We have long known that we were not producing enough doctors for our own needs
13 March 2006
Various people have described the Fottrell report on Medical Education as "timely". I incline towards the view that we needed it at least two decades ago. The 1979 cap on medical school places for E.U. students at 305 was purely for financial reasons. We have known long that we were not producing enough doctors for our own needs and fulfilled service commitments within this country by exploiting doctors from abroad, frequently from developing countries, who had come here for training.
The fact that these doctors, as many told me, failed their postgraduate examinations because they had so little time to study due to service commitments should make us hang our collective heads in shame. I wonder what happened those who had to leave Ireland after their allotted six years here and went back home without a postgraduate qualification.
Most attention has been paid to the suggested changes for entry to our medical schools but the report contains more than this. Firstly, the curriculum is addressed. There is agreement that changes have been made in pre-clinical teaching but I think if I went back into a fourth Med. class I wouldn't find it that different to 40 years ago. Not that bedside method of teaching and so forth is bad, we were and are taught well - hence the reason Irish doctors are sought abroad - but there is the same lack of facilities in many hospitals, even things as basic as rooms to teach small groups.
The clinical teachers are consultants, who are in general not paid, and much work is put into the teaching of students by NCHDs as well, who are not paid for this work also. There are very few academic posts in the country-only 2 percent of consultants hold academic posts.
The report recommends that the number of medical students from the E.U. should be increased to 725, with about two-thirds of these following an undergraduate programme ever five years and the other third a postgraduate programme over four years. Several scenarios are produced to show how this could be implemented in up to ten years.
At present a whopping 62 percent of medical students are non-E.U. and their fees have kept the medical schools afloat for many years due to the fact that the Irish Government pays about one-third of what it costs to teach a medical student for each of them to the medical schools. A continuing supply of proper finance will be needed for the medical schools. Much work went into attracting these non-E.U. students to Irish medical schools, as I told Minister Mary Hanafin when we debated the Report in the Seanad recently. The flow into Ireland of these students cannot be turned on and off like a tap. We face stiff competition from schools in the United Kingdom and courses in English have been set up in some Continental countries, too. The first thing I'd like to know is has the Minister for Finance and his Department officials given their blessing to the new proposals?
Huge investment is needed in the "clinical sites" and they should be enumerated the Report says. The academic corps is to be increased-more money-and those who do clinical teaching are to be paid. (For goodness sake, why does every goodie come too late for me?) At least €100 million as suggested in the Report will be needed but it could be much, much more-this will be Government money, despite the fact that the graduate entrants will be paying fees, probably twenty to thirty thousand euro a year or getting big loans which they will have to repay after graduation and will mean they will need bigger salaries-as happened in America-where many students owe well over $100,000 on graduation. And all the new extra intern posts will cost money, many euro-and looking at the Buttimer report on medical staffing and training-these young people will be seeking junior and senior hospital doctor posts and so on, all costing "big bucks".
I am reassured, by the way, Minister Hanafin has begun to address the Report. For a start off, she took notice of a motion I put down in the Seanad last May and has increased the number of undergraduate entrants by 70 from September 2006. My suggestion, which was supported by my fellow independent Senators, was to do so by last September. (I'm sure the increase was due to my suggestion, not serendipity.) Further increases of 45 and 35 are to follow in the next two years, all under the old CAO system which will give time for proper planning. Some people around Leinster House were suggesting she should take a "big bang" approach but I am very relieved she has not. We already take in a limited number of graduates and this could be expanded gradually. By the way, the planned Graduate Entry University of Limerick Medical School was not given the green light by the Report, the fact that we had one medical school for 800,000 people as opposed to one per 1.6 million approximately in the U.K. being noted.
Finally, let me turn to the question of undergraduate entry. It is suggested an aptitude test should be used-which type of test is not really specified, but as many have pointed out the qualities required to be a forensic pathologist and a general practitioner don't seem that close.
An aptitude test has been used in the United States (Scholastic Aptitude Test S.A.T.) for years. In some 300 universities they are now discarding such tests as useless or only to be used in conjunction with a school's assessment. In the U.K. the value of the Biomedical Aptitude Test (B.M.A.T.) was the subject of a major debate in the House of Commons recently. In Australia such tests are used only in conjunction with other evaluation procedures.
In the Report it is noted that there are a small number of places for students from disadvantaged backgrounds. The working Group points, out amongst other things, that it would be good to have students from more diverse backgrounds entering medicine. Examination of the results of S.A.T. tests by ethnic group and gender shows it will certainly not be achieved by this means. Over the last twenty years whites consistently do best in both the verbal and mathematical sections, except for Asian Americans who beat all comers by a mile in the mathematical section. (I seem to recall a problem with this in Canadian Universities where it was suggested Asian Canadians would have to be handicapped such were their achievements!) Over the years the scores of the blacks, Hispanic or Latino and Mexican Americans did not improve much. There was some improvement in the Puerto Rican and American Indian groups but still they were a long way behind the whites. I have read many reports on the grind schools for these aptitude tests and I suppose the whites being the most affluent in America may be most able to afford to learn how to do these tests.
Some people feel there is a problem in the preponderance of girls entering medical school. There has even been an ignoble suggestion made that using these aptitude tests would disadvantage girls, because they do less well than boys in the mathematical section. Naturally, I do not associate myself with such base suppositions, although while I do feel patients should have gender choice I never remember anyone sighing and moaning when well over 70 percent of medical school graduates were men. Where was gender choice for the women who begged me to find them female obstetricians, gynaecologists, G.P.s?
In the Seanad debate I queried why would-be medical students were to be the only ones given aptitude tests. What about vets, physiotherapists, dentists whose point scores must be nearly as high? And Senator Ann Ormonde, a career guidance teacher by training, wanted to know why those going for courses with lower points shouldn't get equal treatment. "What about engineers" she asked. Maybe they are digging the roads over and over again in her area. She has a good point.
Senator Mary Henry, MD
