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The Department of Health informs us that there are more doctors registered with the Medical Council in Ireland now than ever before. The Department also points out that there has been an expansion in consultant numbers and it notes an expansion in doctors in training within the country also.
However, these figures must be treated with caution. In reality, we know that against the backdrop of the European Working Time Directive (EWTD), which limits the number of hours that a doctor can work, and in the context of the unilateral changes to doctors contracted terms and conditions by health service management – the Department of Health, Department of Public Expenditure and Reform, and the HSE – there are a large number of posts that are filled by doctors working in a locum capacity.
We also know that there are currently over 300 vacant consultant posts in Ireland, many of which have had no applicants to date. A lot of these posts are filled on an interim basis by doctors working in a locum capacity. A doctor working in a locum capacity will not be in a position to drive the strategic development of a service to the same extent as a substantive post-holder would be.
The question therefore has to be asked as to why doctors prefer to stay in a locum capacity rather than commit on a permanent basis to the Irish health service. The answer is a simple one, and that is that there is a lack of faith in health service management’s willingness to honour terms and conditions.
There is also an inherent unfairness that is apparent to all doctors with regard to the expectation that new consultants will work at a significantly lower rate of pay than their existing colleagues for the first nine years of their career, and, potentially, at a lower rate of pay on an ongoing basis for their entire career. This is patently unfair.
The level of expectation of society on medicine has increased in line with our increased ability to provide a higher level of care as a profession. With this increased level of expectation inevitably comes increased demands on the service providers. In a system that has historically been under-resourced, and remains significantly under-resourced, from the point of view of available public hospital bed capacity, there is a real challenge to the safe delivery of care.
If we really want doctors to take on senior positions in our health service then we need to provide them with a contract that recognises the sacrifices they have made personally and professionally to become the specialists that they are. We need to acknowledge the resources that they require to provide the level of service they are trained to provide. We also need to actively put in place those resources in the form of available operating theatres, available intervention equipment, available ward beds, available outpatient facilities, and available staffing to facilitate consultants in the delivery of care commensurate with their professional ability.
As a doctor working in the frontline of the health service throughout the entirety of my career, I have heard many politicians tell me that the problem of hospital overcrowding cannot be solved overnight. This is to miss the point. Nobody expects the problem of hospital overcrowding to be solved overnight. However, it is not acceptable to me to come into work day after day to find patients to whom I provided care the previous day, or the day before that, still awaiting a hospital bed, and still languishing on a trolley in the emergency department (ED) in which I work.
This is the case for many of my emergency medicine colleagues throughout the country. The reality is that these patients are not in a comfortable ward setting, where their care should be delivered. In the ED, the consultant providing the care to them is not afforded the facilities to perform a confidential history taking or to perform an examination in a private manner, and this is distressing for both the patient and the doctor. The Irish hospital system needs beds, it needs valued staff. More than that, many of my consultant colleagues throughout the country work in departments and wards that were designed 20 and 30 years ago that require significant redevelopment and refurbishment.
If we want to address recruitment of senior consultant positions in the public hospital system, then we need to provide consultants with a fair contract that is honoured by the employer’s side and allows appropriate access to the provision of care in both the public and private system. It often goes unsaid, but it is only fair to say currently that if it were not for the private healthcare system in Ireland, the challenges faced by the public hospital system would be significantly greater than is currently evidenced.
As a doctor who works only in the public system I want it to be resourced appropriately. I want to work with colleagues who feel valued and are valued by the health system. I want to provide the highest level of care to patients in an appropriate setting. I want EDs to be used for the emergency management of patients and for admitted patients to be moved to wards in a timely manner. I want my surgical colleagues to have access to theatres so that they can perform the surgeries that they are trained to do. I want my medical colleagues to be confident in their ability to provide care in wards appropriate to the provision of modern medical care. I want doctors in training to feel valued and receive the level of training that they require to become the specialists of the future. I want the patients and doctors of Ireland to be proud of and confident in our Irish health service.
It really is not too much to ask.