The Shortage of Emergency Medical Residents; A Serious Alarm for the Iranian Ministry of Health and Medical Education

Abstract

Dear Editor, Emergency medicine is one of the world’s newest academic disciplines in recent decades (1). This discipline was established in Iran several years ago and its importance in the community is gradually increasing (2). Emergency medical services play a key role in providing health care services. In recent years, the role of emergency medicine specialists was quantitatively and qualitatively studied in Iran, in the light of its emergence and in spite of some disagreements made at the beginning of its establishment in the Iranian universities. Today, it is well documented that in the Iranian emergency rooms, by the presence of emergency medicine specialists in the treatment system, providing medical services to patients is significantly improved and the waiting time to access services remarkably decreased. By the reduction of patient’s waiting time, and time to determine the patient’s status and destination in the hospital, further emergency beds are available for possible admissions and emergency rooms are prepared for future admissions (3), in addition to economical savings and other benefits (4). Officials and deputies of the Iranian Ministry of Health always emphasize on the importance of attracting and educating emergency medicine specialists according to the needs of the country in their interviews and forms of need assessment (5). Despite this emphasis and the needs of the country, studies and experiences in Iran show that the procedure of admission and training of emergency medicine specialists is very worrying and critical, therefore, selection of this discipline has a very low priority for applicants (6) and emergency medicine has the highest rate of withdrawal among residents compared to other disciplines. Many emergency medicine residents are over 35 years old and apply for this discipline with low motivation and energy, while the essence of this discipline requires younger, more motivated and energetic individuals. Research findings suggest that disciplines such as emergency medicine and surgery have lower priorities for applicants due to their stressful nature, increased workload, and the disruption of lifestyles and work life. However, such factors are not limited to Iran and other countries in the region and the world have also the same conditions (6, 7). Nevertheless, a worrisome issue is the release of alarming figures by the Iran Medical Council authorities indicating that more than 11000 medical graduates in recent years did not refer to register and get license from this organization; in other words, they abandoned medicine or immigrated. In addition, 15000 physicians who registered and were licensed by the Iran Medical Council are involved in other businesses, and since 2014 the immigration rate of physicians with different specialties increased 38 times (8). Moreover, shocking figures released by the Iranian Ministry of Health after announcing the results of residency entrance exam, which showed that 305 city-disciplines had no applicants including the emergency medicine, and more than 6000 applicants accepted in the residency entrance exam of 2018 preferred to wait for the next turn, immigrate, or even continue their education in general practice (9). In addition, to the best of authors knowledge, a large number of admitted applicants did not refer to register or withdrew from university at the beginning of the course, to such an extent that some universities registered only two or three emergency medicine residents that is far less than the nominal and actual capacities of the universities. If the same status is observed in the residency entrance exam on March 2018, which is not unexpected, departments of emergency medicine might be inactive in most universities.