Health reforms impossible due to workforce crisis, doctors warn

Any reform of the health system is simply impossible to put in place given the current medical workforce crisis, doctors have claimed.

The Irish Medical Organisation (IMO) told the Oireachtas health committee that reports and reform proposals "without significant and appropriate investment is actually making the situation worse, not better ".

The doctors’ trade union said “there can be no hope of either reforming the system or developing new and much needed service with the level of understaffing we have in the system”.

In an opening statement to the committee ahead of an appearance on Wednesday the IMO said: “More reports and promises of reform are not what the health service and our patients require, nor is it helpful to talk about ‘black holes’ in the health budget. The simple fact is that notwithstanding the spin around high levels of health spending the budget is insufficient to meet the needs of the population and it is time for politicians and policy makers to be honest about this. “

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The IMO said the expansion of the numbers covered by medical card or doctor visit cards should only be based on means or medical need and not on age .

“The long held tradition of successive Governments using medical cards as vote getting exercises must stop.”

It said that over 700 graduates entered basic specialist training each year in Ireland, however the country was "training are doctors for export".

It said since 2015 the number of voluntary withdrawals from the register has almost doubled from 828 to 1,453 in 2018.

The IMO said that on foot of a lower pay system for consultants appointed after October 2012, there were 500 vacant posts and over 100 non- specialist doctors working in specialist posts.

“Our own research suggests that two thirds of non-consultant hospital doctors perceive pay to be the primary reason for emigration and 83 per cent believe the pay disparity at consultant level will impact on their decision as to whether to apply for consultant posts in Ireland.

“Current disparities in pay between consultants employed pre and post-2012 rise to up to €50,000 a year for colleagues doing the same job and carrying the same level of responsibility.

Remunerated

“In terms of public health, Ireland differs from other English- speaking countries in that specialists in public health medicine are not remunerated on an equal basis to other consultant specialists within the health system, despite the fact that they are required to be on the specialist register and must undergo specialist training.”

The IMO said that the development of general practice was the cornerstone of many reform proposals including Sláintecare. However, it said that GPs had until recently been left to shoulder the burden of reduced funding while delivering a greater level of service.

“There is no clear strategy or funding for the development of general practice.”

“Our GP workforce is also emigrating. A survey by the ICGP of GP trainees and graduates in 2017 reveals that one- in- five recently qualified GPs have already emigrated while a further 30 per cent of newly-qualified GPs are considering emigration.”

The IMO told the committee that the Government must end the tow-tier pay system for consultants and invest in the capacity and supports within general practice.

“The training of doctors must be modernised reflecting changes in the practice of medicine and the changing demographics of doctors in training. This requires initiatives to consider the duration of training to bring arrangements in line with international norms.”