Probably the Most Diverse ED in the World…

By Dr Una Harrington

Recently I attended my first NOWEM event and SMACC in Sydney.

What I found there was an omnipresent and compelling conversation around equality, equity and the many advantages that a diverse team can bring to the performance of our Emergency Departments (EDs).

I began to ponder on my own ED – a place that might just be ‘The Most Diverse ED in Australia’.

I work in an Urban non-tertiary ED just outside of Brisbane in Queensland. There are 20 Emergency Physicians (aka FACEMs) in my ED. Twelve (60%) are women and eight (40%) are men. Four were born in Australia and 16 born ‘somewhere else’. That somewhere else might be Sri Lanka, Korea, South Africa or maybe the wilds of West Cork. Many of our FACEMs are also so called ‘International Medical Graduates’ (IMGs). We like to think of ourselves as a pretty ‘young’ bunch though, with ages ranging between 34 and 46 years.

Over the last 10 years, our ED has undergone a major staffing transformation – moving from a Senior Medical Officer (SMO) to FACEM model. Over that time, our centre has employed many women, most of those in the bracket of ‘child bearing’ age. In fact, in that time, it has employed a ratio of 2:1 women to men. There is no quota of women or men that needs to be filled in my Health Sector. This is just what happened.

So what might this mean? I explored the themes that had been raised during the NoWEM event and found some interesting evidence.

This brief review isn’t about pitting men against women as treating clinicians. It is an outline of some evidence which would help further the argument that gender diversity in our hospitals, may provide the best treatment for all our patients. After all, are they not the reason we are all here?

1. Gender diversity may ensure better patient care

Greenwood et al suggests that in a gender diverse team, male doctors may perform better if they have female colleagues and more female patients. Furthermore this paper, in the setting of patients who suffer from ischaemic heart disease, suggested that female physicians may provide care that has a lower mortality rate in both their male and female patients. (1)

Another study by Tsugawa in Jama in 2017 suggested that patients treated by female physicians may have not only a lower mortality rate but also a lower re-admission rate. (2)

2. Gender diversity may provide more financially balanced care across your organisation.

Male physicians may see slightly more patients than female physicians overall. However, female physicians are less likely to have legal action taken against them and have less complaints lodged against them. (3)(4, 5)

So in terms of economically balanced care, having both men and women on your staff may find the right financial balance for your organisation as a whole.

Following on from the above evidence review, I began to think about the current demographics of FACEMs and trainees in ACEM and those working in our Emergency Departments (EDs). As of 2018, 37% of all FACEMS are female. The average age of a FACEM is 46. 48% of ACEM trainees are female. The average age of a trainee is 34. Interestingly both trainees and FACEMs have a very similar proportion of International Medical Graduates (IMGs) in their ranks at 40-42%.

Back in my ED I sat down with my Director and FACEM, Dr Ed Pink, to talk about the evolving diversity of our ED staffing and to try to nut out how we evolved in the way we did. This is what he said:

‘To me it’s a source of pride that we have the diversity we do. In a way, it’s a shame that this sticks out as abnormal and that a blog post is being written about it. I believe that every Director should have this in their mind with each recruitment. We are proof that there is a broad selection of candidates out there. If you are an ED Director and you are recruiting, and notfinding this diversity in applicants too, perhaps this should flag that something needs to change? Diversity if not as scary as you might think!’

I then asked my other FACEM colleagues about what working in such a diverse ED means to them. This is what they said:

‘I don’t feel that it matters that I am a man or a woman. Many of our FACEMs work part time – men and women. Many of us have another role outside of our clinical role – in Education, Retrieval Medicine or Administration. Flexibility in a diverse employment environment is just how we do business’

‘Mums and Dads who are FACEMs or trainees are both supported the same – in how they choose to work (full or part time) and in the support they are given in the tough times’

I know I don’t work in the Perfect Emergency Department. We have our issues just like any other. We continue to strive to address our unconscious bias every day.

But one thing I know about where I work is that no matter what my gender, country of birth or sexual orientation, I will be given equal opportunity to lead, to change my local system and to work freely in my role as FACEM.

The evidence is growing that diversity in Health Care may enable us all to provide better care – not least of all because it will better reflect the diverse nature of the community we serve. Perhaps the first step to addressing change at a systems level is to bring the above evidence to your Executive and say to them:

‘Let’s strive to provide the best care we can, by creating a diverse, inclusive workforce, as a priority’

References

1. Greenwood BN, Carnahan S, Huang L. Patient-physician gender concordance and increased mortality among female heart attack patients. Proc Natl Acad Sci U S A. 2018;115(34):8569-74.

2. Tsugawa Y, Jena AB, Figueroa JF, Orav EJ, Blumenthal DM, Jha AK. Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians. JAMA Intern Med. 2017;177(2):206-13.

3. Bratland SZ, Hunskar S. [Medico-legal assessments of complaints against general practitioners]. Tidsskr Nor Laegeforen. 2006;126(2):166-9.

4. Donaldson LJ. Doctors with problems in an NHS workforce. BMJ. 1994;308(6939):1277-82.

5. Taragin MI, Wilczek AP, Karns ME, Trout R, Carson JL. Physician demographics and the risk of medical malpractice. Am J Med. 1992;93(5):537-42.