The working environment must be improved to improve the retention of A&E doctors, according to the first ever study of why emergency doctors stay – rather than why they leave.
The study in the BMJ Open entitled “How do we retain doctors in emergency medicine?” is by Dr Dan Darbyshire from Lancaster University Medical School, who is himself an emergency doctor.
He said: “The findings suggest that the working environment is a threat to retention—it needs improving.
“Retention is important as more experienced and senior doctors perform fewer unnecessary tests, make better decisions, and get fewer complaints.
“High turnover is correlated with poor organisational performance.”
Dr Darbyshire spent over 132 hours of observations over 11 weeks in a UK hospital
The study looked at strategies employed by doctors to keep working in A&E despite the pressures.
These included education, with senior staff prioritising the education of more junior staff.
Dr Darbyshire said: “The junior doctors in our study were made to feel that their learning was important to the team by the actions of those leading the team.
“The value placed on their education as an intrinsic part of their work created space to develop in the emergency department, and they felt this fostered sustainability in their careers.
“Likewise, for the consultants, these elements of education enriched their interactions with trainees and made a qualitative difference to their daily working lives.”
Community was also important, creating by brief interpersonal interactions between emergency department workers.
One doctor said: “So, I think in terms of the department we are quite a tight knit group, there is a lot of human interaction with the team as well, which I quite enjoy, and I’d say so yeah, that’s kept me going.”
Other retention strategies included portfolio careers rather than full-time working as well as self-rostering.
Participants reported that a good rota helped retention and a bad one hindered it while both annualisation and self-rostering enabled staff to plan essential parts of their lives such as childcare and family holidays, respond to unexpected events, and meet training requirements.
Another strategy was mentorship which provided a way to managing the demands of a career in emergency medicine long term.
Dr Darbyshire said: “This paper shows that it is not enough to fund initiatives to encourage people to join the specialty; it is also vital to understand what makes them stay to ensure that investment in the clinical workforce is sustained over time. “
