herald

Sunday 23 September 2018

Crazy system pushes our junior doctors to the limit

Young doctors are at the moment leaving Ireland in large numbers. We have gone from a position where, in my experience, we could have 20, 30 or more applicants for each job in our emergency departments to a situation where we have unfilled posts and are trawling the subcontinent of India and Pakistan for recruits to our major hospitals and other emergency departments.

There are probably many reasons for this -- but pay and conditions probably predominate at the moment.

Young doctors in emergency departments in Ireland, almost without exception are working European Working Time Directive (EWTD) compliant rosters and yet they are still leaving. I know from talking to junior doctors who have returned from other jurisdictions that the pressures of work they face in other countries such as Australia, New Zealand and the UK, are far less than the type of experience available in Ireland.

For example, a junior doctor recently completed a one-month locum in the smallest emergency department in Cork and told me that she had experienced higher work pressure and was far busier than when she worked in the largest emergency department in Brisbane, Australia.

The difficulties with overcrowding in emergency departments in Ireland are well documented. We have also insisted on maintaining a crazy situation where medical services in all specialities are delivered by our junior staff because we have refused repeatedly to increase the number of specialists. For example, a typical Australian emergency department seeing about 50,000 patients a year (the same size as Cork University Hospital) will have something in the region of 30 to 40 junior doctors and 16 to 20 specialists. Cork University Hospital has 2.4 specialists and 17 junior doctors.

There are of course other reasons relating to training structures and pay rates and so forth. We've had many reports and recommendations over many years and for one reason or another have ignored the conclusions and recommendations. I think it's probably time that we dusted off a few of these and thought about implementing recommendations that we said we would more than a decade ago.

Stephen Cusack (above) is the Professor of Emergency Medicine and a Consultant in Emergency Medicine in UCC and Cork University Hospital

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