Secret Doctor: The brain drain in hospitals must be combatted to ensure excellent care

The Secret Doctor looks at the absurd in the mundane this week

Throughout the bustling corridors of hospitals, doctors form teams affiliated with various departments. In the Irish health system, fresh-faced doctors begin their journey as interns. This initiatory phase entails three-month rotations in different capacities. The intention behind this arrangement is to expose budding doctors to a diverse array of specialties that might capture their interest. From the emergency department to respiratory medicine, obstetrics/gynaecology to orthopaedic surgery, the options are vast.

I recall a tale relayed by a friend about her cardiology rotation. A gentleman arrived, anticipating a day procedure. My friend conducted the necessary consent process, but just as the man mentioned his need for a bathroom break, he was summoned to the procedure room. When contemplating whether he could withstand the urge, he asked about the duration of the impending intervention. The intern ventured a guesstimate: "It should take around 30-60 minutes." Alas, six long hours later, the poor man emerged, his bladder near bursting point, and sprinted towards the nearest toilet.

Completing an internship stands as a vital milestone in one's journey toward a flourishing medical career. Yet, it remains an arduous period, laden with high expectations of hard work and the continuous development of clinical skills. It is during this formative phase that one begins to provide an 'on-call' service, ensuring round-the-clock medical coverage within the hospital. Weekends and bank holidays often bring forth 12-hour day shifts, while night shifts tend to comprise five consecutive 12-hour shifts throughout the week...

As interns, we find ourselves responsible for delivering medical care to admitted patients. 

In the hospital where I work, four interns look after approximately 1,000 patients. An intriguing incident occurred during my tenure as an intern when I received an alert that several pigeons had infiltrated a hospital corridor through an open window. How was I expected to resolve this avian invasion? 

On-call shifts mirror the demands of day-to-day work, encompassing a broad spectrum of responsibilities. These can range from drawing blood samples, conducting acute assessments of unwell patients, implementing treatments, and promptly notifying senior staff if necessary. 

During a 24-hour shift as an intern, I was alerted that a patient had absconded from the hospital, traversing fields in a rural setting at the ungodly hour of 4am. The local authorities were summoned, but to my surprise, all eyes turned to me, as if expecting me to embark on a chase through the darkened countryside. 

Between on-call shifts, a metaphorical changing of the guard takes place, where outgoing interns rendezvous with incoming interns, engaging in a verbal handover of their shared responsibilities. Communication between ward staff and on-call interns persists through an antiquated bleep system. Each intern clings to their bleep, a relentless companion that steadily grates on their sanity as the shift progresses. Its incessant sound reverberates through their weary minds, haunting their dreams long after they depart the hospital's realm.

Ah, the college days, where learning about the intricacies of the Krebs cycle (an extremely complicated process where food molecules are converted into energy) proved futile in preparing us for the harsh realities of life as doctors. The art of stress management and work-life balance remained mere whispers in the winds of academia. Falling into the trap of superficial stress relief, I indulged in material possessions, embarked on elaborate vacations, and drowned my sorrows in excessive alcohol consumption alongside comrades. 

The intern year births a tight-knit network, a camaraderie forged through shared experiences and socialising.

In the Irish health system, this is the juncture where a well-worn exit strategy often comes into play. A considerable number of Irish-trained doctors head to the southern hemisphere, where Australia and New Zealand welcome them with open arms. The contrast is stark. I had the opportunity to work in a large public hospital in New Zealand, akin to the size of my current workplace. The demands of being on-call were less frequent, with an abundance of staff ensuring adequate coverage even in the face of unforeseen sick leave.

During my time in New Zealand, I discovered a refreshing concept. If I covered additional shifts, not only was there substantial financial compensation, but also genuine appreciation for my dedication. Each doctor was granted a number of 'mental health days'. These cherished days provided an opportunity to tend to life's mundane tasks and nurture one's overall well-being.

Such circumstances stand in stark contrast to certain jobs I've held in Ireland, where securing annual leave often required an arduous battle. In New Zealand, every doctor received a paid lunch — a simple gesture that spoke volumes about their commitment to their workforce. It's not a matter of everything being perfect there and everything being dreadful here. Irish-trained doctors are embraced in those far-off lands for our exceptional skill set, our competence, and our ability to excel in high-stress situations. Our training instills a pursuit of excellence. Yet, despite a delightful year in the Kiwi nation, I felt the pull to return home.

But an unsettling worry takes root within me. Throughout the past year, I crossed paths with a solitary intern who plans to stay in Ireland. Competent and well-trained interns are increasingly choosing to depart and not look back. In the hospital where I work, less than 10 individuals from my class of 180 are pursuing hospital-based medicine. The brain drain is a reality we must combat to ensure the sustained delivery of excellent care, both now and in the future.