Outgoing IMO President Dr Peadar Gilligan provides an overview of the challenges facing doctors and the importance of overturning the pay cut for new-entrant consultants
The presidency of the Irish Medical Organisation, for me, has been a year of listening and learning, a year of talking and teaching, a year of representing the medical profession in person, in print, on radio, on television and on the worldwide web, and a year of working with an amazing team of committed professionals who believe in the importance of what we do as doctors.
It has been my honour to hear the concerns and fears of doctors regarding the provision of patient care in Ireland and to try and represent those views as clearly and as cogently as possible.
The presidency of 2018/2019 was not without its challenges for the medical profession.
We have represented interns for the group to get paid for their first two weeks of induction; NCHDs over breaches of contract; consultants over contract breaches, which have lasted more than decade; consultants in their fight to reverse the 30 per cent cut for those appointed since 2012; public health doctors in their battle for consultant status; and general practice in their work practice talks and the reversal of FEMPI.
We have argued that addressing the capacity requirements in the community, in our acute hospitals, in our intensive care units, our laboratories, our radiology departments, our nursing homes and in general practice must be a priority if we as doctors in Ireland are to provide the care our patients need now and into the future.
We have clearly noted that if Sláintecare and providing care at the lowest level of complexity as near to the patient as possible is to be realised, then general practice must be resourced to deliver this care. If we are to address the waiting lists for specialist opinion and surgeries and procedures, then the acute hospital system must be resourced appropriately. If we are to develop a model of population health in Ireland, then specialists in public health must be acknowledged as consultants. If we are to expect NCHDs to remain in Ireland following their training, we must treat them fairly during their training. We cannot, as a nation, continue to say we want a world-class health service and yet treat those who deliver patient care unfairly.
A basic tenet of the trade union movement has been that people doing the same job with the same level of qualifications, and who bare the same level of responsibility, must be paid the same. Why has the Irish Government decided to ignore this basic right of workers? The invoking of pay cuts to new entrants into professions and careers during the economic downturn has been depicted by some as a necessary evil. I would say the time that this argument could be used has long since passed.
New entrants should not be treated unfairly for the fallout from a problem in which they had no hand, act or part.
The need to unite
As an organisation, the IMO has been fighting for fairness and the recognition of the value of doctors. When the Vikings came to Ireland, it was only by the tribes uniting that we were able as a people to repel the invader. The medical profession has become increasingly tribal and this lack of unity is being exploited by those with motives other than the optimisation of patient care.
Doctors speaking with one voice on issues such as acute hospital capacity, access to diagnostics, resourcing of general practice and population health initiatives are far more likely to achieve the health service that we as doctors want to deliver for our patients. Doctors undermining others by word, act or deed is not in the interest of the profession or those for whom we care.
The IMO represents all doctors, from student years up to and beyond retirement, and that is our strength. For that strength to be fully realised, doctors must join their union and contribute, rather than set up special interest groups that inevitably, by their nature, fail to see the big picture.
Healthcare provision is a complex activity and a broad perspective is an essential starting point. The IMO, by way of its membership, has a well-informed position and as a result, the capacity to deliver real and lasting improvements for doctors and their patients.
The theme of last year’s AGM was ‘Valuing Doctors’ and the importance of supporting doctors to provide the best care to their patients is increasingly evident.
Pressures on medical professionals
The Government is currently looking to make open disclosure of adverse events mandatory, yet there seems to be no imperative around making adverse events a less likely phenomenon.
By this, I mean our hospitals are overcrowded; our wards remain multiple occupancy for the vast majority of hospital patients; our emergency departments are the most overcrowded in the developed world; our waits for an emergency admission following the decision that admission to hospital is necessary are the longest in the developed world; our operating theatres are under-utilised; and money is being diverted from the public hospital system to pay for procedures in the private hospitals.
If the public system was adequately resourced, this practice would be unnecessary. We have fewer specialists per capita than most OECD countries and despite having very significant recruitment challenges at this level, the Government insists on continuing to treat senior doctors who take up consultancies in the public health system unfairly. As a result, there are now in excess of 500 unfilled consultant posts nationally.
The Government decision resulting in a 30 per cent pay cut to consultants has caused this recruitment crisis and in turn, this has led to increasing waiting lists, inevitably delayed diagnoses and patients in pain and distress for longer pending their procedure than should have to be tolerated by anyone.
As a doctor in training, I was taught that if an intervention is made that makes things worse, it should be stopped and reversed where possible. The 30 per cent pay cut to new-entrant consultants since 2012 is such an intervention and must be reversed as a matter of urgency to help reverse the harm it is causing to patient care. To call a doctor who has worked as an intern, senior house officer, registrar and specialist registrar and who will have worked in these roles for no less than eight years in the Irish health system a ‘new entrant’ is clearly wrong. How can you be regarded as a new entrant when you have spent almost a decade working in the same system you are now considering applying for a consultant post in?
One of the cornerstones of disaster medicine is that you look after your team, because if they are not kept safe and well, they cannot care for the sick and injured. The Irish Government and the Department of Public Expenditure and Reform seem not to understand this basic principle. I personally have seen first-hand the demotivating impact of the 30 per cent cut to consultants’ salaries for those appointed since October 2012.
As a profession, there have never been so many resignations from the public health system as we have seen in the last seen years. There have never been so few applicants for consultant posts, with a significant proportion of advertised consultant posts receiving no applicants. At a time in one’s consultant life when a newly-appointed consultant should be having most impact, bringing new technologies or approaches to patient care, I see colleagues who are angered and upset by the fact that they are expected to do the same job for 30 per cent less pay.
Their senior colleagues spent a decade to have their contracts actually honoured. Their senior colleagues are paid less than they were a decade ago on foot of the Financial Emergency Measures in the Public Interest (FEMPI) legislation and those appointed since October 2012 are paid 30 per cent less again.
It is in this context that a political consensus on how healthcare in Ireland should be delivered over the next 10 years was developed.
Some might say that Sláintecare was developed with inadequate input from the medical profession, who will ultimately be expected to deliver it. Indeed, one wonders how politicians would respond to a committee of doctors deciding how politicians should work and deliver services would be received by those politicians.
The advocates for Sláintecare have been frustrated by the slow progress and lack of resourcing of the political consensus plan. I would note for those advocates that the medical profession in Ireland has been frustrated for decades by the slow progress and inadequate resourcing of the public health service that results in doctors having to work in dilapidated units with outdated equipment and overworked colleagues.
The aspiration to provide healthcare free at the point of access for all is to be admired, but it is important to remember that it was politicians who introduced prescription charges, charges for emergency department attendances, and increased charges for hospital care. As I told the Minister for Health, doctors in Ireland are sick of being told how to do their jobs by people who do not do it. Doctors are sick of the constant change agenda that often seems politically motivated rather than patient-centered.
If we want a health service that we can rely on to provide timely, appropriate and safe healthcare in optimal surroundings, then we need to resource the provision of that care, we need to value the doctors providing that care, we need to treat doctors fairly and reverse the cuts imposed on doctors in the form of FEMPI cuts and the vicious 30 per cent cut to the pay of consultants appointed since 2012.