (NICU). The department was severely understaffed at the time.
There were 14 residents at Ewha’s pediatric department, and five of them did the night shit per day on average. Two out of the five on the night duty took charge of the NCU and the pediatric ward. The other two tended for the pediatric emergency room. The rest, a fourth-year resident, oversaw them.
This working system started to fall apart as some of the residents left work to prepare exams for obtaining a specialist certification. Three residents in their fourth year of training could not work at the hospital from Nov. 1, 2017, due to the exam preparation. To make matters worse, five residents were unhappy with the demanding work environment and left the hospital on Dec. 12 altogether. The number of residents at the pediatric department shank to six.
In the end, two or three residents had to do the night shift, taking care of the NICU, the pediatric ward, and the pediatric emergency room at the same time. On Dec. 16, 2017, when four newborns died of bacterial infection at Ewha, there were only two residents at work on night duty – one in the third year of residency, and the other in the first year.
Professors propose using vacation to reduce patient visits
Two years later, in December 2019, an internal medicine department is facing a similar situation.
As the period of residency in internal medicine has shortened from four years to three years, residents in the third and fourth year take the test to become a specialist in 2020 altogether. This means that more than twice the number of residents is out of work in preparation for the test, compared to the previous year. This will halve the workforce of the residents during this period
As the law limits the maximum weekly work hours of residents to 80 hours, hospitals cannot exclude the fourth-year (or third-year) residents from work, which used to be a tradition. Nowadays, residents save their vacation and spend it for the preparation for the specialist certification test. The next test is scheduled for Feb. 3, 2020.
According to the Korean Intern Resident Association (KIRA)’s poll on internal medicine residents, from Oct. 23-29, residents in their third and fourth year usually take five to six weeks off from late December to prepare for the test.
The shortage had been predicted, but teaching hospitals are in a panic. Only 30 percent of the respondents said their hospitals discussed how to distribute more work in advance. The rest 70 percent neither discussed the shortage issue nor failed to plan ahead.
Teaching hospitals’ solutions are mostly stopgap measures such as forcing professors or fellows to do the night shift and other departments to share the workload.
Some are trying to curb the number of patients. At the internal medicine department at a university hospital, professors and fellows proposed taking a weeklong vacation in turns in January. If they do not provide outpatient care, the number of patient visits would naturally go down, they said.
Junior residents fear staff shortage in December
Residents in the first and second years of training said they were worried about the upcoming staff shortage in December. They said they felt burdened because they would have to take responsibility for patients without any supervision by senior residents.
“The infant deaths at Ewha occurred after the hospital suffered a staff shortage, following the leaving of residents. As third and fourth-year residents are out for the exam preparation, junior residents will have to see patients. I’m so scared of that situation,” a first-year resident said.
Seo Yeon-joo, vice president of KIRA, said she was also worried about patient safety because third and fourth-year residents, who could do lots of work, would be out of work, while the number of patients and workload would be the same.
“There are many hospitals that say they can’t make a December schedule because half of the internal medicine residents will be off. There is no proper measure now,” she said.
Seo noted that not only residents but professors and fellows are suffering from more work. As someone has to fill the work gap, many hospitals include professors and fellows in the night duty schedule, she added. “This is wrong. Professors and fellows should see patients the next day after doing the night duty. After all, the quality of medical care will worsen,” she said.
Teaching hospitals should have hired additional hospitalists, Seo went on to say.
“The government should also spare no resource to help hospitals increase jobs. To overcome the imminent crisis, hospitals should also reduce the number of patients,” she emphasized.