Mary Harney and the HSE must come up with ways to attract doctors back into the Irish health system
THE THREAT to the continuity of services at a number of hospitals posed by the current shortage of junior doctors has been discussed by the Health Service Executive (HSE) with Minister for Health Mary Harney at a specially convened meeting.
Already the shortage has resulted in GPs being brought in to help run the emergency department at Naas General Hospital and informed HSE sources admit the Irish Association of Emergency Medicine (IAEM) was not being alarmist earlier this month when it suggested the shortage could result in some hospital emergency departments having to close or limit their opening hours.
A senior HSE source said emergency department opening hours at four or five hospitals may have to be curtailed as a result of the shortage of junior doctors in coming months. Obstetrics services in hospitals like Portlaoise and Wexford may also be affected, the source said.
The shortage has been attributed to a range of factors, including a number of policy changes in the past year. This included a change to visa or work permit requirements for non-EU doctors coming to Ireland. The change means these doctors – who, for years, have kept many rural hospitals in particular staffed – have to reapply for a visa every time they change jobs, which for them is usually every six months. The Department of Justice has confirmed it is now reviewing the change.
Dr Mir Abdul Waheed, who came to Ireland from Pakistan in 2006 to work as a junior doctor, said prior to the change in 2009, non-EU doctors got two-year visas. He said the recent change, which sees him having to fork out €800 every six months for a new visa for himself and his family of five, was a disincentive to stay here at a time when visa requirements for the UK had been relaxed.
“You can enter the UK and get a working visa for two years initially as a non-EU doctor,” he said.
He added that after a non-EU doctor was five years in the UK, he or she was more or less guaranteed citizenship as long as they didn’t have a criminal record. However, in Ireland, he said, people were waiting for years to hear back when they applied for citizenship.
This is “pulling” doctors out of Ireland and drawing them into the UK, where there have also been junior doctor shortages, and to Australia and Canada, where passports are more easily obtained after a few years’ work.
“When I came in 2006 there were 14 or 15 people from my medical school class in Pakistan here with me. At the moment there are only three left . . . you talk to any non-EU doctor now, he is planning to leave,” said Dr Waheed, a registrar in a Dublin hospital.
The Irish Medical Organisation (IMO) made a submission to the Department of Justice about the quandary faced by non-EU doctors last December. It is awaiting a response.
Shirley Coulter, senior industrial relations executive with the IMO, said in the submission that a 2007 audit by the Royal College of Physicians found non-EU doctors accounted for in excess of 50 per cent of all NCHDs working as registrars or senior house officers (both are junior doctor grades) in hospitals in Ireland.
“Therefore, non-EU doctors are critical to the Irish health system and must continue to be incentivised to work here. The difficulties caused by the new visa arrangements negatively impact on Ireland’s ability to attract non-EU doctors to work and train here,” she wrote.
The Department of Justice, in a statement, said “the immigration arrangements which should be applied to various categories of migrants, including non-EEA doctors is under review.
“The issue of doctors is being looked at with a view to providing greater clarity and also to deal with the particular nature of the employment of non-EEA doctors, a group which encompasses a range of employment arrangements, qualifications and durations of stay. A submission to the department from the IMO is being considered as part of that process.”
It decided to streamline the immigration regime and address anomalies in the system when, under the new Medical Practitioners Act, the Medical Council established a new registration system for doctors last year.
Notwithstanding the change, it stressed that since January all non-EEA doctors could get 12-month visas by registering with the Garda National Immigration Bureau.
The Department of Health said it had been advised by the HSE that the shortage of junior doctors was due to a number of factors which include “Government policy regarding reductions in NCHD numbers ; the moratorium on recruitment and promotions in the public service; the legal requirement, reflected in NCHD Contract 2010, to employ NCHDs in line with their training or non-training status and related medical registration status; implementation of the European Working Time Directive , and the international recruitment market for NCHDs”.
A reduction in pay for junior doctors in the past year as a result of the current economic climate was also said to be driving young Irish doctors out of the country.
The HSE has been concerned about the shortage of NCHDs for some time. An internal HSE memo, the contents of which were revealed in this newspaper last November, showed there had been a huge drop in applications for junior doctor posts which needed to be filled in January.
There had been a 59 per cent drop in applications for NCHD posts, for example, at Tullamore hospital; a 52 per cent drop at Wexford General; a 49 per cent drop at Mayo General; a 51 per cent drop at St Luke’s Hospital, Kilkenny; and a 56 per cent drop at Connolly Hospital, Dublin.
The memo said HSE medical manpower managers were “very concerned at the reduction” and feared it could lead to “significant gaps” in services in 2010.
There are about 4,500 junior doctors in the system at present for whom there are about 3,500 recognised training posts. Non-training posts are more difficult to staff, but need to be filled to ensure continuity of hospital services.
It’s understood issues around new medical council registration procedures for doctors applying for these posts as well as providing a definite career path for those who have occupied them for a number of years, to make the posts more attractive to applicants, were among the issues discussed at the meeting between the HSE and Ms Harney last week.
The threat to continuity of services posed by the shortage, which could worsen in July when junior doctors rotate jobs again, was also discussed.
Regardless of the shortages, hospital managers are being warned not to take short-cuts to fill posts. Early this month it emerged a junior doctor from Nigeria was taken on at St Luke’s Hospital in Kilkenny without receiving medical council registration, Garda vetting, a work permit or an international police clearance certificate as the hospital was under pressure to fill vacancies in 2009.
He had been hired through a recruitment company and the hospital didn’t even check his references. Dan McCarthy, a medical manpower manager with the HSE, told a medical council fitness to practice inquiry the hospital relied on the recruitment company to have all documentation in place for the doctor, including reference checks. He admitted what happened was unacceptable but said “we were very stretched staff-wise”.
The Department of Health said that in order to ensure adequate NCHD staffing and continued service delivery when the new rotations commence in July, the HSE had set up a group “with responsibility for determining appropriate staffing models, requirements and work practice changes needed in the short term”.
This group is currently “working on initiatives to ensure services will continue to be available when the new cycle commences”.
The HSE said a recruitment drive for a new intake of NCHDs was under way and a number of other “initiatives” were also being considered to address the situation.
“Non-EU doctors are critical to the Irish health system and must continue to be incentivised to work here. The difficulties caused by the new visa arrangements negatively impact on Ireland’s ability to attract non-EU doctors to work and train here