Sir, – In the article “New grade for consultants aims to keep doctors here” (Martin Wall, HEALTHplus, July 31st) the proposals for a new grade give the erroneous impression that the grade would be good for patients, healthcare and medical manpower. This is not so. I would like to put on record the view of the Irish Institute of Trauma Orthopaedic Surgery that this suggested new position has no part to play in the provision of trauma and orthopaedic surgery nationally.
We recognise that we are deficient in the number of orthopaedic surgeons we have in Ireland. We have the lowest orthopaedic consultant to patient ratio in the western world. We have previously submitted a manpower document to the HSE and the Department of Health.
We are satisfied that the standards that our consultants have achieved would stand up to scrutiny by any international body. The answer to our manpower problem is not to appoint inadequately trained surgeons who will lower the standard of care to our patients.
We run a very structured and supervised training programme that allows our specialist registrars exit the six-year scheme with competencies in the broad generality of our specialty. It has been our practice, for more than 20 years, to encourage our trainees to do one, or more often two, year-long fellowships abroad in centres of excellence. This allows them sub-specialise and bring home current concepts of treatment that provide our patients with an internationally recognised high standard of care.
Two major adverse consequences are anticipated if the proposed Level 1 consultant is introduced in Trauma Orthopaedics. First, the trainees in whom we have invested six years of specialised training will be reluctant to return home to positions they feel are below their level of expertise. The ultimate effect is that they will be driven into staying abroad in order to practice at the level to which they have been trained or they will return to Ireland only to go into private practice. Second, if less well trained orthopaedic surgeons are appointed as Level 1 consultants they will never graduate to Level 2 consultants because these posts, if they become available, will go to their better trained colleagues who have completed international fellowships.
These doctors do not deserve the title consultant as that would be misleading to the public, who would be under the impression that their care is being provided by the best trained doctors available. By definition this is untrue.
There may be a role for Level 1 consultants in non-procedure based specialties where the highest standards of training may not be essential to provide adequate care.
We are proud of the level of training that our trauma orthopaedic surgeons have achieved by the time they are currently appointed consultants. We should not lower our standards to allow less well trained doctors look after our patients. – Yours, etc,