HEART BEAT:Many young graduates are seeking their careers elsewhere
THERE IS likely to be a shortage of non-consultant hospital doctors (NCHDs) this year. Many reasons are suggested. Pay and conditions for the group are worse. The European Working Time Directive is making training uncertain. Overseas NCHDs are finding increasing regulation and worsening conditions make Ireland a less welcoming and less attractive place to learn and work. I won’t even mention the crass imbecility of the diktat that requires two NCHD jobs to be suppressed for each consultant post created.
Many young Irish graduates are expressing their opinion of our current service by seeking their careers elsewhere. The HSE does not anticipate reductions in patient services as a consequence. This should not be a surprise, since the HSE apparently does not believe we need beds to treat the sick either. As long as we have enough well-paid administrators everything will be all right.
There is nothing new about Irish doctors emigrating. Over the years many left, some to make their lives in different lands, others to acquire skills to bring back to Ireland. Indeed, it is one of the great strengths of Irish medicine that so many of the consultants have studied and worked abroad. I would go further and suggest that such overseas training, and subsequent pollination of our own service, is highly desirable. New ideas and treatments coming from the best centres in the world prevent stagnation and parochialism and allow doctors offer the best outcomes to our patients.
For many doctors this involved several moves to centres in different countries. This was not easy, particularly for those married with families. That was the way it was – you just got on with it. There was no financial incentive, and work occupied all the hours God sent. You knew why you were there and you worked accordingly. Your Irish predecessors were willing and hard working, and you were the beneficiary. The contacts and friends you met made life easier for those who followed you.
I am at or about the anniversary of my own initial exile, when I left the cocoon of the Mater Hospital for further training. The world of cardiac surgery was changing by the day, with advances tumbling over each other with breathtaking speed. It was an inspiring time to be involved in cardiac surgery and I wanted a piece of the action. There was no certainty that I would return to Ireland. I hoped I might, but there were no guarantees. You knew a lot depended on how you acquitted yourself in your new posts. You knew also that any written references you might acquire were only paper. What counted was what your new chiefs said to your old chiefs about your abilities, your commitment and your part in their team.
Thus it was that on a January day of that year, I was informed that there would be a registrar post for me in the cardiac surgical unit of the Queen Elizabeth Medical Centre in Edgbaston in Birmingham. This was due to start in a fortnight. The logistics were mine and logistic difficulties there were. The HA, then working in anaesthetics in the Mater, was due to give birth to our first, imminently. However, God stepped in and our first son was duly delivered by the late Prof Eamon de Valera, two days prior to my departure. I was tasked by the HA with getting suitable accommodation ready for our little family. I also had the problem of integrating myself into a new service and starting work.
The early bit was easy enough. I arrived at the hospital, having driven from Holyhead, completed whatever formalities there were and was given temporary accommodation in the doctors’ residency. The following morning I presented myself for work with my new team. Prof AL D’Abreu was nominally the head of the unit, but in fact the lead surgeon was Mr Leon Abrams or “Abe”. He was a great, innovative, hard-working surgeon, nothing was too much trouble and no effort was spared for his patients. He expected the same commitment from all his staff and this was readily given.
That was how I started to work in the NHS and the start of our personal exile. It was easy for me, immediately absorbed into a surgical team with all the usual humour and medical camaraderie. The HA, knowing almost nobody in Birmingham, was due to arrive with new baby, and I was expected to have a palace prepared. That’s the next story.
mneligan@irishtimes.com