The bureaucracy associated with recruiting consultants in hospitals in Ireland, a country with a deficit of doctors, is extraordinary and in many cases hopeless, the Master of the National Maternity Hospital has said.
Delivering the Irish Medical Organisation's annual Doolin memorial lecture in Dublin, Dr Rhona Mahony said the number and complexity of administrative functions above hospitals created "a dangerous barrier to effective decision-making and action".
She said an effort to create a vital new post in her own hospital involved three different bodies “in a most mysterious process” and six months later the position concerned still had not reached the HSE’s Consultant Appointment Unit for consideration.
“I can only conclude there is a positive effort to prevent recruitment,” she said.
In a wide-ranging address Dr Mahony argued that the trajectory of the increased cost of medical negligence in Ireland was unsustainable, that there was no coherent national workforce structure and current HSE policies for recruiting and retaining doctors were failing.
She said the HSE was perceived to be a toxic employer. Dr Mahony said among the concerns cited by trainees in obstetrics were working conditions, spiralling medical negligence claims, being named in complaints and the “constant and personalised nature of media reporting in relation to obstetrics”.
“In Ireland, we now spend millions - up to €80 million every year settling medical negligence claims in obstetrics with all the attendant legal costs which can be up to 25 per cent to 30 per cent of the total monies paid out,” she said.
"Interesting while the State Claims Agency has successfully reduced their legal costs, plaintiff legal costs are significantly higher. This is money that could fund vital services. "
Dr Mahony said the “quiet disgrace” of Irish medical training was the “training apartheid” created by the reliance on non-consultant hospital doctors who were not on any training scheme. She said three quarters of these were international graduates.
She said while the number of non-consultant hospital doctors working in Ireland had increased between 2011 and 2015, most of these were recruited to non-training posts.
“Up to 1,000 non-consultant hospital doctor posts funded by the HSE in 2015/16 are not part of any training scheme and therefore trainees receive no credit for their training despite working alongside national trainees and doing exactly the same job,” she said.
“Many are required as additional staff to meet European Working Time Directive requirements and because of increased emigration of Irish medical graduates these posts tend to be located in peripheral hospitals and in services with 24/7 unscheduled care.
“Research suggests that these doctors come to Ireland to further training and career progression. However, as they are unable to accede to national training programmes and their training is not accredited a pattern of remigration is common. Many of these doctors come from developing countries who themselves have acute shortages of doctors posing a global ethical challenge.”
Dr Mahony said while the number of women entering the medical profession now exceeded that of men, “accession to leadership roles has not yet caught up”. She said 90 per cent of surgeons in Ireland were male, despite 20 years of gender parity amount medical graduates.
She said in medical training there was a clear gender split with men more likely to enter anaesthesia, emergency medicine, surgery and genito-urinary medicine while women tended to opt for obstetrics, dermatology, infectious diseases and palliative medicine.
She said 80 per cent of trainees in obstetrics were female but that “even in obstetrics we seem surprised that women have babies”.
“Workforce planning in obstetrics and all other specialties must factor in childbirth because at present there are very few locums available to cover short term maternity leaves and in a specialty that recognises that it has among the lowest number of obstetricians in the OECD and needs to recruit 100 consultants over the next ten years, these vacancies cause real risk.”
Dr Mahony criticised media commentary on obstetrics in one newspaper which she said “perhaps might be considered to constitute an edicotiral campaign”.
“Obstetricians are apparently ‘flat earth people’. In the wake of the Harvey Weinstein revelations, obstetricians were promptly compared to perpetrators of sexual abuse. The practice of symphsiotomy, which had largely ceased before I was born, is conflated with current care as the ongoing horror of maternity services. It has been concluded that ’there is overwhelming evidence that midwife-led care is best for 80 per cent of women, but in Ireland obstetricians are in charge.’”
