The introduction of emergency physicians (SHA, spoedeisendehulpartsen) in Dutch hospitals has not always led to more efficient care. SHAs, however, do satisfy expectations concerning the medical quality they provide. This is the conclusion drawn by Constanze Kathan on the basis of research into the development and organizational effects of SHAs in the Netherlands. Kathan states that these effects depend on the type of emergency help and the role allocated to SHAs within this. The new
professional group has had trouble positioning itself within the medical hierarchy. This means that the envisaged faster throughput of patients has barely been realised and in some instances has even been slowed down. Kathan will defend her thesis on 17 January 2008 at the University of Groningen.
In the United Kingdom, Emergency Physicians (EPs) have been a highly valued professional group for decades. Increasingly complex care needs at emergency centres and the growing demand for a shorter specialization period led in about 2000 to this new discipline being introduced in the Netherlands. Kathan compared the professional groups in both countries and concludes that the Dutch SHA has nowhere near the same recognition as the English EP. Kathan: ‘In Britain, EPs are doctors who as specialists have set up a new specialism. In the Netherlands they are young people who enter the programme as junior doctors and have to establish a new profession. That is extremely difficult because they have to position themselves among much older and more experienced specialists.’
The older specialists are often strongly opposed forces, especially if they have problems with the transfer of decision-making powers and responsibilities. According to Kathan, some specialists are opposed for a number of reasons that are extremely difficult to define. They are afraid of reducing their patient domain, of earning less money for the practice and of losing training places for their assistants. In order for SHAs to succeed, it’s important that hospitals make clear agreements about these aspects with their specialists.
Depending on the climate in the hospital, the arrangement of specialists and other professionals and an individual’s personal preference, two types of SHA have developed. ‘Emergency care specialists’ are what Kathan calls SHAs who profile themselves as medical specialists and are on equal terms with other specialists. In larger training hospitals with a strong medical hierarchy, Kathan more often came across SHAs who have ended up playing the role of ‘internal GP’ as a result of the institutional attitude. Kathan: ‘They are regarded as generalists and not as specialists.’
Kathan calls SHA ‘a difficult profession’, but she is positive about the future. She expects that SHAs will not be used as an extra link for much longer. Protocols that currently require these doctors to involve others at all times in their work will change as the discipline proves its competence and thus gains more of the medical world’s respect. In order to achieve this, it is important that the SHAs grow, both in numbers and in experience. In time, Kathan expects, SHAs will be given more autonomy. ‘And then they will certainly contribute to better and more efficient patient care.’
Constanze Dorothea Kathan (Germany, 1975) studied Business Studies at the University of Konstanz. She conducted her PhD research at the Faculty of Economics and Business of the University of Groningen. Her supervisors were Prof. A.M. Sorge, Prof. R.O.B. Gans (head of internal medicine at the UMCG) and Dr M.A.G. van Offenbeek. The research was financed by the SOM Research School and partly facilitated by the SOSG (Stichting Opleiding Spoedeisende Geneeskunde – Foundation for Emergency Medicine Training) and NWO. Kathan is currently a senior analyst for the Derby Hospitals NHS Foundation Trust in the United Kingdom. The title of her thesis is Emergency Physicians in the Netherlands: The Development and Organizational Impact of New Multidisciplinary Professionals in Hospitals
More information: Constanze Kathan, tel. 0044-7895 144 667,
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