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September 2, 2014

Turn and face the changeover

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Dr Mick Molloy

While the looming NCHD changeover has put our manpower crisis in sharp relief, Dr Mick Molloy points out that the ‘emergency’ has been coming down the tracks for more than 20 years.

The time of the great migration is here again, if delayed slightly to the new date of July 11. This reference date is known well in advance, as is the number of contracts changing over.

What is not known is how many people are willing to take up these contracts again. And this year, just days before the changeover date, many hospitals do not know if they will have sufficient NCHD staff to ensure 24-hour services will be maintained.

This is not a new phenomenon. Indeed, for the past five years the system has been lurching towards the point where hospitals will have to curtail services, simply because the system cannot recruit one small group of staff representing, in most hospitals, less than 5 per cent of the workforce.

The reason this does not happen with other grades is multifactorial, but predominantly it is that all other grades are on permanent and not temporary contracts. Furthermore, there is no single date of expiration for the minority of other healthcare staff who are on temporary contracts.

This problem has been coming down the tracks for more than 20 years — and yet it is being heralded as a surprise. The only surprise really should be why this has not happened before.

NCHDs from abroad
Twenty years ago, when the hours of NCHDs were supposed to be limited to 65, a number of additional NCHD posts were created which could not be filled internally, and thus began the significant recruitment of doctors from India, Pakistan, Egypt, Sudan and elsewhere.

Reports from these doctors about Ireland must have been good because many more followed this initial group. Many came without any job offer and took up ‘positions’ in hospitals as ‘supernumerary’ doctors.

These were a group of doctors who did not get paid but who did everyday, routine work in hospitals and filled in when their employed colleagues went on holidays, thus gaining very short periods of paid employment.

‘How many people are willing to take up these contracts again?’

As the number of NCHD posts increased over the past 20 years, so did the number of doctors who came to work here from abroad. This should, of itself, have been flagged up as an issue. Despite an almost doubling of NCHD employment numbers, there has not been a similar increase in the number or percentage of Irish graduates who occupy those posts.

Historically, we have trained medical students in Ireland to a cap imposed by the Government. Those students, upon graduation, faced a situation where there were not enough intern positions for all of them to secure the employment experience required to gain full registration, so a considerable number emigrated.

Working conditions
Those émigrés fed back to their college friends back home about their experiences abroad, the opportunities available, linear promotional career prospects, lifestyle… oh, and not to forget the working conditions and training provided.

Thus, the newly-educated Irish medical students have been receiving far more positive reports from their colleagues about working abroad than they have from those working in Ireland. This must obviously influence their career choices.

One other issue is the concept of a gap year, where individuals choose to travel the world upon graduation, working possibly in Australia/New Zealand in short-term locum posts to fund their travels as they go.

Quite a number have enjoyed their experiences doing just this and have acted almost as recruitment agents for the hospitals they have worked in, getting more Irish graduates to come to Australia.

We are now educating far more medical students than ever before and yet they are emigrating at earlier stages than would have happened historically. We really need to know why these graduates do not want to work in Ireland.

While a lot of time and effort has been put into trips abroad to try to urgently recruit doctors to fill the gaps for this July, I am unaware of any trips that have been made to our universities or our hospitals to discuss options with students or NCHDs regarding why they do not see themselves working in Ireland, what could be done to retain them in their posts, and encourage them to remain longer in the Irish health service.

Unless this is done, we are at the mercy of international recruitment and the whims of doctors in other countries who may not see Ireland as attractive as it once was — a country in recession where the working conditions are not as good as in our near neighbour, the UK.

Maybe July 12 will be a whole new dawn for the Republic this year, some 323 years after the last momentous ‘Twelfth’.