title: High risk of 'failure' among emergency physicians compared with other specialists: a nationwide cohort study.
abstract: BACKGROUND
  The intensive physical and psychological stress of emergency medicine has evoked concerns about whether emergency physicians could work in the emergency department for their entire careers. Results of previous studies of the attrition rates of emergency physicians are conflicting, but the study samples and designs were limited.
  
  
  OBJECTIVE
  To use National Health Insurance claims data to track the work status and work places of emergency physicians compared with other specialists. To examine the hypothesis that emergency physicians leave their specialty more frequently than other hospital-based specialists.
  
  
  METHODS
  Three types of specialists who work in hospitals were enrolled: emergency physicians, surgeons and radiologists/pathologists. Every physician was followed up until they left the hospital, did not work anymore or were censored. A Kaplan-Meier curve was plotted to show the trend. A multivariate Cox regression model was then applied to evaluate the adjusted HRs of emergency physicians compared with other specialists.
  
  
  RESULTS
  A total of 16,666 physicians (1584 emergency physicians, 12,103 surgeons and 2979 radiologists/pathologists) were identified between 1997 and 2010. For emergency physicians, the Kaplan-Meier curve showed a significantly decreased survival after 10 years. The log-rank test was statistically significant (p value <0.001). In the Cox regression model, after adjusting for age and sex, the HRs of emergency physicians compared with surgeons and radiologists/pathologists were 5.84 (95% CI 2.98 to 11.47) and 21.34 (95% CI 8.00 to 56.89), respectively.
  
  
  CONCLUSIONS
  Emergency physicians have a higher probability of leaving their specialties than surgeons and radiologists/pathologists, possibly owing to the high stress of emergency medicine. Further strategies should be planned to retain experienced emergency physicians in their specialties.
authors.affiliation: Emergency Department, Buddhist Tzu Chi Dalin General Hospital, Chiayi, Taiwan.
authors.forename: Yi-Kung
authors.initials: YK
authors.lastname: Lee
authors.forename: Ching-Chih
authors.initials: CC
authors.lastname: Lee
authors.forename: Chien-Chih
authors.initials: CC
authors.lastname: Chen
authors.forename: Chun-Hing
authors.initials: CH
authors.lastname: Wong
authors.forename: Yung-Cheng
authors.initials: YC
authors.lastname: Su
mesh_terms: D000328:Adult; D002055:Burnout, Professional / Q000523:psychology; D002321:Career Choice; D002322:Career Mobility; D015331:Cohort Studies; D004635:Emergency Medicine; D005260:Female; D013502:General Surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data; D010336:Pathology; D010563:Personnel Turnover / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011871:Radiology; D012044:Regression Analysis; D013624:Taiwan; D000078329:Workforce
keywords: Attrition; abdomen; burnout; emergency department; emergency physicians