For many provincial hospitals, Saturday will mean an even bigger challenge than usual for the July 1st changeover of medical staff. General hospitals in Cavan, Naas, Monaghan, Portlaoise and Ballinasloe will wake up to unanswered bleeps and significant medical manpower shortages.
Hospital consultants say they do not expect much improvement in the situation as a result of this week's announcement by the Minister for Health, Mr Martin, that he is to allow non-EU graduates to extend their period working in Ireland, from five to seven years.
The worst-hit specialities will be anaesthetics and accident and emergency. Most provincial hospitals have only two consultant anaesthetists in post, who will find it difficult to function without registrars who have typically doubled the manpower in anaesthesia. Epidurals will become a luxury. Victims of road-traffic accidents will not have the services of a resuscitation specialist. Overdoses will have to be managed without specialist input.
Accident and emergency departments will fare even worse. Most provincial hospitals are not staffed to consultant level in such departments. With the junior doctors absent, medical staff will have to be pulled from other specialities to cope.
Naas General Hospital serves 150,000 people. With a 136-bed unit, including 10 critical-care beds, it provides a full range of surgical and medical services. In addition, its accident and emergency department deals with one or two high-speed crashes from the Kildare end of the Naas dual carriageway every week.
From Saturday, the Medical Council has declined to give accreditation for temporary registered non-consultant doctors in accident and emergency and anaesthetics at Naas.
Anaesthetic services are provided by two part-time consultants and two full-time registrars. According to Prof Gerard Bury, the Medical Council president, the hospital was routinely inspected in 1999, following which concerns arose concerning the level of supervision of doctors in training there. The withdrawal of accreditation was due to take effect this January 1st, but following a request from the Eastern Region al Health Authority, a six-month extension was granted by the Medical Council.
However, when the health authority sought a further six-month extension in late May, the Medical Council refused.
Dr Joseph McDonnell, one of the two consultant anaesthetists employed part-time by Naas hospital, has criticised the decision.
"This decision threatens the future of the hospital's accident and emergency department. Each week we treat trauma victims from car crashes on the Naas dual carriageway. Without the two registrars, we are effectively withdrawing Naas hospital's availability to stabilise seriously injured people prior to their transfer to Dublin's Beaumont and Tallaght Hospital."
It is this lack of a permanent consultant presence which has led to the Medical Council's decision to withdraw accreditation for training. A minimum of three full-time consultant posts is the usual cut-off for training post approval. There are plans to have six consultant anaesthetists appointed to Naas General Hospital by the end of 2001.
Responding to the particular difficulties of the hospital, Prof Bury says: "The people of Naas deserve a clinical service that is adequately resourced and of a similar quality to the rest of the country. NCHDs provide part of the service but they need supervision and support to allow doctors in training to carry out their jobs properly." This is a serious development for any general hospital, but for one with one of the highest multiple trauma admissions in the State, it represents a potential disaster.
Mr Finbar Fitzpatrick, IHCA general secretary, has called on the Minister of Health to divert ambulance services from Naas to Dublin hospitals from Saturday. The situation in Naas reflects a growing tension between the need for adequate accountability and supervision of doctors in training and the day-to-day service requirements of a health system bursting at the seams.
Dr McDonnell said he had two candidates "waiting in the wings" to take up the registrar posts at the Naas hospital even at this late stage. "If the Minister would direct the Medical Council to lift the embargo on these posts, I can have a full complement of anaesthetic staff in Naas from July 1st," he said.
In the meantime, he has cancelled a two-week family holiday and is preparing to work a 168-hour week every second week for the foreseeable future.