Over-reliance on junior doctors
Sir, – While I’m not sure it has much to do with the current chaos in our emergency departments, the reliance of many hospitals on doctors who are neither consultants nor members of a specialist training programme is undeniable (“Reliance on junior doctors ‘a risk to patients’”, News, January 8th).
Many are excellent practitioners of course, and give good value to patients and, indeed, taxpayers. People who lack the rights of EU citizenship have little chance of accessing our training programmes, and so their status should not be interpreted as a professional criticism but rather as a consequence of EU employment legislation.
Occupational mobility is a major difficulty for such doctors, though. Their contracts are either six or 12 months in duration, and often depend on visas and work permits. The jobs they hold are classified as training posts, with the implicit logic that consultancy is the long-term objective. Given the requisite paperwork, rental markets in Ireland and basic common sense, many try to change job (and thus location) as rarely as possible. Once they are employed for over three years, though, legislation applies that allows them to take a contract of indefinite duration, so making this appointment permanent.
One then has the absurdity of someone appointed to a “training” post which will run until they reach retirement age. As many small units can barely recruit enough staff to function, they cannot reject a capable and familiar practitioner even where it may lead to this absurdity. Whether some trainees are “training” in any meaningful sense is thus debatable, nor are they necessarily in any sense “junior”. I’ve worked with many over the age of 50, for example.
It’s worth adding that this is the reality all year around, and certainly has been for more than a decade. It doesn’t alter or explain the predictable spikes in emergency department demand. These seasonal patterns perhaps relate more to the behaviour of microbes than medics. – Yours, etc,