You have to go back almost 30 years to find the last major industrial action by doctors in the health service and, ironically, their success in that strike has partially contributed to the current impasse over long working hours.
The dispute in the 1980s was about pay and the solution found at the time was to throw money at the junior doctors in the form of overtime allowances.
This compromise enabled the health service to get more work out of the same number of doctors but hardly addressed the underlying issue of under-staffing.
Instead, there was an intensification of the long-hours culture that was already in existence.
Hierarchical profession
Medicine is, perhaps by necessity, a hierarchical profession, with a coterie of highly remunerated consultants calling the shots and bearing most of the risks.
Paying junior doctors a relatively low basic wage and then supplementing it with long hours of overtime ensured the bodies were there to fill the awkward shifts in round-the-clock hospital activity.
Long hours also meant the training opportunities for junior doctors were maximised and helped to contribute to the generally high standard of Irish doctors.
Yet, for years, the system managed to ignore the risks involved and the delays caused by the fact that while junior doctors were doing the work, most decisions had still to be made by consultants.
Roll the clock forward three decades and several things have changed.
The medical profession is increasingly feminised and, more importantly, family duties are more likely to be shared between partners.
The massive hours clocked up by junior doctors are more inimical than ever to family and life planning and, accordingly, the pressure to reduce these long hours has increased. At the same time, health spending is being cut back drastically as a result of the economic crash.
Junior doctors report that many of their extra hours are actually unrostered, for example, unpaid, and, accordingly, are less attractive.
Rite of passage
In the past, the long hours worked by non-consultant hospital doctors (NCHDs) were seen as a rite of passage, something to be endured on the long but inevitable road towards a lucrative consultant post.
But not anymore, now that the Government has cut the salary for new posts by 25 per cent, not even taking account of across-the-board salary cuts in the public sector.
All of these factors explain the restiveness of the current crop of NCHDs, for whom emigration to better run and better paid health systems is increasingly a live option.
There’s also frustration at the repeated failure of the politicians to keep their promises and ensure compliance with the European Working Time Directive (EWTD), which was supposed to come into force four years ago. This would limit the length of the working week to 48 hours, while the other key demand of the doctors is an end to shifts of over 24 hours.
The HSE says significant progress has been made towards implementing the directive, but even on the basis of its own figures – more than one-third of doctors are working shifts of more than 24 hours – there’s still some way to go.
Only this week, this writer met a heavily pregnant doctor who had just completed a 33-hour shift.
The cut in pay for new consultant posts should, in theory, make it easier to employ more senior doctors in the system, but the HSE has struggled to fill consultant vacancies since pay rates were reduced.
It's hard to see how it can tackle the underlying problem of under-provision of consultants in an era of cost-cutting.
Intelligent rostering
The Irish Medical Organisation maintains the problem can be resolved by more intelligent rostering and, in the big hospitals and main specialties, that may have some truth.
But in smaller hospitals and narrower medical sub-specialties, it is hard to see how the existing staff can work shorter hours without new doctors being drafted in to plug the gap.
By referring the dispute to the Labour Relations Commission, the HSE obviously feels it has a strong hand to play. It can show that some measures have been taken, others are in hand and an implementation deadline of the end of next year has been set.
Health bosses are also likely to argue that strike action of the type envisaged by the IMO – starting with a one-day strike later this month – would have a disproportionate effect on patients relative to the issue at stake.
For the NCHDs, this has been a grassroots campaign, spurred on by years of inaction and given emotional weight by the tragic suicides of two colleagues over the past year. Win or lose, there is a sense that the manpower issues in Irish medicine run far deeper than the immediate issue at stake here.