Each year the brightest and best of the Leaving Certificate candidates work hard to achieve the extraordinary grades - six As - required for a medical school place. Eight to ten years later 50 per cent of them, disillusioned by the labyrinthine nature of post graduate training and lack of job security, go abroad to pursue their medical training and join the British and American health services. Why do we tolerate a situation where half the highest academic achievers of a generation are lost to their country?
"I know of no other profession where the next generation go abroad so early in their training and spend so much of their careers there", the Minister for Health noted recently. There appears to be general consensus as to why this exodus takes place: with few exceptions medical postgraduate training is largely unstructured and takes place over an indefinite period of time; trainee doctors are used as "the work horses of the hospital system" to quote the Irish Medical Organisation's spokesman, with no time for study or training. According to the Tierney report, they are often doing specialist work because of the shortage of consultants.
Meanwhile, 80 per cent of the junior hospital doctors in some health board areas are non nationals, mainly from India and Pakistan. These posts do not attract young Irish doctors because they are outside the training loop and the chance of advancing to consultant level outside the main training hospitals is seen as very low. Clear and obvious solutions to this problem have been articulated. A properly structured postgraduate programme with a defined curriculum and duration, time tabled training, and more job security than existing six month contracts would help to solve the problem. Local hospitals could easily be involved in such a scheme, thus further reducing emigration levels.
Making space for more time tabled learning by trainee doctors inevitably means more consultants are needed. The Tierney report on medical manpower in hospitals has already recommended this and its findings are being discussed at a consultative conference this week. there are financial implications, it is true, but there are financial implications in continuing to train hundreds of doctors to work in foreign medical services and medical implications in patients being treated by trainee doctors and not by fully qualified specialists.
As reported in this newspaper today, the Irish Medical Council is about to make radical and badly needed recommendations on undergraduate medical training and address the serious problems of the intern year. It is to be hoped that in conjunction with the Postgraduate Medical and Dental Board, it will now become concerned with the equally serious problem of postgraduate training. A concerted effort is needed to end what the IMO's spokesman describes as "this outrageous situation whereby doctors are educated for export while, hospital posts remain vacant. The continued emigration of so many medical graduates is a serious brain, drain. No nation can lose its brightest young people without repercussions.