Emergency medicine in Norway: The road to specialty recognition

Abstract

Emergency medicine (EM) in most of Europe is a much newer specialty than in the United States. Until recently, emergency departments (EDs) in Norway were staffed with unsupervised interns, leading to a government report in 2008 that called for change. From the establishment of the Norwegian Society for Emergency Medicine in 2010 to the creation of the specialty in 2017 and the approval of the first emergency physician in Norway in 2019, our review article describes how a small group of physicians were able to work with politicians and the media to get an emergency medicine specialty approved despite resistance from a much larger group of existing specialists. Norway faced many of the same obstacles as the United States did with implementing the specialty 60 years ago. This article serves as a review of the conflict that may ensue when enacting a change in public policy and a resource to those countries that have yet to implement an emergency medicine specialty.

Comparing International Experiences With Electronic Health Records Among Emergency Medicine Physicians in the United States and Norway: Semistructured Interview Study

“…Municipalities have urgent care centers with on-call physicians ( legevakt ) [ 50 ]. The ED or acute receiving area ( akuttmottak ) is only accessible via ambulance or physician referrals [ 50 , 52 ]. The department is traditionally staffed by internal medicine, neurology, orthopedics, and surgery physicians [ 53 ]; however, EM was recently recognized as an independent specialty in Norway in 2017 [ 52 ].…”

“…The ED or acute receiving area ( akuttmottak ) is only accessible via ambulance or physician referrals [ 50 , 52 ]. The department is traditionally staffed by internal medicine, neurology, orthopedics, and surgery physicians [ 53 ]; however, EM was recently recognized as an independent specialty in Norway in 2017 [ 52 ]. Historically, ambulance and other health personnel would communicate with hospitals to determine the most appropriate inpatient specialty service to receive the patient upon arrival [ 50 ].…”

The relationship between regional inequalities in the provision of emergency health services and other health services

“…The health services provided in the emergency departments may include serious processes that limit the vital activities of individuals and even result in death in some cases. [17][18][19] For this reason, access to emergency services is of vital importance and is an individual and social issue that should not be compromised.…”

Implementing a new emergency department: a qualitative study of health professionals’ change responses and perceptions

“…Resistance to the establishment of a new medical specialty of EM was mainly raised by well-established medical specialties, who e.g. argued that other specialties such as anesthesiologists already competently managed critically ill patients and it was proposed that existing specialties should send attending physicians down to receiving areas to supervise [ 46 , 47 ]. Skeptics’ resistance in Norway was overcome by using Zink’s [ 48 ] work on the history of EM in the US as a playbook and support for the specialty, as well as demonstrating the goal of doing the best for the patient to policymakers and the general public through the use of the media [ 47 ].…”

“…argued that other specialties such as anesthesiologists already competently managed critically ill patients and it was proposed that existing specialties should send attending physicians down to receiving areas to supervise [ 46 , 47 ]. Skeptics’ resistance in Norway was overcome by using Zink’s [ 48 ] work on the history of EM in the US as a playbook and support for the specialty, as well as demonstrating the goal of doing the best for the patient to policymakers and the general public through the use of the media [ 47 ]. In Iceland, creating acceptance of the new specialty was aided by visiting international EM physicians, by getting medical students and graduates interested in EM, by formalizing educational and training programs, by establishing an EM society, and by hospitals hosting case conferences with other specialties for them to obtain better understanding of how the patient’s course was in the ED, what was done and why.…”