Barriers to retaining medical staff


Sir, – As a solicitor, Roger Murray is understandably concerned with the question of why the health service repeatedly recruits dangerous medics (“Why does the HSE continue hiring such bad doctors?”, Opinion & Analysis, December 16th).

But as a consultant preoccupied with patient care at the “sharp end” of hospitals for many years, I pose an even more pressing question: why is it so hard to recruit doctors of any sort to look after our citizens? And why are we so desperate that we must continuously “lower the bar” when it comes to assessing candidates’ qualifications for a post?

Surely the stark mismatch between the numbers of graduates who leave our medical schools annually and the gaping holes in the medical workforce at all levels partly explain the troubling stories that regularly emerge from the Medical Council building?

Some of us have been berated for suggesting “obligatory” return-of-service by the hundreds of fine young doctors that we train.

But as part of the solution to “quality control” of medical practice in this country, starting with the trainees, I continue to recommend some sort of “incentive” scheme involving a waiver of the Hpat (health professional aptitude test) for entrants to medical school here who commit to a stint in the health service as a graduate for a period of, say, six months; or a financial arrangement in the costs of medical schooling with the same provisos.

Naysayers among my (usually younger) colleagues point to “unattractive” terms and conditions within the health service.

I am better acquainted than most with these admittedly real reasons for the difficulties in recruitment and retention, and these fundamental causes must be urgently remedied, but I look to the growing stream of superb Irish doctors now returning to work in our hospitals from such places as Budapest and Prague, where they sought the medical training denied to them here by an ill-conceived and primarily political hurdle, the Hpat.

Their passionate vocation and determination to overcome homesickness and the other challenges of training in a foreign language are a wonderful tonic, and they represent an invaluable cohort of excellent indigenous medics willing to staff our struggling emergency departments, for a start, and then press on to become first-class consultants and general practitioners, etc.

The dangers of hospital bed shortages are now obvious. It is beyond time that we recognise that the hazards of “ideological” medical recruitment and indifference to retention are just as great. – Yours, etc,


Consultant in

Emergency Medicine,

Mercy University Hospital,