Three consultants forced to emigrate every month, IHCA conference told

‘Brain drain’ caused by poor work conditions, lower pay and budget cuts

Ian Carter, the HSE’s director of acute services: warned of further dysfunction if the Government kept taking money out of the system. Photograph: Dave Meehan.

Ian Carter, the HSE’s director of acute services: warned of further dysfunction if the Government kept taking money out of the system. Photograph: Dave Meehan.


Hospital consultants are emigrating at the rate of three a month because of deteriorating working conditions, lower pay and “unrelenting” budget cuts, their annual conference has heard.

The Irish Hospital Consultants’ Association warned at the weekend of a “brain drain” forcing some of the country’s best consultants to leave the country and seek work overseas.

Younger consultants have as little as half an hour a fortnight of operating theatre time because of a lack of beds, nurses and anaesthetists, the conference also heard.

Vacant posts
Doctors often go overseas when training to improve their skills but the IHCA says it is virtually unprecedented for mid-career senior consultants with positions in Irish hospitals to emigrate again, as they are now. One in five consultant posts in the public system are either vacant or filled on a temporary basis.

Speaking at the conference in Maynooth, Co Kildare, IHCA president Denis Evoy said the continued degradation of consultants’ working conditions and contracts was changing the medical landscape in Ireland and creating a system that cannot cater for its patients.

“Ireland’s health service is being run with a focus on the implementation of declining annual budget rather than encouraging excellence across the system and making patients the priority.”

Mr Evoy said as Ireland competed globally for medical staff it could not recruit and retain the most talented doctors and consultants. “The brightest and best graduates, having finished prestigious fellowships, are accepting well-resourced and well-remunerated posts in America, Australia and New Zealand. The prolonged expectation of the HSE that consultants will endure declining working conditions, uncompetitive contracts and systems failures that result in compromised patient care cannot continue. The inability to appoint permanent consultants with appropriate contracts is impacting on patients directly through growing waiting lists, longer waiting times and cancellations of elective surgery.”

The system was dealing with an additional 230,000 patients a year while budgets were about 25 per cent lower, he pointed out. Frontline staff could not continue delivering the services expected of them while maintaining “acceptable” levels of patient care.

Closures needed
He suggested a “re-alignment” of resources, to include the closure at night of half the country’s 28 24-hour emergency departments. He acknowledged the proposal was politically controversial but added that “we just can’t go on” staffing emergency departments in close proximity to each other. Kilkenny and Waterford, which both have 24-hour facilities, are just 20 minutes apart, while Loughlinstown was six miles away from St Vincent’s in Dublin.

The consolidation of cancer care into eight centres from an original 31 had greatly improved outcomes for patients, he pointed out.

Prof Paddy Broe, president of the Royal College of Surgeons in Ireland, said many consultants were spending long hours doing non-medical work while others struggled to get even half a day of operating time each week. Young surgeons risked becoming deskilled, and the system risked them becoming disaffected if left idle. He said the college had changed its training system after noticing a fall in the number and quality of applicants to study surgery, and an increase in the dropout rate.

HSE national director of acute hospitals Ian Carter warned of further dysfunction if the Government kept taking money out of the system. He said the premise put forward by the Department of Public Expenditure that the health services were inherently inefficient had to be challenged. Mr Carter said the budget had been cut by 22 per cent since 2008 and much cutting had been crude, for purely fiscal reasons.