A request to hospitals that doctors in training should no longer assess patients in emergency departments for admission has been described as “threatening” and “tone deaf” by hospital consultants.
The Institute of Medicine in the Royal College of Physicians of Ireland (RCPI), which oversees medical training, wrote to hospitals on March 13.
The letter says emergency patients are being referred to trainees for evaluation, without first being reviewed by ED doctors. The RCPI urged hospitals to stop this, saying otherwise they are “at risk of having their status as BST (basic specialist training) training sites removed”.
Responding to queries, an RCPI spokeswoman said of the 560 doctors on this scheme: “They do not assess patients for admission in the ED. As the letter states, this practice may initially have arisen as part of the response to the covid pandemic.”
The Irish Association of Emergency Medicine (IAEM) described the letter as “threatening” and said it is “inappropriate from a patient care perspective” at this time.
“This tone-deaf circular comes at a time of unremitting, unprecedented demand, manifested as excessive wait times to be seen by a doctor for patients presenting to our hospitals with an emergency or urgent medical problem,” said IAEM.
It said changes to how patients are assessed were also brought in to address overcrowding this winter. The number of patients was such that the “traditional pathway” was overwhelmed and people could not be seen quickly, said IAEM.
Under advice also from HSE chief clinical officer Dr Colm Henry, IAEM said patients can be sent to acute medical assessment units or on-call teams for assessment.
“Unfortunately, it would seem that RCPI has very inappropriately targeted these important patient-centred patient safety developments in their threats to hospitals of withdrawing medical trainees,” said IAEM.
“It must be remembered that such trainees and training programmes are actually funded through the HSE by the taxpayer.”
Meanwhile, a group of 214 locum doctors have written to the HSE and Government calling for reform of “outdated” salary and working conditions.
Locums work on temporary contracts and can work across a hospital from interns to consultants' roles, and can work as GPs.
In the letter, the group Train Us For Ireland said: “Immediate reforms of current locum policies are needed to attract healthcare workers and restore stability to the system.”
The letter says that “locum services are the backbone of the health system” filling gaps among permanent staff.
“Locum work provides flexibility and financial stability to healthcare workers. On the other hand, it provides emergency and immediate relief to the system where inadequate staffing has been a long ongoing issue,” said the group, explaining that a number of challenges exist.
“There are restrictions on who can do locum work, scales are outdated, rates are low (not linked with current inflation levels), and travel expenses cannot be claimed.
Revision of hourly rates in line with inflation, travel expenses, and expansion of pay scales to recognise experience among other reforms are needed, said the group.