BACKGROUND: Irish-trained doctors are emigrating because of long hours, pay cuts and poor career prospects
THE CURRENT shortage of junior doctors in the Irish healthcare system didn’t just happen overnight.
The shortages have been well known about since at least 2009 but the fact that they have worsened to a point where even large hospitals like the Mid Western Regional Hospital in Limerick may have difficulty keeping its emergency department open from next month has helped focus fresh attention on the problem.
Reasons for the shortages are multifaceted but undoubtedly one factor is young Irish-trained doctors are leaving for Australia and other countries in greater numbers because of long working hours, pay cuts, lack of protected training time and little prospect of career advancement. They have a one in four chance of going on to be consultants.
Added to that is the fact that in the last couple of years it has became more awkward for non-EU doctors – which a 2007 audit by the Royal College of Physicians found accounted for in excess of 50 per cent of all junior doctors working as registrars or senior house officers in hospitals in Ireland – to get into the country and register to work here.
In 2009 their visas were restricted so they would have to be renewed every six months, though this has now been changed to every two years.
Then changes to the Medical Council registration process under the 2007 Medical Practitioners Act, which came into effect in 2009, meant they had to get a higher mark in their English language exam – a change also since reversed – and had to pass what’s called the Pres exam, which includes a 2½-hour multiple choice question exam to test their medical knowledge as well as a 3½-hour examination of their clinical skills. This exam is only held in Ireland.
About 4,600 junior doctors are needed to staff our hospitals and most of them rotate jobs every six months as part of their training schemes, so they get six months’ experience in paediatrics, another six months in surgery, psychiatry and obstetrics and so on.
Of the more than 4,000 junior doctor posts in the system, about 3,650 or 80 per cent are in training posts accredited by colleges such as the Royal College of Surgeons in Ireland.
The 1,000 non-training posts have traditionally been the ones which proved more difficult to fill – though more than half of these are now staffed by doctors on contracts of indefinite duration – but this year even training posts are proving less attractive to applicants. Eunan Friel, managing director of surgical affairs at the royal college, said that to date 219 out of a total of 255 places across the three years of its basic surgical training scheme have been filled, leaving 36 vacant.
In April it was predicted some 400 junior doctor posts could remain unfilled on July 11th but more recent estimates presented to Minister for Health James Reilly suggest that figure could be 180. There are now fears that while locums will have to be retained to staff essential services in larger hospitals, the Health Service Executive may no longer continue to fund costly agency staff to keep smaller emergency departments open.
So where lies the solution?
The HSE on the one hand says there is a worldwide shortage of junior doctors and on the other says it has found more than 420 experienced doctors during a recent trip to India and Pakistan who would be willing to come and work here if only they didn’t have to jump through so many hoops to get on the medical register.
Yet the Medical Council says only 30 of these 420 have even applied to register here yet.
It appears the HSE is hoping Dr Reilly will amend the law to make it easier for non-EU doctors to come and work here. He is considering this option but must exercise caution so as to ensure patient safety is not put at risk.
The Irish Medical Organisation is meanwhile urging the HSE to take steps to retain Irish doctors in the system rather than focusing on overseas recruitment.