Call for mandatory emergency work for graduates

A SENIOR consultant in emergency medicine has called for the introduction of a mandatory requirement that all Irish medical graduates work for a period in emergency departments as non-consultant hospital doctors following their internship.

Dr Chris Luke, consultant in emergency medicine at Cork University Hospital and the Mercy University Hospital in Cork, said the situation in emergency departments had now reached critical levels in terms of the lack of Irish-trained NCHDs.

Dr Luke said although young Irish doctors won’t say it publicly but will admit to it privately, many don’t want to work in Irish emergency departments because they find the work too arduous despite the fact that terms and conditions have improved greatly in recent years.

Young Irish doctors are opting to go to Australia and elsewhere upon completion of their internships and the same problem exists in the UK.

“They have an obsession with their own work-life balance rather than serving the citizens of the country,” he said.

Up to 100 doctors are being trained annually in Cork, but only about 12 per cent of them are choosing to work in emergency departments at CUH, MUH and the South Infirmary Victoria University Hospital and then for just six weeks as part of a surgical rotation, he said.

This contrasts with the situation 25 years ago when 25 per cent of NCHDs spent time working in emergency departments in both Ireland and the UK, which resulted in these departments being “reliably staffed” by local graduates with no major issues regarding competence.

“Now, because our medical graduates are choosing not to work on emergency departments from day one as opposed to from year three, it’s making matters untenable and unsustainable – frankly, it’s the greatest threat to the viability of emergency medicine,” he said.

According to Dr Luke, recent attempts by the HSE to recruit foreign doctors before the January 11th changeover to work in emergency departments is not the solution to the medical staffing crisis as many may not have the necessary familiarity with the Irish medical system

“I remain quite critical of the position we’ve managed to create for ourselves here where even at the eleventh hour we were still recruiting literally the week before the changeover on January 11th from places as far away as Bombay and Romania.

“We’re bringing in NCHDs to work in our emergency departments who may or may not be able to speak English acceptably, who may or may not be up to a certain standard of clinical practice and who may or may not manage to get their registration through in time.”

Dr Luke said the medical staffing arrangements for emergency departments in Ireland were “so erratic and unstable” as to be detrimental to patient care as many senior doctors and management ended up devoting much of their time to ensuring adequate cover.

“If a senior doctor spends all his time trying to plug gaps and then reacting to litigation because of incompetence and complaints which, as we know, are more common with non-locally trained doctors, then the whole thing becomes self-defeating,” he said.

Dr Luke said that the lack of certainty as to who would be working on any particular day in the emergency department was causing huge stress for staff and patients alike and he believed that “a stable medical manpower” would help improve the quality of patient care.

“If the majority of Irish medical graduates choose not to work in Irish emergency departments, then it seems the only option is to make it mandatory that they would work six-month stints in emergency departments immediately after their internship,” he said.

The Health Service Executive (HSE), in a statement, said that in recent months and as part of a wider recruitment drive, it had been working with international recruitment agencies to identify suitable candidates whose experience and qualifications were commensurate with Irish requirements.

All recruits are vetted by the Irish Medical Council before being granted a licence to work here and the recruitment process has focused on securing doctors who hold a valid international certificate in English and all appointments are subject to local hospital vetting and agreement.

The HSE pointed out that it had facilitated and was funding the introduction of a Basic Specialist Training scheme in emergency medicine, commencing in July 2011 which would make posts more attractive and assist recruitment of both Irish-trained and other doctors.