Time abroad needed for senior posts?

IN THE PAST five years, according to Dr Doiminic O Brannagain, chairman of the IMO's committee on junior hospital doctors, not one single specialist (consultant) has been appointed in the Republic who had not undertaken some of their training abroad.

"That is outrageous," he says. "There is no other profession where you cannot start and finish your training in your own state."

The perception is created that without foreign training a doctor cannot advance in Irish medicine, he says.

Part of the problem is that there are not enough specialist or consultant posts in Irish hospitals. The Tierney report on medical manpower in hospitals published in 1993, recommends that we should have more consultants and fewer junior doctors working in hospitals.

It recommended an increase of 350 in the number of consultants, this to be phased in by the year 2003. There would be fewer junior doctors, but the consultants would have have to undertake more of the tasks performed by non consultant doctors at the moment.

For patients, what this would mean is greater ease of access to consultants and less dependence on junior doctors to provide them with specialist services.

The Tierney report was commissioned by the Department of Health, Comhairle na nOispideal and the Postgraduate Medical and Dental Board. Representatives of these three groups, of the Higher Education Authority and other medical/educational bodies have been invited to a conference in Limerick this week to discuss its recommendations.

According to the Minister for Health, "The issues raised by the Tierney report need to be addressed as a matter of urgency... there are obvious and serious manpower problems ... The provision of the bulk of hospital care by doctors in training cannot continue."

Given this context it is hardly surprising that Irish medical graduates are so reluctant to take up junior hospital doctor posts at home. Over one third of all non consultant hospital doctor posts in the State are filled by non nationals, according to a survey of the Postgraduate Medical and Dental Board.

At any one time roughly 800 non national doctors - mostly Indians and Pakastani - are working in Irish hospitals. In the Midland and North Eastern Health Board areas, some 80 per cent of all non consultant hospital doctors are non nationals.

"Irish graduates perceive that the people who have the influence are in the large training hospitals in the cities, they feel they will get nowhere if they take up posts in small local hospitals," O Brannagain says. "In fact, small hospitals can provide very good training, but they need to be involved in a more structured programmes with longer term contracts covering a number of hospitals tied in with the training hospitals. It has been done in psychiatry, for example.

"If the structure is there, young Irish doctors will take up the posts. Most of us do.not want to emigrate, to uproot ourselves - we would prefer to train at home. Why do we have to export our doctors for training?"