It’s the week before Christmas and Dr Clare Skinner, an emergency medicine registrar, has been on her feet for hours. She’s one of eight doctors on duty to treat up to 180 patients during her shift in the emergency department at a busy Sydney hospital. Tonight, there should have been ten doctors on duty but, as usual, they’re operating without the full complement of staff.
Steering a course through the irate patients who have waited too long, the psychiatric patient who is trying to kick and bite her, and the intoxicated young woman who is vomiting on the floor, Dr Skinner is terrified of what might come through the door next. “It’s just chaos,” she says. “I don’t think the general public realise we’re working on the brink of what we are capable of all the time, and things can easily tip over the edge.”
Beyond the Emergency Doors
Inside the emergency department, harried and burnt-out staff are trying to manage the workload. But it’s hard when you lack enough trained staff.
A major problem is emergency wards being staffed by juniors, who need constant supervision. “It means that what I do is fragmented. I’m constantly interrupted,” says Dr Sue Ieraci, an emergency medicine specialist at Sydney’s Royal North Shore Hospital.
It’s not just inexperienced young doctors who are the problem. Many of our doctors come from different countries – anywhere from Ireland to Nigeria, brought in by public health departments desperate to boost staff numbers. While most have adequate clinical skills, their lack of knowledge of the local system causes problems. “After a year or so they’re fantastic, but you really have to nurture them through that,” says Dr Ieraci.
Australia does not have enough medical staff. There are shortages in the medical workforce across nearly three-quarters of the country, affecting 59% of the population. In 2005, the Productivity Commission reported that shortages will get much worse in the next decade due to changing disease patterns, more medical technology and an ageing workforce.
The Australian Medical Workforce Advisory Committee found serious shortages in nearly all the medical professions, including a shortfall of 1300 GPs and 12,000 nurses. We don’t have enough trained dentists, pharmacists, occupational therapists, physiotherapists, podiatrists or radiographers.
Shortages mean staff are stretched to breaking point, wards have closed and patient safety is at risk. A recent Reader’s Digest survey revealed that 51% of Australians see the lack of
doctors as the main cause of slow treatment in emergency departments.
Beyond the emergency wards things are just as serious. In NSW, several high-profile spinal surgeons recently resigned, saying long waiting lists for surgery are endangering their patients’ lives. In Queensland, CT scans are being put on hold because there aren’t enough radiographers. Around the country, new psychiatric wards are sitting unused because there are no staff.
Existing staff are so overworked that safety is a real concern. Lorraine Long, who runs the Medical Error Action Group, receives at least 300 e-mails a day from people complaining about hospital treatment. “There are problems with wrong patient surgery, wrong site surgery, wrong medication, wrong dosage, contaminated blood products, poor sterilisation and morphine overdoses,” Long says. “There’s just not enough people to do these things. It’s like running an airline without pilots.”
