Doctors completing specialist training are voting with their feet, choosing to emigrate to take up hospital consultant posts to a greater degree than ever before. The result can be seen in the small number of Irish- trained applicants for vacant consultant posts in the Republic, leaving a growing number of jobs either vacant or filled by a succession of temporary locum doctors.
Many young doctors speak of “rediscovering the joy” of professional practice abroad, a sentiment in marked contrast to the chaos and uncertainty surrounding the health service here. But a two-tier system of remuneration is also a factor, with newly appointed consultants paid some 30 per cent less for doing the same work as more established colleagues.
A realisation that the top specialists of tomorrow are making decisions now about where to practise in five to seven years time led to the Minister for Health, Leo Varadkar signalling a major change in policy last weekend. Effectively proposing to roll back existing consultant contract arrangements, he told the annual conference of the Irish Hospital Consultants Association the system is no longer working. "I would prefer to move to a single contract, perhaps similar to that of consultants in the NHS with a basic salary and a system of bonuses and excellence awards," he said.
While this would remove some of the present inequity, a separate suggestion by the Minister that current restrictions on private practice could be relaxed is a more controversial one. Any return to an unregulated and unbridled system of private practice whereby a minority of consultants left the bulk of their public work to junior doctors would not be acceptable. While a modern public hospital consultancy is now a demanding full-time job, senior doctors could work a small number of additional hours seeing fee-paying patients. However such a facility must be highly regulated.
The tax -payer, already contributing substantially to the medical education of those who emigrate, will not tolerate a return to the laxity of the previous consultant common contract.