Medical entry system failing patients and graduates

A leading consultant in emergency medicine has hit out at Ireland’s inability to keep medical graduates in the country, blaming a “fatuous” entry system.

Chris Luke, an A&E specialist based in Cork, described this problem as “the greatest threat” to the quality of care in emergency departments.

If more students were given the chance to study medicine, said Dr Luke, more of them would stay in the country after graduation, thus alleviating staffing problems at emergency departments.

“In spite of the well-publicised shortages of beds and other resources, I actually think the medical manpower situation is by far and away the greatest threat to the quality of care,” Dr Luke said on RTÉ Radio One’s Today with Sean O’Rourke.

“From my point of view, the strategic planning of medical manpower — recruitment, retention, training, development and so forth, has been so badly mismanaged as to be an ontological, an existential threat to our health service.”

Dr Luke, who was the director of postgraduate medical education in both Cork University Hospital and The Royal Liverpool University Hospital, has devoted many years to improving the prospects of medical graduates.

“I have written books and articles, I’ve developed courses, I’ve given hundreds of hours of my time freely over two decades to try to train and encourage medical graduates,” he said.

“My own daughter is approaching the end of her medical training.”

Dr Luke said it is time for the system to change.

“Is it fair to our patients that they can not be treated by a reliable supply of medical graduates given that we train in excess of 500 people in medicine in this country every year?” he asked.

“From the very beginning, from the fatuous points system, the CAO points system, the HPAT system, right the way through to appointments as consultants it seems we have managed to fail medical student, doctors, graduates and consultants all the way through.”

Now, Dr Luke is advocating major change in the way in which Ireland recruits medical students. He has suggested lowering the Leaving Cert points for medicine, asking prospective students to guarantee they will stay in the country for at least a year after graduation, and rowing back on the Human Professional Aptitude Test [HPAT].

“What we really need now is to establish a baseline of Leaving Certificate points,” said Dr Luke. “For example you might say 550 points, combined with a commitment to provide service as our basic criteria, rather than this other bizarre psychology testing which does not seem to have yielded the kind of doctors that we actually need.

“If somebody who wants desperately to be a medical student and doctor says ‘Look I’ve got my 550 points, and I will commit to you to give a year to the service’... just a year no more than that, a year to the service, to the health system, in return for say a waiving of 10 or 15 points for the Leaving Cert equivalent, or the HPAT itself, I think if that applied even to a small percentage of medical students we could staff our emergency departments adequately.”

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