More than half the counties in the nation have insufficient pediatric emergency doctors and medical supplies, and the government should amend the national health insurance (NHI) system to keep pediatricians in emergency rooms, Taiwan Pediatric Association members said yesterday in Taipei.
“Children are not just a miniature version of adults,” association president Huang Jing-long (黃璟隆) said.
Huang said that medical procedures for children are not always the same as adults, and it is worrying that the number of pediatricians, especially in emergency rooms of medical centers and hospitals, is rapidly declining.
The association showed a video of a news report about a young father in Nantou County, who had to drive to different hospitals for two hours at night to find a pediatric emergency doctor who was willing to receive and diagnose his baby that had a 40°C fever.
Taiwan Society of Pediatric Emergency Medicine president Hsia Shao-hsuan (夏紹軒) said the Ministry of Health and Welfare’s statistics showed that the number of pediatricians in medical centers had dropped from 764 to 552, but the number in clinics had increased from 1,597 to 1,947 in the past three years.
Hsia said the survey also showed that counties with insufficient pediatric emergency medical supplies — fewer than two hospitals with 24-hour pediatric emergency service — had increased from six counties (27 percent) to 11 counties (61 percent) in the past four years.
Only 42 percent of metropolitan hospitals have specialized pediatricians dealing with emergency cases and many hospitals have emergency room physicians that treat both adults and children, he said, adding that 54 percent of the specialized pediatric emergency doctors have to deal with several jobs at the same time.
“There are usually enough adult patients that can support the cost of running an emergency room … for example, there might be 20 emergency adult patients and only five child patients in one night … so while the NHI’s standard payments are too low, hospitals find it difficult to keep their pediatric emergency services open,” Huang said.
Several pediatricians also said that as the NHI’s standard payments are based on the number of patients a doctor sees, pediatricians who need to spend more time communicating with parents and comforting children are often assessed as having lower performances compared with doctors from other departments.
Pediatrician Song Chi-chun (宋季純), who has just left a pediatric emergency department of a hospital affiliated with the ministry, said heavy workload, low wages (the NHI’s payment mechanism), low respect (from hospital management and some over-worried parents), insufficient support (including fewer assisting nurses) and high risks (parents’ high expectations) are reasons why pediatricians are leaving emergency rooms.
Huang said they urge the NHI administration to utilize a more reasonable payment scheme for pediatric emergency doctors and improve pediatric emergency manpower, and consider the pediatricians’ professional abilities as a criteria in hospital evaluations to help keep good pediatricians on the frontline and dealing with emergency cases.
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