When all else fails, talk to them

Dr Garrett FitzGerald

Dr Garrett FitzGerald knows how to deal with the crisis of our departing doctors — ask our NCHDs what it will take to keep them at home, and make the changes to our failed system.

The young Irish doctors are legging it to foreign parts. The authorities are on safari in the subcontinent trying to ensnare the expensively-trained Indian and Pakistani juniors into unapproved-for-training cul-de-sacs in our peripheral hospitals — in order to keep them ticking over.

Meantime, our medical schools are producing a record crop of doctors from our brightest sons and daughters. There will be a severe acute shortage of doctors in our health system come mid-July.

You couldn’t make this up. I write outlandish, suspend-disbelief fiction. I have some respect, however, for my readers; you can only hold their attention if the matter is half-believable to the wackiest science-fantasy buff.

How deranged you have to be to write it is for a later unbelievable dissertation entitled ‘The Frontal Lobe Zone — where no man has gone before’.
I won’t bore you with the details of our young doctor migration. Frontline had a whole programme on it the other week. Barry O’Donnell wrote an excellent letter to The Irish Times. Dr Chris Luke, ‘dayanee’ man from ‘demercy’, in the same paper, also penned his own thoughts on the matter recently.

Missing from the discussion generally is the view of the doctors who are leaving. A young doc interviewed briefly on Frontline gave as the main reason the lack of a proper career structure in Ireland. Statistics which verify his viewpoint were quoted. Minister Reilly promised that he will move on the matter.

From the grapevine information, young doctors are leaving because their terms and conditions have seriously deteriorated in recent years, in line with the atmosphere of generalised hopelessness abroad in the community. Whatever about old geezers like me and many of my consultant colleagues, young bright people find no great attraction in doomsday scenarios.

Class of ’67
When my class of 1967 finished their final examinations, half of them were on the next planes out to the USA and Canada. They didn’t even wait for graduation on July 11th — ‘just send on the scroll to Texas, boss; here’s my last tenner’. Same applied to UCC, TCD and UCG. Most never came home. And nobody gave a shit, either!

It has been my experience that whenever cutbacks to hospital services were on the agenda, managers looked first at junior doctors as if they were entirely surplus to requirements.

It was generally the accepted atmosphere in admins that you couldn’t quite tell a consultant what to do, you probably had to be kind of equals with a nice registrar, but you should feel that you are ‘over’ a less senior doctor. Over generations, solemn agreements with junior doctors’ representative bodies were there for the breaking. You knew the consultants wouldn’t push out the boat for them, so you could do what you liked.

'They didn’t even wait for graduation on July 11th — ‘just send on the scroll to Texas, boss; here’s my last tenner’. Same applied to UCC, TCD and UCG. Most never came home. And nobody gave a shit, either!'

In recent years, attention has been drawn to the few senior-junior doctors who were making massive money on overtime. Tut-tut, you can’t have these guys in ENT in Fish-and-Chipsville Pretend Infirmary taking home such an overabundance of ducats.

The fact that he was on duty seven days and nights a week, and the service would collapse without him, didn’t enter into the equation; nor did the fact that his work was only half supervised and unapproved for professional training. The oldest Irish solution was best: bring the hoor down.

We now find ourselves in a conundrum from which there is only one way out. We have had waves of this staffing dysfunction for 40 years. There is a need to appoint more senior doctors and offer realistic career goals to the juniors.

If this means that services have to be centralised, so be it. The argument for the small hospital in this day and age of specialisation has been lost.

The day of the generalist (I am one) is over, except in the setting of the bigger hospital.

Leaving in droves
If we want to keep our doctors, we’ll have to do better. Calls to patriotism and pleas about the quality of training which we offer do not address the major reality; the doctors are leaving in droves. Nor indeed can we expect anything but derision from them when we suggest coercion — like telling them that, in payment for their education at the nation’s expense, they are to become bound-boys and indentured servant-girls for five to seven years. Everyone’s just itching to have a cut at them.

Perhaps, as a last resort, we should talk to them. Maybe it would do no harm if we asked them what it would take to keep them at home. Why would they fly to parts close to Van Diemen’s Land and away from their kin, perhaps permanently, rather than stay in our system?

Demeaning motives
The Irish like to live in Ireland ahead of any other country. Let’s be honest; they wouldn’t be getting out without good reason. Ascribing all sorts of demeaning motives and character attributes to them is at the very least unhelpful.

We must look at our failed system — it is ‘failed’ because we can’t hold on to our brightest young people. The young docs did not produce this system. A combination of entities did — political, administrative and medical.

When we come up with a better one — ideally with the help and advice of the young doctors — we can reverse the emigration. Maybe we should stop talking down to them and wish them happiness in their careers. Bon voyage.

Meantime, we owe an apology to the peoples of India and Pakistan for fecking their young doctors.