Patients attending hospitals in Waterford and Tullamore were affected by this week's industrial action by non-consultant hospital doctors. Dr Muiris Houston, Medical Correspondent, examines the doctors' case and the chances of a solution
Many patients must feel themselves torn both ways in the current hospital doctors' dispute, with sympathy over the doctors' very long working hours tempered by reports that they are earning vast amounts of overtime. The employers have said that the doctors are averaging €45,000 a year in overtime payments.
The kernel of the dispute is the need to reduce non-consultant hospital doctors' (NCHDs') excessive working hours, which average 77 hours per week at present. An EU working directive has said their hours must be reduced to 48 hours by 2010. The initial phase of this reduction aims to achieve a 58-hour working week by the end of 2004.
Both sides in the dispute are committed to a reduction but where they differ is over which hours must be reduced.
The Irish Medical Organisation, which represents over 2,500 Non-Consultant Hospital Doctors, says doctors must be in hospital during the prime training period of 9 a.m.-5 p.m. and that cuts in hours should be aimed at night and weekend work.
The Health Service Employers' Agency (HSEA), representing hospitals and health boards, rejects the notion that hours outside 9 to 5 have no training value and wants to cut overall hours worked. For example, a proposed roster might involve working 9 a.m. - 1 p.m. on two weekdays with time saved used to cover "on call" commitments.
Which brings us to the contentious issue of what constitutes a core working week for NCHDs.
According to the Labour Relations Commission in a ruling of June 14th, 2000, "under the existing arrangements NCHDS are normally rostered to work between 9 a.m. and 5 p.m., Monday to Friday, for which the annual salary is payable". It also said that overtime rates would be payable for hours worked outside 9 - 5 in the context of a 39-hour week.
The IMO has fought a long battle to get recognition of a core working week and to achieve overtime rates of time and a quarter for the first 15 hours and time and a half thereafter. Up to two years ago, NCHDs were paid 50 per cent of their normal hourly rate for additional hours worked.
According to Dr Mick Molloy, the first non-consultant hospital doctor to be elected president of the IMO, the Department of Health agreed to set up a verification board to investigate under-payments to junior doctors from 1997. "Substantial payments of money have been paid to NCHDs who claimed payment for work done but who were refused payment by their employers", he says.
Mr Rory Costello of the HSEA accepts that, historically, NCHDs had legitimate grievances but maintains these were addressed proactively in the 2000 agreement. "There has been no lack of commitment from employers over the last three years", he says, pointing out that €254 million was committed to improving training for junior doctors in the first year alone.
According to the IMO, if the HSEA-imposed rosters were introduced, patients would suffer by having fewer NCHDs available to attend to them when the hospital is at its busiest.
"Waiting lists would grow longer, NCHDs would not receive proper training and the standard of professional medical excellence would suffer."
Doctors' training time may be reduced by as much as 20 per cent if the proposed rosters continue, according to the IMO. And this is in the context of fewer than 4 per cent of hours worked currently spent training in the Republic, compared to 15 - 20 per cent in the best international centres.
But the HSEA says the notion of a 9 - 5 roster in a 24-hour health service is not acceptable and would have implications beyond this dispute.
With doctors in training earning from €29,351 for an intern to €58,781 for a senior registrar, what about the HSEA argument that the IMO is more interested in protecting overtime earnings than reducing NCHD hours?
Dr Molloy totally rejects these claims. "If junior doctors were motivated by money, they would work elsewhere. The IMO emphatically wants a reduction in the number of on-call hours for NCHDs, the period for which they are paid most at present. What the HSEA wants is to remove NCHDs from hospitals when they are at their busiest and when NCHDs are supposed to receive training".
So do the doctors have a case and what will it take to achieve a resolution?
Certainly in terms of training needs, NCHDs would lose out to some extent with the new rosters. Until we have consultants rostered for nights and weekends it will be difficult to provide training for junior doctors on a 24- hour basis. And if there was a significant reduction on NCHD manpower between 9 a.m. and 5 p.m., then patient care could suffer.
A withdrawal of the controversial roster pending an expected report from the taskforce on medical staffing would bring this dispute to an end. An alternative is to appoint more NCHDs so that the on-call hours for each individual, rather than core working time, could be cut.
But with a history of mistrust and misinterpretation of past agreements between the parties, it is likely that patients will continue to suffer before the issue is resolved.