Emergency Medicine Challenges in Ecuador

Introduction: Emergency medicine (EM) was recognized as a specialty in Ecuador in 1993.Currently, there are two four-year EM residency programs and an estimated 300 residency-trainedemergency physicians countrywide. This study describes the current challenges in EM in Ecuador.Methods: We conducted 25 semi-structured, in-person interviews with residency-trained emergencyphysicians, general practitioners, public health specialists, prehospital personnel, and physiciansfrom other specialties. The interviewer asked about challenges in the areas of emergency care,working conditions of emergency physicians, EM residency education, EM leadership, andprehospital care. We analyzed data for challenges and registered the number of interviewees whomentioned each challenge.Results: Interviewees worked in the three largest cities in the country: Quito (60%); Guayaquil(20%); and Cuenca (20%). Interviewees included 16 (64%) residency-trained emergency physicians;six (24%) residency-trained physicians from other specialties working in or closely associatedwith the emergency department (ED); one (4%) general practitioner working in the ED; one (4%)specialist in disasters; and one (4%) paramedic. Shortage of medical supplies, need for bettermedico-legal protection, lack of EM residencies outside of Quito, and desire for more bedsideteaching were the challenges mentioned with the highest frequency (each 44%). The next mostfrequently mentioned challenges (each 38%) were the need for better access to ultrasoundequipment and the low presence of EM outside the capital city. Other challenges mentioned includedthe low demand for emergency physicians in private institutions, the lack of differential pay for nightand weekends, need for more training in administration and leadership, need for a more effective EMnational society, and lack of resources and experience in EM research.Conclusion: Emergency medicine has a three-decade history in Ecuador, reaching importantmilestones such as the establishment of two EM residencies and a national EM society. Challengesremain in medical care, working conditions, residency education, leadership, and prehospitalcare. Stronger collaboration and advocacy among emergency physicians can help strengthen thespecialty and improve emergency care