• Since abolishment of the regional division, we are bringing the patients to a hospital within “the golden hour”

    November 12, 2014

    Now the ambulances are rarely called without reason. Dr. George Gelev proposes the starting salary of physicians to be BGN 1 500.

    – Dr. Gelev, what you found in the Centre for Emergency Medical Care (CEMC) – Sofia, is there a change to what you left?
    – I did not find any significant difference. If you talk about people coming under civil contracts from other hospitals, this has not happened. There are no such candidates and this is completely understandable, because for a narrow specialist, drawn from the hospital, you have to select addresses that are wholly in his specialty. Or he, after his first duty, will leave immediately because a surgeon with a long practice and experience can not examine a baby with a cold. In order this venture to have success; these must be specialist who work in emergency care. To have such volunteers, however, firstly their pay must be increased. This is an old problem that is dragging for years – the incomes of emergency physicians are far behind the income of their counterparts in hospitals or in outpatient healthcare. The second idea – for a 7-hour working day is not bad, but it is impossible. The Labour Code (LC) says that whoever works reduced hours, the maximum duration of his/her working shift can be increased only by one hour. That is, if you are on 7 hours, you can work 8. This for our center means that for 24 hours we should have three shifts. When I was doing the calculations whether this can happen, it appeared that without more specialists – at least 45 to 65 teams, per shift instead of 20 teams there will be 7 or 8.

    – Is there an increase in personnel in CEMC – Sofia?
    – Unfortunately, for several years the number of people joining is almost the same as those leaving. Turnover is very high. The lowest is of drivers, while doctor turnover is permanent. Colleagues and medical graduates come who work for several months and then request a recommendation – usually in English, and leave to work in France, England or Germany, where the pay is very different from the one here. There was even a colleague who left in January aged 59, and went to England to become senior intern, and was employed immediately. Even older colleagues than I decide at some point to change their lives, to start anew, but with other conditions and pay. In this line of thinking, nothing has changed, everything is as usual.

    – How many teams per shift are there now?
    – Given that the holiday season is over, we have an average of 20 teams on duty. But, of course, they are not enough; they should be at least 45. We agreed that so many people cannot come unless something essential is not changed, so that this job will become attractive.

    – What does something essential mean, how much should the average salary be?
    – We have at the moment an average salary of about BGN 700, for physicians with speciality it is about BGN 900. But with night work it can reach above BGN 1 000, and with a few duties – BGN 1 200 – 1 300. After tax about BGN 1 000 remain. I think that when you are 50, they are absolutely insufficient for a doctor.

    – How much it should be?
    – I think that the starting salary should be about BGN 1500. In other words, almost double.

    – The caretaker minister abolished the regional division in Sofia, are there any results?
    – The regional division is long gone for all diseases except for invasive cardiac cases. The cardiac catheter laboratories had set shifts for different periods of the month. When this schedule was established, however, there were three laboratories, and then they became 6, 9, and now 11. The directors organized their work so that now they have teams available 24 hours, and the regional division by itself was gone. This is positive. Otherwise, if “Sv. Anna” in “Mladost” is on duty, and there is a patient with a heart attack in “Lyulin” or “Obelia” we have to go 18 kilometers in rush hour. That regardless of the lights, sirens, giving way slows the transit. The abolition of the regional division and the order to drive the patient to the nearest facility where emergency can be provided has good effect – we are always within the golden hour.

    – Is there an analysis of how the results have improved?
    – No, but no hospital is more than 10 minutes away for any submitted address. Those with cardiac facilities are evenly distributed in the capital.

    – Are there complaints that the patients are not objectively taken to the nearest hospital after abolition of the regional division?
    – I do not know, but certainly there is a decline in patients in each hospital because they are many. With the same contingent of patients, it cannot be otherwise! I understand that everyone wants such patients, but the number of patients is not changing.

    – Why periodically there are complaints that the ambulance circles around all night before the patient is admitted somewhere?
    – This happens to tramps who are uninsured. These patients have a lot of sufferings, their treatment is difficult and entirely at the expense of the hospital. As the directors like to say: “He takes the salary of the doctor.” Unfortunately, this has not changed in years. Now we still have no such cases because it is warm, but when the winter comes they will appear.

    – What is their fate, where do you finally leave them?
    – There is one hospital in “Botunets” which the municipality suited for such cases. The bad thing is that these people on the third or second hour leave the hospital alone and return to where they were – under the bridge, in the basement, the entrance, the loft and continue as usual.

    – Do the hospitals turn back insured people?
    – No, the only problem is with the uninsured.

    – Is there always someone to take in the children?
    – Yes, there are some units – the pediatric surgery and orthopedics “Pirogov”, the pediatry in Hospital “Alexandrovska”, the Pediatric Cardiology in the National Cardiology Hospital, and there are other places.

    – Are you still engaged in uncharacteristic activity like driving corpses?
    – Yes, all the time. In order someone to take this activity there should be legislative changes, so that this becomes the priority of the units of Forensic Medicine. It is not appropriate for the Emergency to deal with corpses. Another uncharacteristic activity is the delivery of planned blood to hospitals. Many of them do not have adequate transport and turn to us for help. Usually they place their orders with us in the afternoon. This we should not be doing also.

    – How many teams do these activities “consume”?
    – We have one team for corpses each shift which means 12 person plus two cars. For the blood we have engaged only 6 drivers. That means in total 18 persons are responsible for these activities.

    – Do the patients abuse the emergency care?
    – It seams the number of silly calls is reduced. For example – for high fever or pain that can go with a pill or a consultation with the GP. Of course, if there is a flu situation the number of addresses with such complains increase sharply.

    – Have you been called for ebola?
    – No, not yet.

    – Do you often have problems with violence against your teams?
    – There is still hostile attitude towards our teams, usually it is in minority neighborhoods and at night, when most of the residents are intoxicated. Thanks god, this year we don’t have men beaten, but in other areas of the country there are. Clearly this phenomenon will never cease completely, but these cases are reduced also.

    – Does the police assist you?
    – Yes, we have good collaboration with them. Usually our team says “and police”, we call 112 and immediately they sent a patrol.

    – Nevertheless, how many minutes it takes for the arrival of the ambulance after the call?
    – This is not the correct measuring, because we select the signals and send ambulances with priority to those recognized as the most urgent. So some could be delayed. If, however, we speak about after taking the dictated address, how long it takes for the ambulance to reach the place, we are almost always within the norm – up to 20 minutes. We have also overachievements, but these are exceptions.

    – So why are there addresses which are reached on the 60th minute?
    – Obviously there were no available teams, you can not take out an ambulance if it visits an address and send it. While the number of teams is small, there is no other way.

    – Now comes a new government, Parliament, what should they do, so that the people could feel the emergency care really is such?
    – If we speak about 2015, the budget for emergency care should be revised and doubled. The income of all working in the system, regardless of whether they are physicians, nurses, paramedics or drivers, should be increased, and then there will be no turnover, but instead competition for employment. And 30% of the vehicle fleet should be renewed. It is good that we have the mindset for buying equipment for telemedicine. Thus, even if in some cases there is a paramedic team, a competent physician can be included, if needed, from distance. In neighbouring Romania, almost all ambulances have such devices, and also in northern Greece. Here the Ministry of Health (MoH) begins with equipping one ambulance in each centre. Funds have already been allocated.

    – Is there a possibility of reorganization, so as to improve the activity without help from the state?
    – Without the help from the MoH this cannot be achieved. Already several times I offered to get rid of the uncharacteristic activities, to change the legislation so that the separate regulations do not collide. There must be a correction in the standard for emergency medicine, because, for example, there are requirements for equipment that a paramedic will never use. Why spend money on something that will lay unused. And, of course, the opportunity should be given to people in emergency to specialize what they want, not just emergency medicine.