The days of medical emigration will largely be over when new education reforms are implemented, writes Muiris Houston, Medical Correspondent.
The announcement yesterday of a €200 million package of medical education and training reforms is most welcome. It is clear from the proposals that the Ministers for Education and Health have taken on board the recommendations of both the Fottrell and Buttimer reports into medical education.
The Fottrell working group recommended that the intake of EU students into Irish medical schools be increased from 305 to 725 a year. It called for a multi-streamed entry model, with graduates to take up 40 per cent of the 725 places and undergraduates to fill 60 per cent of doctor-training slots. And it suggested that the intake of non-EU students be effectively reduced to 25 per cent of the total intake, from its present level of over 60 per cent.
These reforms were promised by Mary Harney and Mary Hanafin yesterday. In addition, the proposals call for the development of a new aptitude test for graduate entry to medicine as well as a new selection mechanism for undergraduate entry, made up of a suitability test and Leaving Certificate points.
A working group is to develop an aptitude test based on best international practice.
What will it all mean in practice for aspirant doctors? For undergraduates, there will be 70 additional medical school places available next September, based on Leaving Certificate results alone. Those students sitting their Leaving Certificate in 2008 will probably have to reach a threshold of 450 points to be eligible to sit the aptitude test, subject to the working group's final recommendation.
For students taking the Leaving Certificate this June, and facing the daunting task of achieving 580 or more points, a second-chance option will open up for 2007 when graduates of other disciplines can apply. The first 70 graduate-entry medical school places will be available then; this number will rise to 240 over following years. We do not know where the first of these graduate schools will be located, but it is expected the University of Limerick will tender for a graduate-only medical school, while existing undergraduate schools have also expressed an interest in expansion.
Yesterday's package is, of course, part of a wider health service reform agenda. The retention of medical graduates within our system is a significant problem. Graduate students are known to be well motivated and are more likely than undergraduate entrants to remain in medicine, so the move to a multi-stream entry system should help.
But the major loss of doctors in the Republic occurs during postgraduate specialist training. Many leave to pursue this training in the US, the UK and Europe, but never return to consultant posts here. The Buttimer report suggests a range of measures to enhance the quality and attractiveness of postgraduate training. It also promotes the development of research in the health sector, the dearth of which has been one of the reasons why medical graduates went abroad.
There is no reason why we cannot provide specialist training to a high standard in the State, in partnership with centres of excellence abroad. When these proposals are implemented, the days of medical emigration should largely be over.
Wider health reform has advocated a shift from a consultant led to a consultant provided service; the training reforms should help this come about. And the commitment to quality and oversight structures will be welcomed by patients, who need to know they are being treated by doctors who have been trained to a uniform standard. The reforms announced yesterday are well thought out and appear to have been adequately financed. When implemented, it should return the Republic to the upper echelons of international medical education.