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As the global health care workforce faces a shortage, several EU nations focus on employing foreign-trained physicians. So much so, that in some countries of the EU, the percentage of foreign-trained physicians has reached 30 % and the percentage of foreign-trained psychiatrists has risen to 40 %. After Croatia entered the EU, together with a significant number of other Croatian citizens, a great proportion of Croatian physicians emigrated. Currently, Croatia is among the three EU countries from which the most physicians emigrate. There are both economic and non-economic factors that are influence individuals’ choice to emigrate. Benefits of emigration for Croatian physicians are high satisfaction with life standard, income, professional development, and better work conditions. However, there are also clear psychological costs involved, which hinder both the emigrants and their families, and make building of a social network and integration into society difficult. These are: moving away from family members, friends and a familiar environment, mastering another language, finding work opportunities for partners, adjusting to life in another country under discrimination by colleagues, patients and the general public. Countries of immigration face challenges with foreign-trained physicians because of their native linguistic and cultural background. Language proficiency training and national familiarization programs can improve integration of immigrant physicians and their families. In recognition that national skill shortages can cause disbalance on a global level, the WHO calls on high-income countries to strive for self-sufficiency, through educating, retaining, and sustaining enough physicians to staff their own health care systems.

This combined approach changes the emotional profile of parents, reduces high expressed emotions (fear, sorrow and anger) in parents and helps re-establish their psychic balance and the balance of the whole family system.

Study Objectives: Geriatric emergency department (GED) accreditation (GEDA) through the American College of Emergency Physicians requires developing a strategic plan for education, equipment, policies, environment, staffing, and quality improvement. To support Veterans Affairs (VA) EDs in achieving accreditation, an interdisciplinary group of leaders in the VA National Offices of Emergency Medicine and Geriatrics and Extended Care and subject matter experts created a council that hosted a bootcamp, mentored support, created a Web site housing sample policies, staffing descriptions, workflows, and order sets. Additional individualized support was provided to assist with implementation of GED processes during the COVID-19 crisis. We sought to identify feedback on the accreditation process to inform onboarding of future cohorts.Methods: This was a dissemination plan for GED implementation at 20 VA EDs. VA medical centers were invited to submit an application for GEDA mentored support and fee waiver. An in-person kickoff bootcamp was held February 2020 for 10 VA EDs applying for Level 1 or Level 2 GEDA. As part of the planned quality review and to prepare for future VA GEDA, we performed follow-up surveys on the accreditation process, new interdisciplinary services relationships established, outcomes, and feedback on the process.Results: A total of 26/110 VA facilities with EDs applied for VA GEDA support; 10 were accepted for the in person bootcamp and virtual support and 10 additional for virtual support only. Nineteen supported sites have applied for accreditation and 14 have received accreditation: one level 1, four level 2, and nine level 3. Mean ED visit volume in 2019 for accredited sites was 25, 475 (range 8, 212-42, 589 visits/year) with 47% of visits made by veterans 65 years or older (range 33-60%). Sixteen sites responded to the survey. Ninety-four percent (15/16) described new interdisciplinary services (figure 1). When asked what accomplishment associated with the accreditation process they were proud of, 6 reported ED outcome improvements, 12/16 reported connecting patients to VA services, and 13/16 reported improved patient care team engagement. Feedback on the process suggested the need for standardization of data collection, workflow, and documentation, which has led to the development of a central dashboard and patient care note with standardized geriatric screens and assessments.Conclusion: A central supported system allowed 14 VA EDs to achieve geriatric ED accreditation despite the COVID pandemic. Almost all facilities reported they formed new associations with interdisciplinary services as a result of the accreditation process. More than half reported improved patient care team engagement and connection to VA services as additional accomplishments. Feedback has led to increased standardization of geriatric emergency care assessments across the healthcare system.

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