Hospitals’ reliance on junior doctors a threat to patient safety – report

Doctors of “uncertain” professional ability and “limited” experience are being recruited to work in Irish hospitals while more experienced staff leave in massive numbers for jobs abroad, a major new report has warned.

The report says this “turnover effect”, generated through an over-reliance on junior doctors who are not training to be consultants, may compromise patient safety.

Without these doctors, most of whom are from outside the EU, many hospitals could not continue to provide 24/7 cover and other essential services, the report recently presented to the HSE board says.

However, the “ad hoc” way doctors are employed currently is not sustainable, and patient care is likely to be compromised if current trends continue, it warns. Spending on agency staff is also likely to increase further, and smaller hospitals will struggle to maintain existing service levels.

Over-reliance on junior doctors one of the factors behind trolley crisis

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Details of its findings come in a record week for overcrowding in hospital emergency departments, with 760 admitted patients waiting for beds on Tuesday, matching Monday’s unprecedented level.

Minister for Health Simon Harris said on Tuesday that more bed capacity was needed to alleviate the trolley crisis, as well as additional consultants and changes in work practice.

Working group

The new report was drawn up by a working group including clinical lead Prof Des Carney of the Mater Hospital and Prof Frank Murray, director of the HSE National Doctors Training and Planning (NDTP) service.

The report focuses on non-training scheme doctors, basically all junior doctors (non-consultant hospital doctors, or NCHDs) who are not on a training path to become a consultant. This group accounts for about half of all NCHDs, and up to 70 per cent in smaller hospitals – higher than in comparable countries such as Australia or the UK.

Almost 60 per cent of these doctors were trained outside the EU; 26 per cent alone studied medicine in Pakistan, and 16 per cent in Sudan.

Since 2014, the number of non-training scheme doctors in the Irish system has soared, from 900 to 2,724 last year, after the European Working Time Directive limited long working hours for doctors. Other factors behind the increase include the emigration of Irish junior doctors, difficulties recruiting and retaining medical staff and restrictions on trainee numbers.

"The two-tier consultant salary structure in Ireland, [and] attractive consultant and GP posts and training opportunities abroad with better working conditions are contributing factors," the report adds.

Many non-training scheme doctors are frustrated with their lack of a career path and difficulties accessing training opportunities. Often, non-EU doctors find their intern year and other prior experience is not recognised, and priority is given to candidates for training posts from EU states.

Lowest numbers

Ireland has the highest reliance on foreign-trained doctors in the EU, at 39 per cent, the NDTP report notes, but one of the lowest numbers of consultants internationally.

An earlier draft of the report warned hospitals could have to discontinue services due to a reliance on “transient” junior doctors, but these references have been dropped from the final version presented to the HSE board in November. It has been obtained by The Irish Times under the Freedom of Information Act.

A separate report by the group found 153 doctors who were not on the specialist register of the Medical Council were nonetheless being employed as consultants, as a result of recruitment and retention issues. Again, smaller hospitals were most affected.

The MacCraith report into medical training came out in 2014 and made 25 recommendations, including the development of career structures for NCHDs to be overseen by an implementation committee. When Mr Justice Peter Kelly and TDs raised issues around these doctors in May 2018, this committee wrote to the HSE asking for the position to be reviewed.

A project team was then set up to oversee the project, chaired by Prof Murray, then president of the Royal College of Physicians of Ireland and director of the NDTP.

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