Stop talent haemorrhage from medical system

The treatment of young doctors by the HSE is causing an escalating crisis, writes Colm Burke

THERE is an alarming exodus of young, talented doctors from Ireland which should concern us all. HSE figures indicate that 50% of non-consultant hospital doctors (NCHDs) are leaving the country.

At the same time an OECD study shows a dramatic increase in the number of non-Irish doctors working in Ireland. In 2010, according to the OECD report, 33.4% of all registered doctors here were non-Irish medical graduates.

The same study shows the number of non-EU doctors registered in Ireland increased from 972 in 2000 to 4,700 in 2010. This is equivalent to a quarter of all registered doctors. This is a dramatic change in the composition of the medical profession in a very short period of time.

There are issues surrounding the levels of training, language skills, and cultural factors in the employment of such a large number of non-EU trained doctors. There is also the bigger issue of Ireland taking doctors from countries which desperately need them, while we have in place a system which effectively forces hundred of young Irish doctors to emigrate.

Ireland’s pattern of international recruitment of medical personnel is in clear breach of the World Health Organisation (WHO) code of practice in this area.

Students entering medical schools are among the brightest and most hard working of their generation. They undertake a very rigorous training programme for five years in undergraduate school, or four years if they take the postgraduate stream. As a group they are highly motivated and show exceptionally high levels of dedication and application. They should be treated as a vital and critical resource by the Irish health system. Instead they are treated in a cavalier and careless fashion in their early years after graduation. The inevitable result is a determination by many young doctors to seek better career prospects abroad.

Each young doctor who leaves Ireland is of course a personal loss to their family and the wider society. There is also the loss of very valuable human capital.

It costs the State in the order of €150,000 for each medical student going through undergraduate medical school. In addition, family and personal costs involved in rearing and educating a person to become a doctor in their mid 20s must be of the order €250,000.

The total human capital invested in each young medical graduate is of the order of €400,000. For every 100 young doctors who emigrate there is a loss of human capital investment of €40m.

During the last 10 years, a clear pattern has emerged. Young NCHDs are emigrating in increasing numbers. During the same period, the HSE has massively increased its recruitment of non-Irish NCHDs.

This pattern may well pose a threat to the quality of care being provided in our health system. The WHO is very clear on what needs to be done. Its code of practice on the international recruitment of health personnel emphasises that countries should implement effective health workforce planning, education, training, and retention strategies to sustain a health workforce that is appropriate for the specific conditions of each country and to reduce the need to recruit migrant health personnel.

Ireland’s medical schools produce world class young doctors. Where the HSE fails abysmally is in work force planning, postgraduate training, and retention strategies. Young Irish doctors graduate with high ideals and strong ambitions. Studies indicate that within a very short period of time of entering the hospital system, many of them become disillusioned, unmotivated, and determined to emigrate.

There are real and serious concerns surrounding support and mentoring structures for NCHDs. Young doctors need and deserve high levels of support in the early years of their careers. There are issues regarding postgraduate training programmes and careers structures in the HSE.

Many young NCHDs have substantial grievances regarding the implementation of the EU working time directives and non-payment of hours worked.

Excessive on-call obligations, excessive overtime, which are a feature of NCHDs’ working lives, are unfair to them as well as being unhealthy and dangerous. A tired and over-worked NCHD is much more likely to make mistakes. In particular, the hospital contract system for NCHDs is a cause of justified resentment.

Offering highly qualified professionals six-month contracts, with no certainty as to where they might be working is demeaning. Young doctors deserve better.

At the end of their intern year, young hospital doctors should be offered a three-year contract.

In addition to fair pay and decent conditions of work, that contract should include training elements, rotation between hospitals, and ideally should also include a semester in an overseas hospital.

NCHDs rightly put great value on training and building their levels of expertise.

An overseas placement early in their career in well-run hospitals in other countries would be of enormous benefit to their professional development and would also enrich the Irish medical system through knowledge transfer.

The HSE and the Department of Health need to wake up and respond in a thoughtful and considered way to needs of young doctors. Every year the State continues to invest heavily in the training of medical students. Yet more than 50% of young doctors emigrate shortly after completing their intern year.

The medical profession is a global profession. People will leave unless they are treated fairly. Irish doctors are respected and are highly valued all over the world. The careless attitude of the Irish health system to our NCHDs is counter productive. We need to value them a great deal more.

Allowing Irish doctors to emigrate in increasing numbers and an ever growing reliance on foreign trained medical professionals in our hospital system is not conducive to good long-term health outcomes. We must stop the haemorrhaging of talent from the Irish medical system.

The HSE urgently needs a human resources policy clearly focused on the retention of young doctors in hospitals. Our health system will be the better for such a policy.

*Colm Burke is a Fine Gael senator and Seanad spokesman on health