The Netherlands Field Report: 2015

Published on October 29, 2015
With 450 trained EPs now working in 85% of Dutch EDs, the EM specialty continues to gain traction in Dutch hospitals and among medical students.

The Netherlands is a small country in the northwest of Europe with 400 inhabitants per square kilometer, making it among the most densely populated countries in the world. Primary care is highly developed and accessible to everyone through local general practitioner (GP) offices during daytime and GP-cooperatives during the evenings, nights, and weekends. GPs are considered as gatekeepers for hospital care, including emergency care provided in 89 available 24/7 emergency departments (EDs).

Modern emergency medicine (EM) has been developing since 1999 in the Netherlands, but it wasn’t until 2009 that EM was recognized as an independent medical expertise with a three-year training program. Today, 450 trained emergency physicians (EPs) work in 85% of Dutch EDs. In 20% of Dutch EDs, 24/7 EP-staffing is already being guaranteed and this number is increasing rapidly. The Netherlands Society of Emergency Physicians (NSEP) holds the position that every ED should be staffed by EPs 24/7. One-hundred eighty residents are being trained in one of the 28 training programs.

Over the last few years EM has become one of the most popular medical disciplines for specialization amongst medical students and recently graduated doctors. With their presence, EPs bring continuity in the availability of acute medical expertise in the ED. They also introduce skills to the ED that are obvious in international EM but new in the Netherlands, like procedural sedation and analgesia, emergency ultrasound, and loco-regional anesthesia. The rise of EM in general, and EPs in particular, has also aroused renewed interest in the ED and emergency care among established medical specialties. These developments are all either directly or indirectly of benefit to patients with an urgent medical problem.

The NSEP proudly hosted the annual European Emergency Medicine Conference (EuSEM) in 2014. Bringing together approximately 2,500 participants from 80 countries all over the world, the conference was the most successful EuSEM conference to date. To further underline the Dutch permanent ambition with regard to EM, a bid for ICEM 2021 has been submitted.

Various challenges remain, however. Established medical specialties and governmental agencies must be convinced of the added value of EM as a medical specialty with at least a five-year training program. Both the specialization and the five-year training program are required according to the NSEP and the European Union of Medical Specialists (UEMS). In 17 out of 27 other European Union countries, EM is already a specialization with a five-year training program. Besides extending the training program to five years, the NSEP strives for regionalization of the 28 hospital-based teaching programs, aiming instead to consolidate into eight regional teaching programs. The scientific basis for the discipline needs to be strengthened as part of further emancipation and in order to improve quality of emergency care for patients continuously. The affordability of healthcare in general is a subject of debate in the Netherlands, therefore access to EDs is increasingly under pressure for patients seeking urgent care. Despite these challenges, emergency medicine in the Netherlands is without any doubt there to stay!

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