Minister pledges new grade of hospital doctor by end of year

MINISTER FOR Health James Reilly has pledged to establish a new grade of hospital doctor by the end of the year to fill the vacuum between junior doctors and consultants.

Dr Reilly admitted there was a problem in relation to “the lack of a career path” when it came to non-consultant hospital doctors (NCHDs) that prompted many to leave the system when they finish training.

The Minister said he wanted to avoid a situation, which had arisen in other countries, whereby the sector became “a sort of graveyard” for those who failed to make consultancy grade.

Dr Reilly said his department planned to establish a new grade of hospital doctor, similar to that in the UK, which could deliver routine and emergency care under the supervision of a consultant.

“I want to send a message to those NCHDs who are coming to the end of their specialist training that we will have a new grade by the end of this year so that they shouldn’t look to leave immediately as there will be opportunities,” he told RTÉ’s Morning Ireland.

Dr Mark Murphy, chairman of the Irish Medical Organisation’s NCHD committee, said, however, that it was hard to comment on the merits of the proposed grade when the specifics were still unclear.

Nevertheless, he said the public health system was overly reliant on NCHDs for the day-to-day operation of the health service, and many of their roles needed to be shifted on to other healthcare professionals as part of a wider reconfiguration.

“Equally, the majority of NCHDs who wish to pursue a career as a hospital consultant will never end up working in Ireland.”

Faced with such a bleak future, Dr Murphy said, many NCHDs were opting earlier in their careers to emigrate to countries which provided better opportunities and where they worked less hours.

Dr Reilly admitted that the long hours frequently worked by NCHDs, often in contravention of the EU’s working time directive, was “wrong” and that his department was working to address the issue.

The Government was recently forced to inform the European Commission that it was not in a position to comply with the rules governing the amount of hours junior doctors worked given the pressure on the system.

The commission had put the Government on notice that doctors in Irish hospitals were potentially putting patients at risk by working in excess of the 48-hour maximum allowed, and in some cases worked in excess of 70 hours.

While admitting it was not ideal to have NCHDs working such long hours, Dr Reilly described the work practices in some public hospitals as “archaic”.

“I was astonished that interns are still sent scurrying around hospitals as messengers looking for X-ray reports and this and that and the other,” he said.

“This is not the sort of work that’s appropriate for someone you’re paying €36,000 or €40,000 a year to.”

Why i am leaving Ireland: A non-consultant doctor speaks

AFTER SIX years working as non-consultant hospital doctor in the Irish public health system, Dr Toby Gilbert is emigrating to Australia today to take up a post in Royal Adelaide Hospital.

After completing his initial training in the Mater hospital in Dublin, he spent two years as a senior house officer in Beaumont Hospital.

He has spent the last year and a half as a registrar at St Vincent’s hospital in Dublin.

“I’m training as a nephrologist – kidney specialist – but currently there are about five times as many people coming off the higher specialist training scheme than there are consultant posts available.

“I think if you look at the consultants that get posts in Ireland the vast majority have been away at some stage.

“So I suppose I’m partly leaving because it’s going to be a good experience professionally which will hopefully broaden my horizons and my CV but I’m also leaving because my work-life balance is going to be better. The longest shift you’re going to be forced to do in Australia will be no longer than 12 hours.

“During my time in the Irish system, I frequently worked shifts in excess of 24 hours and my working week consistently averaged out at about 65 hours.

“If you’ve been on your feet and awake for more than 24 hours you’re considered not fit to drive and yet they expect you to practise medicine.

“In most other countries, they’ve got rid of this ancient, archaic system where doctors are expected to work after being up all night.

“The formal training or teaching I received during my time in the Irish system amounted to about two hours a week which contrasts sharply with my peers in the US who are getting several hours a day.

“What you have in Ireland is a pseudo manpower crisis. If you had the doctors working more effectively, namely diagnosing and treating patients, instead of getting tied up in paperwork or routine procedures on the ward, the system would not be in such a crisis.

“Much of my time in Irish hospitals was spent doing paperwork or performing minor procedures on the ward; everything from routine phlebotomies [drawing blood] to putting in intravenous cannulas which are performed by different health grades in other countries.

“I expect practising medicine in other countries will be a much more fulfilling experience.”