Emergency Medicine Challenges in Ecuador

Abstract

Introduction: Emergency medicine (EM) was recognized as a specialty in Ecuador in 1993. Currently, there are two four-year EM residency programs and an estimated 300 residency-trained emergency physicians countrywide. This study describes the current challenges in EM in Ecuador. Methods: We conducted 25 semi-structured, in-person interviews with residency-trained emergency physicians, general practitioners, public health specialists, prehospital personnel, and physicians from other specialties. The interviewer asked about challenges in the areas of emergency care, working conditions of emergency physicians, EM residency education, EM leadership, and prehospital care. We analyzed data for challenges and registered the number of interviewees who mentioned each challenge. Results: Interviewees worked in the three largest cities in the country: Quito (60%); Guayaquil (20%); and Cuenca (20%). Interviewees included 16 (64%) residency-trained emergency physicians; six (24%) residency-trained physicians from other specialties working in or closely associated with the emergency department (ED); one (4%) general practitioner working in the ED; one (4%) specialist in disasters; and one (4%) paramedic. Shortage of medical supplies, need for better medico-legal protection, lack of EM residencies outside of Quito, and desire for more bedside teaching were the challenges mentioned with the highest frequency (each 44%). The next most frequently mentioned challenges (each 38%) were the need for better access to ultrasound equipment and the low presence of EM outside the capital city. Other challenges mentioned included the low demand for emergency physicians in private institutions, the lack of differential pay for night and weekends, need for more training in administration and leadership, need for a more effective EM national society, and lack of resources and experience in EM research. Conclusion: Emergency medicine has a three-decade history in Ecuador, reaching important milestones such as the establishment of two EM residencies and a national EM society. Challenges remain in medical care, working conditions, residency education, leadership, and prehospital care. Stronger collaboration and advocacy among emergency physicians can help strengthen the specialty and improve emergency care. [

Emergency Department Characteristics and Capabilities in Quito, Ecuador

“…Information on which specific services staffed each ED was not collected. However, based on experience visiting and working in Ecuadorian EDs, typical services include pediatrics, obstetrics, internal medicine, and surgery [ 12 ]. While EM has existed as a distinct specialty in Ecuador since 1993, there are relatively few EM residency-trained physicians nationwide [ 12 ].…”

“…However, based on experience visiting and working in Ecuadorian EDs, typical services include pediatrics, obstetrics, internal medicine, and surgery [ 12 ]. While EM has existed as a distinct specialty in Ecuador since 1993, there are relatively few EM residency-trained physicians nationwide [ 12 ]. As this number continues to grow, it is expected that these physicians will play a larger role in the provision of emergency care within the ED.…”

“…Contact information was obtained by authors AM and DT through their own social and professional networks. After completion of the survey, we transferred responses from paper forms into a secure online database (LimeSurvey) [ 12 ]. Data were collected from April 2018 to July 2019.…”

“…Overall, Ecuador has approximately 20 physicians per 10,000 population [ 8 ]. However, the urban zones in metropolitan Quito have an estimated 40 physicians/10,000 residents [ 11 ], and the majority of Ecuador’s residency-trained emergency physicians work within the greater Quito area [ 12 ].…”

“…This deficit is expected to be corrected by 2030 as more residents graduate [ 6 ]. A recent qualitative study described the current state of emergency medicine in Ecuador cited challenges across multiple sectors, including medical care, working conditions, residency education, leadership, and prehospital care [ 12 ]. The authors identified specific areas for improvement and argued in favor of stronger collaboration and advocacy amongst EM physicians.…”