Sir, – As senior emergency medicine trainees, we note the recent proposal by the Minister for Health to impose a 30 per cent pay cut on new consultant posts.
While such a move will indeed earn the Minister for Health significant public relations plaudits in the current economic climate, it will have a profoundly damaging impact on the national emergency care system and thus on patient care.
It has become increasingly difficult to recruit consultants to positions in Ireland already, especially to posts in emergency medicine, as is reflected in the number of vacant consultant posts.
The pathway to becoming an emergency medicine specialist in Ireland is longer than most other systems in the Western world and results in an end-product that is highly sought after in the international medical labour market. Future consultants are opting to go abroad and stay abroad, not least because those trainees abroad will be on a higher wage than consultants on this new pay scale. It is also the case that more junior trainees will, we suspect, move abroad in even greater numbers in response to this unambiguous message from government.
Laudable initiatives including the national clinical care programmes will prove difficult or impossible to implement without such appropriately trained consultants.
One of the traditions of medicine is to continuously strive for improvements in patient care and outcomes, with the younger generation of doctors inheriting this superior system along with these goals and values. We fear with these measures, there may be no-one to pass this baton to. This is not just about appointing to fill a position, but crucially adding expertise to the system. While the public may not appreciate this in the midst of an incessant vilification of public sector workers, and consultants in particular, they may come to realise this in their time of need in the future. – Yours, etc,
Sir, – It was with dismay I read your unqualified and somewhat triumphant commentary on consultant pay. Reducing healthcare to a single item agenda with a consultant target is politically expedient but misleading and unhelpful.
Irish hospital doctors have a unique medical tradition of extensive post-graduate training in the very best centres in the world. Irish patients expect and deserve this level of care. Succession planning is a central aspect of our future and as consultants we train junior colleagues in the full expectation that their youth and skills will succeed and surpass us in delivering excellence. Once broken this system will likely not be rebuilt.
Two of my talented trainees met with consultant colleagues from America, Australia and Europe to plan their advanced training abroad. Though on Friday we spoke of three-year programmes, by Saturday we spoke of permanent emigration for them and their families.
Our training bodies are fighting a rearguard action to coax house officers to return from abroad. We are not creating a competitive future for our registrars. Hospital records show an unprecedented withdrawal of consultant candidates from interview or appointment in recent years. Ireland has already lost world leaders in healthcare to the current contract. I do not know the training and education profile yet of those who will accept these new contracts but I know already very well the profile of those who won’t.
Two governments have sought to demonise consultants and seek to commodify their expertise. Doctors are voting with their feet and we cannot in good conscience advise them otherwise.
Politicians lack vision beyond fielding the media in crisis and though money will be saved our society will be much the poorer for it. But maybe being a world leader is meaningless and maybe the public won’t notice the steady creep of change – I suppose that is the bet. – Yours, etc,