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August 20, 2014

More thoughts on SHO and Registrar training

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Dr Mick Molloy says the recently published audit on SHO and Registrar posts throws up some very interesting questions for doctors and the HSE.
Last week I wrote about the recently published Audit of SHO and Registrar Posts — May 2008. The report published data for SHO and Registrar posts together, in tabular and graphical form for Anaesthesia, Emergency Medicine, General Medicine, Obstetrics and Gynaecology, Paediatrics, Pathology, Radiology and Surgery and in a separate section, data on psychiatry.


In the general information, General Medicine had the largest number of SHOs and registrars with 1087, of which 164 were not approved for training. The figures for surgery were 725, of which 207 were not recognised for training and close to my own home, Emergency Medicine (366 posts with 139 not approved for training), a significant number.
h4. Interesting results
There were some very interesting results with respect to radiology, which had only four posts, three registrars and one SHO, all of which were unrecognised for training. The reason this is so interesting is that radiology is a service specialty where the workload predominantly depends on the other specialties.
Historically, when there have been service deficits in Ireland, hospitals have responded by throwing registrars at the problem. This has not happened in radiology, indicating that there has been very good protection of the training component of SPR posts in radiology. It could also mean that there has been an unhealthy workload piled on radiologists over the last two decades without a concomitant increase in the number of radiologists, depsite us entering a highly technological age with respect to diagnostics, but that is for another day.
Of the 3,016 active posts, identified questionnaires were given to occupants and also face-to-face interviews were organised with varying degrees of success. There was a 76 per cent response rate to the questionnaire, with further details being obtained on core data from the various medical manpower managers.
The nationality of those occupying posts is presented cumulatively and separately for SHO and registrars, which throws up some interesting facts — I think I will have to stop using that phrase. Of SHO posts, 46 per cent were occupied by Irish nationals, with Pakistanis, Sudanese, Malayisans and Nigerians the next highest nationalities.
With respect to Registrars, 33 per cent were occupied by Irish nationals, 19 per cent occupied by Pakistanis, 11 per cent Sudanese and other nationalities accounted for less than 10 per cent each. One emerging trend is the number of doctors in Ireland now coming from other EU states.
Up to seven per cent of doctors came from other EU countries such as the UK, Poland, Slovakia and Germany. When I was an SHO it was rare to have a UK graduate working as an NCHD in Ireland and I only remember meeting two German NCHDs in my early years and none from any other EU country. Are we suddenly becoming more attractive as a training destination or is the value of being paid in euro at a local rate a big draw for doctors from Eastern Europe?
At SHO level there are more doctors who are graduates of Irish medical schools working here than there are Irish nationals, meaning a percentage of the Non-EU graduates of Irish medical schools have decided to remain in Ireland — at least for the early years of their post-graduate training.
That is a good thing for us at the moment, as we have not paid to educate them and they have supported our own educational institutions, but may be a bad thing for the countries which have sponsored their training to date and which would ordinarily have expected to have a doctor return to their country at this stage.
h4. More Irish nationals
At Registrar level the opposite is the case, there are more Irish nationals working as Registrars than there are graduates of Irish medical schools, as identified by the audit, meaning a significant number of Non-EU nationals have now become nationalised Irish, laid down roots and plan to stay here in the long-term.
One would expect the age profile of SHOs and Registrars to be pretty similar if there was a standardised career progression of two to four years being spent at SHO level, but here there are large numbers of individuals in their 30s, some in their 40s and a few even in their 50s acting as SHOs up and down the country.
There seemed even to be a doctor who was 60 years of age acting as an SHO which seems at odds with the concept of a training post. The age range was from 23 to 60 with a mean of 30. The Registrar grade had a wide dispersion in age, with a range from 24 (which seems a little young) to 62 with a mean of 38. Interestingly this mean was the average age of consultant appointments in Ireland also over the last few years.
What is clear is that there is a significant body of experience at both SHO and Registrar level in Ireland which may not currently be used to the maximum of its potential considering that 14 per cent of doctors at these grades had between 10-14 years post-graduate experience and 20 per cent had more than 15 years.
One particularly worrying point in all of this is that many of these doctors believe they occupy a training post which can be used to accumulate training credit at some point, but are wrong in their assumptions. Of the 664 posts not recognised for training, 232 occupants believed their post was approved for training, 182 knew it wasn’t and 187 did not answer the question. I am surprised by this considering that one of the recommendations of the Hanly Report a number of years ago was that all posts, when being advertised, should clearly state whether it is recognised for training. One wonders is there false advertising of posts going on here.