San Francisco General Hospital (SFGH) is the most important medical resource in the city. The Family Medical Inpatient Service led the response to the HIV/AIDS crisis; its history and reputation attracts many Residents. But at present there is a crisis. If the hospital administration does not act soon the health of our patients will continue to be at risk.
As one of the preeminent residency training hospitals in the country, we chose to work at SFGH to learn the best way to take care of everyone in our community, including the most vulnerable. The current situation is untenable for patient safety and resident well-being and threatens SFGH’s ability to attract the best residents.
The number of patients the Family Medicine Department treats has increased significantly, by as much as 55% on some shifts, with no increase in physician staffing. This is forcing resident doctors to work unsustainable hours, creating increased wait times for patients and putting added stress on the system.
Resident doctors work hard, but at SF General we are being asked to work more than the eighty-hour limit put in place by the Accreditation Council for Graduate Medical Education (ACGME). This limit exists because overwork and burnout create dangerous conditions for our patients. With cold weather months and flu season approaching, our already overworked medical teams could be stretched to the breaking point.
More than a year ago both the Internal Medicine and Family Medicine Departments made hospital administration aware of these conditions. There has been no meaningful response. As of today, 534 doctors and medical professionals at SFGH have signed a petition calling on hospital administration to act and prioritize patient care. Still they have not.
Because of inadequate attending physician staffing at SFGH, many patients are receiving the wrong level of care for their given condition. As some patients receive too much care, too many patients are not receiving enough.
Doctors at SFGH lack the needed time to provide care, to understand the symptoms a patient exhibits and take appropriate steps. This impacts every department at SFGH; not just internal and family medicine, but also psychiatry and emergency services.
Perhaps the most frustrating part of the problems at SFGH is how little it would take to fix these issues and the lack of action by hospital administration. The immediate steps that can be taken to prevent a crisis are:
• Add a team of attending physicians to allow residents in the Family Medicine Department to provide better care to their patients.
• Create an Emergency Department observation unit that can monitor patients and address the issues the hospital has with providing the proper level of care.
• Give residents that are providing frontline care a voice in the process of fixing issues with patient care.
We expect to put in long hours providing the best possible care. Many in the administration, consider the long hours worked by residents a “right of passage” but hazing of young doctors should not come at the expense of patient safety.
The most forward thinking hospitals have an observation unit that allows patients to be monitored so the appropriate amount of care is provided. By adding an attending physician service, the hospital will free up resident physicians to provide the needed care to our patients.
Most importantly by giving the frontline doctors providing care a voice to address the issues at hand, we can insure patients are receiving the best possible care and that valuable resources like patient beds and staff time are being used appropriately.
The resident physicians understand the importance of the care they provide to our community and it is time for the hospital’s administration to act so that we can focus on our patients. We demand an immediate action.
Crister Brady MD, MPH, is a UCSF/SFGH Family and Community Medicine Resident and member of the Committee of Interns and Residents.