Extended hours for junior doctors just not working

Young clinicians are on the verge of industrial action over what they consider unsustainable shift patterns

Tue, Aug 13, 2013, 01:00

The fate of young doctors will be in the news for some time as they ballot on a strike that, if it goes ahead, would have a serious impact on an already overstretched health service.

The source of the grievances of the 2,000 junior doctors in the system is the long hours they continue to work despite repeated pledges that it would be reformed.

According to the Irish Medical Organisation (IMO), junior doctors have run out of patience with the HSE and the Department of Health.

An overwhelming majority are expected to vote for some form of rolling industrial action after balloting ends on September 2nd.

Meanwhile, the European Commission, which has repeatedly taken Ireland to task about not implementing the European Working Time Directive, is monitoring hospitals that already have a 48-hour week to ensure that progress is being made.

The Government faces the prospect of being fined millions of euro if the commission decides to refer Ireland to the Court of Justice over the issue.

The cause of the long hours worked by Irish doctors would appear to be a case of misallocation rather than a lack of resources.

The Medical Council of Ireland, which retains the registration details of all Irish doctors, has conducted the first comprehensive audit of the number of doctors in Ireland; who they are, and where they come from.

According to registration data from the end of 2012, there are 16,392 doctors in Ireland, giving an average of between 3.6 and 4 per 1,000 depending on the time of year, according to the council’s medical workforce intelligence report.

This puts Ireland either third or seventh among 28 OECD countries, depending on when the registration is taken.

Mass of data
The situation is complicated, though, by the number of foreign doctors in Ireland, of whom some are in Ireland all year and others who come and go. A quarter of all doctors registered in Ireland either work part-time outside the country or practise only outside Ireland.

When their numbers are discounted, Ireland ranks only 13th or 18th out of the 28 countries.

The most startling fact that emerges from the mass of data provided by the Medical Council is that the percentage of female doctors has grown in every generation.

Some 61.9 per cent of doctors in Ireland between the ages of 25 and 34 are women. Overall in the health service, the gender balance is reversed as men dominate in the older age categories.

Between 35 and 44, there is still a small majority (53.4 per cent) of women in the profession. At the other end of the scale, of the doctors who are still practising over the age of 65, fewer than one in five (18.1 per cent) is a woman.

More than one-third of all doctors (35 per cent) in the Irish system are from abroad. Of all the OECD countries, only New Zealand has a higher proportion of foreign-born doctors.

The largest number in Ireland, 13.4 per cent, come from the Middle East. This is followed by Africa (7.5 per cent) and the rest of Europe (9.6 per cent)

Critically, 10 per cent of foreign-born doctors in Ireland are from countries identified by the World Health Organisation (WHO) as being challenged with a critical shortage of human resources for health.

This is in breach of the WHO Global Code of Practice on the International Recruitment of Health Personnel, which states that countries should strive for self-sufficiency and sustainability in the development and retention of health workers.

Foreign-born doctors, especially those from Africa, Europe and the west Pacific, are more likely to leave the Irish system.

At the same time, an average of 6.3-6.4 per cent of Irish-trained doctors between the age of 25 and 40 leave the health system every year.

Cumulatively, it would mean that one-third of all Irish medical graduates would no longer be working in Ireland five years after graduation.

Irish-trained doctors
The chief executive of the Irish Medical Council, Caroline Spillane, says the council’s report does not focus on why so many Irish-trained doctors leave the system, nor on why so many are recruited from abroad.

However, she expresses the hope that the figures presented in the report will inform policymakers who devise future recruitment policies.

“The data does show us . . . the status of international qualified doctors. It is telling us about the number of doctors who are exiting, but it doesn’t tell us why,” she says.

“But in terms of workplace planning, the key thing to establish is that we have a strong, sustainable workforce for the longer term.

“We are hopeful this report will be taken up by those involved in workforce planning and those framing longer-term policies to inform the actions they are going to embark on.”

Minister for Health James Reilly has already called the exodus of Irish doctors from the health system “perverse”.

Last month he told the Joint Oireachtas Committee on Health and Children that the existing scenario, where Irish doctors are leaving and the health service is scouring the developing world for replacements, is “immoral and wrong”.

Whether the Minister’s actions match his rhetoric in time will be another matter. He has asked Dublin City University president Brian MacCraith to compile a report by November into why so many doctors are leaving and how the exodus can be stopped.

Junior doctors
There is no doubt that the hours junior doctors work contribute to the exodus from Ireland.

The title junior doctor is something of a misnomer. Some junior doctors can be in situ for 15 years and find themselves frequently having to make life and death decisions.

Dr Shane Considine, who works in St James’s Hospital in Dublin, says the working hours and conditions “undoubtedly” contribute to the high rates of exit from the Irish medical system and the reliance on foreign doctors as identified by the Irish Medical Council report.

“Nobody wants to go on strike. It is out of sheer frustration that it has gone so far. We’ve known about this situation for the past 10 years and not enough is being done about it,” he says.

Considine says he worked a 60-hour shift two years ago, from Saturday morning to Monday evening – punctuated by only short bursts of sleep.

“This is by no means unusual in this country. My situation was not an outlier. We know of doctors falling asleep at the wheel and all the mental health issues that come with such long hours.”

Considine worked for a year in New Zealand, where he encountered none of the same problems.

“The grass is definitely greener on the other side. Irish doctors used to go away to get more training, but now more of them are not coming back.”

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