Medical brain drain leading to ‘dumbing down’, says Rotunda master

The medical brain drain is leading to a "dumbing-down" in the quality of doctors in Ireland, the master of the Rotunda Hospital in Dublin has warned.

Sam Coulter Smith said the problem is getting worse as fewer doctors return to Ireland after training abroad.

“We are still seeing good-quality people but they are not coming back in the same numbers. There isn’t the same level of competition for jobs as there might have been in years gone by.”

Dr Coulter Smith is stepping down shortly after a seven-year term leading the world’s oldest maternity hospital. The period has been marked by recession-driven cuts and continuing uncertainty about its proposed relocation.

The “exacerbation” of poor quality is a problem in other specialities, not just obstetrics, and relates to both trainee doctors and consultants, he said.

The Rotunda recently got no applicants when it advertised for a foetal medicine specialist to work jointly in Dublin and the northeast.

“It is very difficult for someone to come back to that kind of job as a single-handed specialist in a peripheral hospital.

“They need to be working in a department with colleagues where they can get time to go on study leave and present at conferences.”

US-trained doctors tended to have very specific skills but in smaller Irish hospitals they are expected to do a wider range of work, he said. The problem of attracting and retaining good staff is “not just about the money, although that is important. It is also about where they can work, and what research possibilities are available.”

Maternity hospitals are seeing a fall in the number of obstetric and midwifery trainees. “We thought the big maternity hospitals would be immune but it has started to affect us,” Dr Coulter Smith said of the recruitment difficulties.

“Litigation may be part of it but so too is the stress and strain people suffer on a day-to-day basis working in a demand-led service that is being stretched. You can only do that so long without burning out.”

The Rotunda should have one obstetrician per 350 deliveries but “we are closer to one per 1,000”.

Despite the staffing shortfall, he said the hospital’s safety record, as measured in terms of baby deaths, is “very good”.

Survival figures

Better staffing could improve the survival figures by one per 1,000, he estimates, but would also improve the quality of the service for patients.

It has been an “interesting and varied” seven years as master, he said. But budgets have been cut, salaries reduced and much-needed decisions on renewing infrastructure delayed.

“It’s been a perfect storm, happening when demand in maternity services was going up.”

By 2012, the Rotunda found itself delivering 30 per cent more babies with fewer staff and resources, in a creaking rabbit-warren of a building.

Plans to move down the road to the Mater collapsed after the planning application to build a new national children’s hospital there was rejected. That project has since gone south of the Liffey, to St James’s Hospital, leaving the northside maternity hospital licking its wounds for some years.

The proposal now is to move to a greenfield site by the M50 but that may take up to a decade.

Dr Coulter Smith is critical of the “territorialism” underpinning much of the analysis of maternity services.

“We need to get away from the idea of one group of professionals having ownership over maternity services. Obstetrics and midwifery are complementary and terms such as obstetric-led or midwifery-led should be parked in history.

“It should be about patient care by the appropriate professional.”

Nonetheless, the strategy group plotting the future of maternity services has “very few obstetricians on it”, he noted, and faces a “huge challenge”.