In Taiwan this year, 38 people have applied for the subspecialty certification exam for pulmonary and critical care medicine, while the number of doctors who have applied for subspecialty training programs in the same area — in other words those expected to take the certification exam after two years — is only 26. Having worked as a pulmonologist for more than 20 years, I find these numbers deeply troubling.
Statistics show that beginning in 2001 the number of test-takers for the subspecialty certification exam was no less than 60 per year — and at the highest was 102 — but the number has fallen sharply in the past three years. If the government allows the situation to deteriorate, in a few years’ time there will be a shortage of specialists in pulmonary and critical care medicine and Taiwan will face a serious crisis.
The statistics indicate that it is increasingly rare for doctors to choose a career in pulmonary and critical-care medicine; and the upshot is fewer specialists in the area. This directly affects the quality of care provided to patients. Without a sufficient number of medical specialists, who will care for patients with life-threatening conditions?
When I was younger, critical-care medicine was still a burgeoning field. Many chose to pursue a career in the field, believing nothing could be more satisfying than bringing a dying person back to life. Nowadays, while people understand that working at an intensive care unit (ICU) can be demanding, the increase in legal disputes over medical malpractice has caused many young doctors to choose other specialty areas over critical-care medicine.
Critical care is an essential aspect of a hospital’s medical services. A hospital’s ICU team provides support to every medical department with its specialized skills in treating the most severe conditions.
Theoretically, a hospital should make sure its ICU is well-supported with sufficient resources and specialized staff so that doctors can concentrate on battling life-threatening conditions with patients. However, at major hospitals the ICU is seen as nothing but an accessory.
While hospitals love to boast about the quality of their critical-care services, in reality, unless there is a major crisis, they tend to neglect it. Purchasing new equipment, or training specialized staff, for the ICU is usually not their priority.
While there is a grading program — run by the Joint Commission of Taiwan — for evaluating the quality of a hospital’s critical-care services, the organization has never had enough doctors with experience in critical care to take part in the evaluation process. The government agency apparently neither understands nor cares enough about critical-care medicine.
These are some of the major reasons many intensive care workers feel pessimistic about the prospect of critical-care medicine. With the lack of new blood, they also fear no one will pick up the slack when they retire.
According to the National Health Insurance Administration (NHIA), there are more than 7,000 intensive care beds in hospitals across Taiwan. However, in times of epidemic or serious disasters, there is hardly enough beds for patients, due to the lack of specialists in critical-care medicine.
Less than one-third of the beds for intensive care are fully used — as many ICUs simply do not have the expertise or resources to handle all types of patients with life-threatening conditions. Meanwhile, each of those beds contributes to a 20 to 30 percent deficit for the hospital. As high-quality critical-care services are always costly, it is far from profitable.
The National Health Insurance (NHI) program was founded with the goal of providing critically ill patients with the treatment and care they need, hence ICUs are primarily funded through the NHI. However, critical-care expenses covered by the NHI are quite low.
The government has not been encouraging hospitals to treat patients with minor illnesses — perhaps for a good reason — yet its lack of support — and sometimes indifference — toward critical-care departments cannot be justified. As the situation continues to worsen, medical services might soon face a serious breakdown.
The government should procure more resources for the nation’s critical-care departments and make absolutely sure that they can provide adequate support for their hospitals.
Yu Chong-jen is president of the Taiwan Society of Pulmonary and Critical Care Medicine.
Translated by Tu Yu-an
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