Exodus in health care begs the question: ‘What will make you stay?’

Before refrigerators were in every household, my grandfather delivered ice blocks in South Carolina’s rural low country. Knowing many families in the area, he often attended either a wedding or a funeral (or both) on Saturday afternoons.

When the pews looked thin, especially for funerals, he’d make the rounds by the barbershops and ask neighbors to attend. “Everyone deserves a crowd,” he would say.

Years after his death and now three years of pandemic uncertainty, I hear his words when another emergency department staff member slips off the roster, some leaving their first job for something easier, others for work where they are less likely to get punched or to retire in silence after 30 years of devotion. Many leave without plans for their next step or are too ashamed to tell us they are moving on.

These days, I cannot help but wonder what we are losing when we barely acknowledge or even commemorate our departing co-workers.

At times, our emergency departments feel like the last remaining modern-day sanctuaries. Our teams of nearly 200 nurses, doctors, guards, social workers, clerks and cleaners keep us triaging, de-escalating, resuscitating and caring in 50-person shifts. Most days it seems like society’s other institutions must be turning the desperate away since our sliding doors keep sliding open.

What patients on emergency department stretchers may never know is that compared to before, the odds now are stacked against them.

And while hospitals hum at all times of day and night, at any moment, an emergency department can flip to a sudden roar – the EMS patch rings, a team of paramedics roll in doing compressions, ‘Protected Code Blue’, ‘Clear [body jolts]! Resume CPR!’, beginning what can be hours of resuscitation.

Three years ago, it would be many people on one, trying to keep the person alive. But our resuscitation teams are smaller now, and only a few of the masked faces were here before the pandemic. “Everyone deserves a crowd,” echoes again.

And what patients on emergency department stretchers may never know is that compared to before, the odds now are stacked against them. Care delays, virtual misdiagnosis, space constraints, burned-out staff, inexperience and the departure of collective team knowledge means a person’s chances of meaningful survival are likely less.

When we don’t acknowledge the quiet departures, it leaves those of us who remain unsettled and asking, ‘why stay?’ if it is barely noticed when someone leaves. Moreover, as our co-workers walked away, no one took notes to gather their collective knowledge. How did you know when the ‘regulars’ looked sick? Where did you place the toughest IVs? Can you show me that sweet spot to plug the resus oximeter when it won’t connect?

And we are not asking if there was a straw that broke their backs and made them leave.

“Everyone deserves a crowd,” I thought, when I read an email announcing another colleague’s early retirement. As we carry on amidst this uncertainty in health care, it is long past time for us to ask all who remain, “What will make you stay?”

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Catherine Varner

Deputy Editor

Catherine Varner is a Toronto emergency physician, clinician scientist and freelance journalist. She is on the deputy editorial team at Healthy Debate.

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