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Doctor health and patient safety key focus for Medical Council

Doctor health was among the predominant topics discussed at the recent launch of the Medical Council’s Annual Report 2015.

Last year, the Council and the Practitioner Health Matters Programme signed a Memorandum of Understanding (MoU) to support doctors with health difficulties.

Moreover, in April 2015, the Council published a report based on findings from its 2014 Your Training Counts survey on the reported health and wellbeing of trainees. One-in-five rated their quality of life as poor or very poor.

In addition, the Annual Report noted that some 51 doctors attended the Health Committee during 2015. Nineteen were referred by a third party, 18 by the Council and 14 self-referred.

Speaking at the launch of the Annual Report, Medical Council President Prof Freddie Wood described signing the agreement with the Practitioner Health Matters Programme as “particularly rewarding”. He also noted that the majority of postgraduate colleges had developed “health and wellbeing units” for their Fellows and Members “because of our active interaction with them over the last two years”.

“This is a major advance. Indeed, we have stressed that it is important for the profession to look after its own doctors as it does the public,” noted Prof Wood.

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Prof Freddie Wood, President, Medical Council, at the launch of the Council’s Annual Report 2015

Prof Wood, a leading cardiothoracic surgeon for many years, revealed that his initial call for pastoral support when he became Council President had not been particularly well received by the profession.

Criticism

“I got a lot of criticism from my professional colleagues for it — ‘oh, we don’t need it’ — when in fact we do,” he said.

Prof Wood noted the suicide rates in the medical, dental and veterinary professions were the highest of any groupings classified as professions. He added that there were specific areas of medicine such as anaesthesia where the suicide rate was “particularly high”.

Until recent years, doctors were expected to have a “stiff upper lip” and not speak to anybody about their problems, added Prof Wood. This was “probably because the profession was predominantly male-orientated”, he contended. 

He said the Council believes it is important for the profession to provide care and treatment access for doctors.

‘I got a lot of criticism from my professional colleagues for it —‘oh we don’t need it’ — when in fact we do’

Prof Wood said that if doctors have problems — be they psychological, marital breakdown, financial difficulties or addiction — this can affect the quality of care provided to patients. Losing doctors to medicine because they were poorly treated or untreated for mental health issues also represented a “huge economic loss” to the country.

Patient safety

Patient safety issues were also discussed at the report launch. Just two of the 369 complaints received about doctors in 2015 emanated from the HSE. The overall number of complaints received rose from 308 in the previous year. Complaints in relation to communication were up by 40 per cent.  

Prof Wood made specific reference to the low level of complaints coming from the HSE. He said this issue “raises a concern — does the HSE, for instance, have a system in place or [does] a particular institution have systems in place to recognise doctors in difficulty and if they are, are they providing them with remediation?”

He indicated that the HSE had provided no information to suggest such a system was in place.

“We can only draw attention to it; it is an area for other branches of our society that provides healthcare to address,” he noted.

Exit rate from register increases — the Workforce Report

Some 6.4 per cent of doctors exited the Medical Register at the time of the annual retention process in 2015, according to the Medical Workforce Intelligence Report 2016. This is an increase from 5.6 per cent in 2014 but less than the exit rates in 2013 and 2012 (6.8 per cent and 8 per cent respectively).

Among graduates of Irish medical schools aged 25-29 years, there was a relative increase of 16 per cent in the exit rate between 2014 and 2015.

The highest exit rate was observed in the General Division (10.5 per cent); and a relatively low exit rate was seen among doctors registered in the Specialist Division (3.7 per cent). However, a higher than average exit rate was observed among some specialties, including otolaryngology (9.4 per cent) and obstetrics and gynaecology (7.5 per cent).      

Overall, some 18,766 doctors were invited to retain registration for the period July 2015 to June 2016. Some 17,571 (94 per cent) of doctors retained registration. Twenty-three per cent of doctors who retained registration were aged 55 years and older; 31 per cent of specialists were aged 55 years and older.

The proportion of older doctors differed across specialties, with public health medicine (57 per cent), occupational medicine (54 per cent), psychiatry (38 per cent), general surgery (35 per cent) and general practice (34 per cent) among the larger specialities with higher than average proportions of older doctors.

In 2015, 37.9 per cent of doctors retaining registration with the Council graduated with a basic medical qualification from a medical school outside Ireland; this compared with 35.7 per cent in 2014.

Ireland’s reliance on international medical graduates is among the highest of OECD countries, noted the report. The five leading countries of qualification for doctors who did not qualify in Ireland were Pakistan, Sudan, the UK, South Africa and Romania.

 The skill mix and roles of international medical school graduates differed from those of Irish medical school graduates. Some 27.5 per cent of doctors who graduated from Irish medial schools were registered in the General Division, compared with 64.2 per cent of international medical graduates.

Additionally, 76.8 per cent of doctors who worked as NCHDs (not in training) were international medical graduates, and the proportion of international graduates in the medical workforce varied across areas of practice. The areas with high proportions of international medical graduates were obstetrics and gynaecology (58 per cent), emergency medicine (56 per cent) and surgery (53 per cent).  

Speaking at the report launch on the high dependence on international medical graduates, Prof Wood said: “I would hope that with the development of the six Hospital Groups and rationalisation of particular services, and general improvement in delivery, that the overall requirement on the international workforce is actually reduced. It does create ethical dilemmas for us all, having such a high number.”

Mr Prasifka also noted that the majority of those on the Medical Register between the ages of 30-44 years are female; however, from 44 years and upward, the number of females on the Register begins to decrease.

“Data from our Your Training Counts report also found that 40 per cent of female trainees — or tomorrow’s specialists — want to work less than full-time and this definitely poses some questions for the health sector and all of those involved in the future planning of Ireland’s healthcare service.”

The Workforce Report also provides interesting data on density of GPs per 100,000 population, with Galway, Westmeath and Waterford having the highest densities and Meath, Kilkenny and Leitrim the lowest.

Safe start

During 2015, the Council announced its intention to develop a “registration support programme” called Safe Start.

The Medical Independent (MI) asked Council representatives if this initiative would be obligatory for new registrants and how its effectiveness would be gauged. 

Medical Council CEO Mr Bill Prasifka said the programme is still in “the design phase”. He added: “So we are designing it with the goal to implement it next year… Obviously, if we have a programme and it is not being used, that is not a successful programme, so we are going to have to come to grips with those issues… ”

Overall, Mr Prasifka described 2015 as a year characterised by “increased activity levels” across the entire work of the Council. Some 35 fitness to practise inquiries were completed last year, in comparison with 19 in 2014. The outcome in 11 cases was an undertaking pursuant to section 67 of the Medical Practitioners Act; no finding/fit to engage in practice of medicine/no case (seven cases); professional misconduct (six cases); poor professional performance (six cases); contravention of the Medical Practitioners Act 2007 (four cases); and relevant medical disability (two cases).

During 2015, there were five cancellations of registrations sanctioned by the Council.

There was a significant increase in the number of new doctors registered in 2015, with over 2,600 doctors gaining the right to practise in Ireland, compared with 1,800 in 2014.

According to Mr Prasifka, there had been “huge” investment in Council registration processes and “absolutely no diminution in our quality standards”.

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