A heavy workload but it's challenging

The most controversial issue in medicine is career structure, according to Dr Geoff Chadwick, director of UCD's centre for medical education. After college, graduates spend one year in an internship in a hospital. Then, the two main avenues are into general practice or a hospital-based career.

There are about 3,000 GPs in the country and the numbers taken into the three-year postgraduate training programme are reasonably well linked with manpower requirements, says Chadwick. The only reservation is that it can be difficult in larger cities to get a GMS list.

"The real problem with manpower is in the hospital sector," he says. "There are 3,500 doctors in all grades - about 1,100 are consultants while 2,500 are in training. Typically, it takes 10 to 11 years, after medical school, to be appointed to a consultancy.

"So, most consultants are appointed in their mid- to late30s . . . if there was to be a perfect balance there would be one trainee for every three consultants, whereas the ratio is one consultant for every 2.5 trainees."

Doctors in training posts are not permanent members of hospital staff and may have to move frequently. Typically, they may spend up to half their time in training abroad.

One-third of hospital posts are held by non-nationals, who are mainly in less desirable posts. In effect, they prop up the service. The 1993 Tierney report recommended a change in the balance between consultants and trainees and there has been an increase of about 100 new consultancy posts. However, says Chadwick, the number of junior doctors has also increased.

Advice for anyone contemplating a career in medicine? "It's still a challenging and rewarding career - there are very few unemployed doctors in Ireland. But, there are quite a few doctors in work they don't find satisfying. For every consultant you see in Ireland - and there are examples of consultants making a lot of money - there are at least a dozen doctors sitting in various countries around the world.

"If you want to do medicine, don't expect to spend the rest of your life in Ireland. I graduated in 1978 and there were 11 interns in the hospital. I'm the only one working in Ireland."

For the undeterred, Dr Philip Kearney, dean of NUI Galway's medical faculty, says that the curriculum is being revised throughout the country. Clinical skills are being introduced at an earlier stage.

Traditionally, students would first come in contact with patients about half-way through their six-year education. There has been some criticism of doctors' communication skills. Now, they come into contact with patients much earlier in their education and they also study communications and interview skills.

"This is not the curriculum that their brothers, sisters or parents did," says Kearney. "A new shape has been given to it but it's no less demanding."

In the past the clinical experience was almost entirely hospital-based. Now, medical schools have professors of general practice, he says. Students in NUI Galway also do an information technology course.

In common with the other medical schools, a substantial proportion of students in Galway are foreign. "That enhances the quality of life for the undergraduate students. They learn about new cultures." Students may also go abroad as volunteers to work in developing countries.

Kearney concludes: "Medical education is heavy but it's interesting. It's a challenge."