Madam, – Dr Chris Luke’s assertion that a chaotic medical manpower planning process exists within our nation is entirely correct. All doctors agree that a serious manpower crisis is looming this July, jeopardising hospital services, particularly as a result of the failure of rural emergency departments to recruit NCHDs (non-consultant hospital doctors).
However, Dr Luke has avoided any attempt to address the cause of the “NCHD shortage”. We cannot get sustainable change by merely massaging a resulting symptom, as he has offered.
Dr Luke fails to acknowledge that we have a massive over-reliance on NCHDs in this health service. There is a pseudo-manpower crisis that has been caused by a failure to implement expert group reports on medical manpower staffing over the past 20 years (Tierney 1993, Hanly 2003).
The three main causes for this over-reliance on NCHDs are: 1. Ireland has far too few consultants and GPs, per capita, compared to the other OECD nations, causing an artificial swelling of NCHD numbers to plug this service gap. NCHD numbers have accordingly swollen to 4,600 in 2008, compared to our 2,400 hospital consultants; we have amongst the highest NCHD to consultant ratios in the world. 2. Irish NCHDs perform bizarre, inappropriate working roles for a modern healthcare service (portering X-rays, portering bloods, administering medication, etc), which are unique to this nation. Where is the promised information technology? Where are the nurse practitioners? 3. The politically unpopular, but absolutely necessary, reforms in acute hospital care were deliberately avoided over the past 20 years by successive governments, preventing any possibility to achieve European Working Time Directive compliance in our smaller hospitals, resulting in the illegal, excessive working hours of NCHDs, which again are unique to this nation.
Accordingly our hospitals are entirely dependent on NCHDs and in July 2011 we are met with an embarrassing struggle to import 300-400 Indian and Pakistani NCHDs to cure our pseudo-manpower crisis; to staff our emergency departments and hospitals wards.
The goal of postgraduate medical training must be both expedient and excellent training, paralleled with providing professional patient care and service. The majority of NCHDs in Ireland receive neither expediency nor excellency in their training. However, NCHDs universally give plenty of service, being the backbone of our hospital system. NCHDs endure the longest training times in the western world and those NCHDs who cannot get on training schemes (the numbers of which are legion) must reluctantly leave Ireland to receive this appropriate training.
Understandably NCHDs are demoralised, frustrated and disenchanted. Dr Luke is correct, many NCHDs will emigrate after years battling a system which is epitomised by a lack of training opportunities, a lack of future job prospects, unworkable terms and conditions and extreme family sacrifices.
Dr Luke’s well-meaning, but overly simplistic, solution of indentured service is coercive, punitive and will do nothing to address this complex problem.
Ireland must match the vision of the healthcare service we desire with an appropriate capacity planning of Irish doctors; channelling medical school entry, through the layers of postgraduate training, through to the offering of a specialist position, without numerical bottlenecks, to give the Irish public the the healthcare they deserve. Only when such a joined-up, sustainable process is created will the ongoing problem of NCHD recruitment be solved. – Is mise,