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Another blow to public health doctors

Just as ‘spin’ was synonymous with the Tony Blair-led New Labour administration of the late 1990s/early 2000s, ‘optics’ became associated with the former

Taoiseach, and now Tánaiste, Leo Varadkar and his Government. Both are pejorative and shorthand for a politics valuing style over substance.
While it might be superficial, there is sometimes value in judging political decisions even in these hollow terms.

Earlier this month, the IMO was told in a meeting with the Department of Health and the HSE that the Department of Expenditure and Reform is effectively blocking the consultant-status for public health specialists by withholding approval for the revised terms of the new consultant contract and stalling progress on the required legislative changes.

There is little doubt that the ‘optics’ of blocking public health specialists from being recognised as consultants at a time when a global pandemic is raging is bad, to say the least.

This is what Chairperson of the IMO’s public health committee, Dr Ina Kelly had to say: “Politicians have been falling over themselves to praise the work of public health specialists for the past six months, but when it comes to recognising their status by granting them long-promised consultant contracts, they refuse. This is not only unfair on the hard working specialists who are battling Covid-19 at the moment, it will directly discourage future doctors from considering a career in public health medicine.

Even as we speak our public health specialists are being actively recruited as consultants in other jurisdictions. That will accelerate when they see that their reasonable expectations are being ignored in their own country.”



The argument for public health specialists being recognised as consultants had been put forward in reports from Crowe Horwath and the Scally report on CervicalCheck, yet there is little progress to show.

Despite the financial devastation Covid-19 has brought, one would have thought the pandemic has highlighted the need for the specialty of public health to be properly supported and resourced. Yet the opposite seems to have happened.

This is more than just bad ‘optics’; it raises serious questions about how the health service is being run at a time when we need it most.

In a feature in this issue of the Medical Independent on Irish doctors based abroad during Covid-19, Dr Niall Conroy points to the disparity in how public health doctors are treated in Ireland compared with their colleagues in other specialties and indeed compared to the same specialty in other countries. Dr Conroy is currently based in Queensland, Australia, where he works as a consultant in public health medicine and director of public health.

When asked whether he would return to Ireland, he said he would find the decision “extraordinarily difficult” to come back to a non-consultant job.
“I love outbreak control,” he said, “but it’s very hard to do the job properly in Ireland without the team and the autonomy that comes with a consultant contract.”

There are, unfortunately, a number of others in Dr Conroy’s position, who are understandably beyond frustrated at the current impasse.

The Covid-19 pandemic has highlighted how public health is not a luxury, but an essential part of the health service and it is high time the Government, Departments and the HSE accord these doctors the status which they deserve.

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