Sir, - I qualified in medicine in 1980. As a surgical intern in a county hospital, I worked alternate weekends, averaging 104 hours a week. When on call for the weekend, I would cover the basic medical needs of the surgical inpatients, including the reception clerking of 20-plus patients on a Sunday. No problem!
The only difficulty was that I also had to see every patient who attended the casualty department. I remember weekends when I had two to three hours in bed each night, taken in broken snatches. Tasks which took 15 minutes to perform at 9 a.m. on Saturday took over an hour to perform at 3 a.m. on Monday. I distinctly recall looking blankly at a line of writing on a page and trying desperately to think what word needed to be placed next. This was not writers' block, but the sheer exhaustion of sleep deprivation, a condition induced by inquisitors and torturers to break the spirit of resistant captives. After such a weekend I was expected to work until 5 p.m. on Monday.
Matters have improved only marginally in the ensuing 18 years. The reason is a simple economic equation. A non-consultant hospital doctor is paid less for overtime than he is for his standard working week. Hours from 40 to 60 each week are paid at time and a quarter for 10 hours and at half time for 10 hours. But some quirk of ingenious interpretation allows the hours from 40 to 60 to be paid on a 1+1 basis, so every hour is actually paid at 87.5 per cent of the normal rate. Every hour over sixty is paid at 50 per cent of normal rates. That is the rate - not an addition to pay, but a subtraction! So a junior doctor working an 80-hour week will cost the employer 1.275 times the normal salary, rather than twice the normal salary. There is thus a positive disincentive to the employer to increase the number of junior doctors and reduce the hours worked by them.
The recent move from the EU Council of Ministers to exclude such hard workers from the protection of society is appalling. It has been claimed that we will need over 10 years to train sufficient doctors to fill the slots needed. Poppycock! We already produce enough from our medical schools but, because of restrictive practices at Department of Health level over the past three decades, most of these export themselves early in their postgraduate career, in order to get their feet on the bottom rung of the ladder in other countries and ensure promotional prospects both abroad and here. What must be acknowledged is that those who graduate from medical school are neither stupid nor metaphorically blind. They can well divine the career options open to them at that stage.
At a time when the coffers of this State are brimming over, we are told that more is being spent on health than ever before. This is true. But the percentage of the Gross Domestic Product being spent on healthcare is, if anything, falling. This will leave us heading for the equivalent funding of a third-rate nation, when our patients expect a service appropriate to that of the wealthy nation state we have become. With the millennium celebrations approaching, and murmurs of barmen taking home £1,000 for a night's work, I would not be surprised to find that the blue flu of last summer was mirrored by many junior doctors who are browned off. It is time our politicians stood up and accepted that, for too long, doctors in training have been abused by our system. They should be paid appropriately and not forced to work inhumane hours, which are neither tolerated by, nor indeed legal for, any other employees. - Yours, etc.,
P. K. Plunkett FRCS(ED) FRCS(GLAS) FFAEM
St James's Hospital, Dublin 8.