23rd April 2002
Terry Keane and I entered pre-med in Trinity College in the same year. Pre-med in those days, and not the CAO forms, was the great sorting office. There were about one hundred and twenty of us, and sixty places, in 1st med. Terry obviously saw the light somewhere during the year, left, and went on to a dazzling career, starring recently in the Four Courts in a libel case. She was a sparky lady in college and I am glad to see from her performance in the witness box she is still the same.
Of those of us who went on into 1st Med, more or less all sixty of us plodded along to the final examinations and after that went into various branches of medicine. Very few of us went into alternate careers over the next thirty five years; we are still what we started off as, medical practitioners.
How different is the situation nowadays where so many people seem to see a medical degree as a primary degree and go off in all sorts of directions after qualification. Some surveys have said 10% of medical graduates are lost to medicine at once and this is followed by a steady rate of attrition over the following years.
Comparing notes about this desertion of the profession with someone who was a few years ahead of me in college we agreed that times are not as good for young doctors now as when we qualified. But are the powers that be watching what is happening? It doesn't look like it.
The Medical Practitioners (Amendment) Bill 2002 went through the Houses of the Oireachtas with great speed recently. The main effect of the Act will be to give permanent registration more easily and quickly to non-EU doctors. Let us not think that this is because we have suddenly decided we were treating non-EU doctors very badly and decided to make amends. No, it is to ensure that the most peripheral hospitals with inadequate training schemes and heavy service commitments will be staffed. A few years ago in an effort to improve training, the Medical Council decided that they would not give credit to temporarily registered doctors for working in such posts. So, rather than improving the posts, the Department of Health has ensured that those unfortunates who are here to get higher training can fill those posts by allowing them become permanently registered, therefore the Medical Council stipulation will not count.
98% of NCHD posts are filled, we are cheerily told, but for how many was there no competition at all? Surely we should be concerned that some hospitals must be so desperate to fill posts that anything will do?
Then there is the situation in general practice. It is apparently impossible to get anyone to take over practices in some areas where a general practitioner wants to retire. Other young doctors write in the medical press about the difficulties they have setting up practice in doctorless areas because of lack of suitable premises or ones at an economic rent. There are no practising GPs, apparently, on the Primary Care Task Force which means deliberations will be less practical than they might be.
On to the hospitals. During the nurses A and E strike recently one doctor who works in A and E told me he was looking at advertisements for jobs in New Zealand because he was so fed up here. By the way, will anything happen as a result of that strike? NO. Public Health doctors are naturally enraged at being given instructions without any consultation.
More and more hospital consultants are taking early retirement. How many now would "work their own locum", an Irish phenomenon of some years ago. In other words after reaching retiring age he or she worked on for two or three years until someone got around to advertising the job and filling it.
It's all very well to talk about continuing education and competence assurance but I am beginning to wonder how many people there will be in medicine for long enough between qualification and "seeing the light" and moving into something else, or retiring, to get involved in either process.
Terry certainly has had an exciting career. I have enjoyed my career, too, very much and would not change one year of it. But for someone qualifying now - what about the NCHD - I'll have to talk to Terry and see what she would advise. Perhaps she could chair another forum in the Department of Health on "Why doctors are so fed up".
Senator Mary Henry, MD
