Sir, – "Better work conditions sole solution to hospital-doctor shortage" (Niamh Humphries, John-Paul Byrne, Jennifer Creese, Opinion & Analysis, April 1st) correctly draws a distinction between consultant doctors and non-consultant doctors. Their situations are very different. That is the nub of the problem and also why it is so difficult to implement Sláintecare.
In the article, consultants are reported as being disengaged and reluctant to initiate change. Perhaps, that is because they are relatively content with their pay and employment terms as permanent hospital consultants so why rock the boat? Non-consultant doctors, many of whom are foreign but also include our own Irish trainees, are reported as feeling underpaid, undervalued and overworked.
It is not feasible to “level up” as we already have one of the most expensive healthcare systems in the world (OECD data, per capita spend). A fairer deal and better conditions for all hospital doctors is the solution to our doctor shortage but that will require concessions from incumbent consultants which, understandably, they are reluctant to make.
That is the Gordian knot facing anyone who tries to fix our health system. – Yours, etc,
CORMAC O’CARROLL,
Salzburg,
Austria.
Sir, – Your opinion piece correctly highlights the extreme working hours, underpayment and unmanageable clinical workloads which have become accepted as normal for non-consultant hospital doctors (NCHDs) in Ireland.
The authors fail to mention unequal treatment of newly appointed consultants as a major contributing factor to our current 837 vacant consultant posts.
Those appointed after 2012 receive 30 per cent less pay than the colleagues they work alongside doing the same job and have greatly reduced pensions.
This is an incredibly stark disparity that does not exist anywhere else in the public service. The next generation of doctors who we need to recruit see this for the discrimination it is and are voting with their feet. Can you blame them? – Yours, etc,
NIALL O’DONOHOE,
Galway.
Sir, – The commentary by the RCSI researchers on how poor working conditions are a key element of the doctor shortage in Ireland is to be welcomed.
However, by focusing on factors external to the profession as the sole cause, the authors may have missed the added element of the factors from within the profession which add to the stressful work environment.
These include the rejection by the profession of the Fitzgerald and Hanley reports which would have provided fewer hospitals but of greater critical mass and likely better working conditions, and the failure to ensure an even quality and consistency of support and supervision of trainee doctors.
While most medical trainers provide appropriate supervision, they and the trainees would wish to see a much stronger degree of oversight and enforcement of the quality of training by the medical training bodies of the minority that do not support trainees adequately, including removal of trainer status if necessary.
In a stressful job in a stressful system, trainees need to be confident that they are effectively supported, and it is critical that the training colleges and Medical Council act forcefully to ensure that this is the case. – Yours, etc,
Prof DES O’NEILL,
(Consultant Physician
in Geriatric Medicine),
Tallaght University
Hospital, Dublin
Dublin 24.