Junior doctors are drowning in a health system in perpetual crisis

“I don’t know how you keep going!”

Over the years, this phrase has been used as an observation on my working life many times. It might come from a taxi driver, taking me home from a 25-hour shift. Or from my mother, as I set off on a Sunday evening to commence another 80-plus-hour week. Or from a patient, whom I have admitted at 9am on Tuesday, who is surprised to see me at 9am on Wednesday, having not been home in between.

As a non-consultant hospital doctor (NCHD) in Ireland, you enter the medical profession with the expectation that you will work hard and that you will push yourself. The road is steep, the stakes are high, the learning curve – enormous. You start the job with the assumption that if you put your heart and passion and energy into the role, then you will go on to help people.

'That's the way it has always been' and similar phraseology have paralysed progress for NCHDs for decades

What you never anticipate, is that you will enter a system that is so relentlessly demanding that it expects work volumes and patterns not possible from a human being. You do not expect to be both full-time doctor and full-time apologist for a system in perpetual crisis. You do not expect the guilt that accompanies caring for a patient, full in the knowledge that you are too exhausted to do so safely or empathetically.

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The situation for NCHDs, which comprise roughly three-quarters of the doctors in Irish hospitals (from newly qualified intern to right before consultancy), has been made needlessly challenging for years. Rosters so brutal, that a doctor might start work at 4pm on a Friday, to finish at 9am on the Monday. A workforce so lean, that NCHDs are frequently asked to cut short annual leave, sick leave and to work through illness. A system, that works doctors into the ground, and then sues them into the bargain.

The knock-on effects for patients is undeniable. The vast majority of us have or will be patients at some point in our lives. Have you ever felt unclear about a diagnosis on discharge from a hospital? Have you ever felt like your doctor has whizzed past you before you have had a chance to ask questions, process results? I promise that this is not borne out of a desire to confuse or ignore. We are drowning.

“That’s the way it has always been” and similar phraseology have paralysed progress for NCHDs for decades. At present, contracts for NCHDs last no longer than one year, which aside from creating seemingly needless paperwork for manpower departments, lead to deep-rooted feelings of impermanence and accompanying disconnect. “Will I have to uproot my family again next year? Will I ever be able to settle?” For the minimum of 10 years to qualifying as a consultant, you are treated as a temporary staff member, despite often never leaving the employment of the HSE.

External commitments? Dependent relatives? Forget about it. There is not a childcare or a homecare service in the world catering for 24- to 36-hour shifts. Moving house every year? Good luck maintaining a relationship, securing childcare or leaving the rental market. The patients of Ireland cannot hope for an improvement in their health service when we are driving our workforce out of Ireland (or out of the profession) with these impossible asks.

All of this could nearly be surmountable, if you had enough time to rest. It feels somewhat hypocritical to be preaching the importance of sleep to your patients, as you proceed to work, and prescribe, and operate without any.

NCHDs are not prepared to put up with these barriers to the delivery of effective care any longer. The patients of Ireland and our healthcare workers deserve better

According to the vital research carried out by Dr Niamh Humphries and her team over the last four years through the Hospital Doctor Retention and Motivation Project, significant dissatisfaction with deteriorating job quality, long working hours and poor work-life balance are driving doctor emigration. I know of four doctors in the last week who have left Irish shores to work abroad indefinitely. It is upsetting and frustrating that they will not be here to look after our families, our friends, our communities here in Ireland.

If we can protect NCHDs from unsafe work shifts, if we can ensure payment for hours worked and leave entitlements. If we can recognise that they are human beings, like everyone else; then we might have a chance of retaining the stellar workforce we have created and safeguarding the health of the population.

NCHDs are not prepared to put up with these barriers to the delivery of effective care any longer. The patients of Ireland and our healthcare workers deserve better. Our campaign “#standingup4NCHDs” is looking for meaningful engagement on the above issues as a matter of utmost urgency, for patients and for staff.

The Irish Medical Organisation has called an emergency meeting of NCHDs across the country, both members and non-members, on April 11th.

Dr Rachel McNamara is a member of the NCHD Committee of the IMO