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A staggering 60 per cent of advertisements for consultant posts in the Irish health service last year attracted two applications or fewer, according to the Irish Medical Organisation (IMO).

The deep unattractiveness with which those seeking consultant posts view the Irish health service has been outlined by the IMO in detailed submissions made to the Public Service Pay Commission on Friday 8th December.

Figures obtained by the organisation from the Public Appointments Service (PAS) has revealed that, of the 84 consultant posts that were advertised and closed in 2016 by the PAS, one-quarter (22) received just one application, while another quarter (21) received just two applications. One-in-ten (8) advertisements were closed without a single application being lodged for the position. The PAS was unable to identify a suitable applicant for 22 of these 84 posts.

Recruitment efforts this year have fared no better; of the 38 consultant positions currently being advertised by the PAS, 16 have been open for over twelve months.

Furthermore, 128 consultant positions are currently being occupied by practitioners who are not on the specialist register, although it is a condition of the consultant contract that those occupying these roles must have achieved specialist qualification and be listed on the Medical Council’s specialist register.

The organisation has warned that, unless radical action is taken to resolve this crisis within the medical professional in Ireland, we will be unable to deliver the kind of specialist and specialised medical care taken as a right in other jurisdictions.

In the report focusing on consultant recruitment and retention issues, the IMO highlighted the present shortages: “…when analysed comparatively, Ireland is already precariously short of doctors with only 2.9 practising physicians per 1,000 population, compared with an EU average of approximately 3.4.

Citing research conducted by the RCSI, the organisation has expressed concern that consultant doctors are no longer following previous patterns of working abroad to enhance their skills before returning home, instead recent years have indicated that this has shifted and that they are remaining abroad.

While the exact level of consultant vacancies within the Irish health system is unclear, it is generally accepted that 400 such posts are either vacant, or are filled on a temporary basis.

 

Emigration

Doctors are emigrating earlier in their training and are opting to remain abroad due to dissatisfaction with working conditions in the health system and uncertain career progression opportunities at home.

This means that we are increasingly reliant on foreign- trained physicians. In 2015 only half (53 per cent) of newly registered specialists in Ireland were Irish medical school graduates, the remainder were graduates of non-Irish EU medical school (30 per cent), and non-EU medical schools (17 per cent).

The report states: “The importance of strong medical workforce within the hospital system is reinforced by the overwhelming evidence available to demonstrate that consultant-delivered care, care which is provided by comprehensively trained medical experts with extensive experience, is the best model by which to organise hospital services; immediate steps should be taken to ensure its implementation in Ireland.

“While there has been a gradual increase in the number of consultants and NCHDs employed in the HSE, NCHDs still outnumber consultants by two-to-one and one in eight consultant posts currently remain unfilled”.

The report addresses factors contributing to the low number of doctors working in Ireland, such as unattractive working conditions and levels of remunerations, referencing a Medical Workforce Analysis, published by the Department of Public Expenditure and Reform from 2015, where 87 per cent of medical students claimed to have either been intending to emigrate or to have been contemplating it.

A 2016 Medical Council examination of the retention intentions of Irish trainee doctors also revealed that just 58 per cent of trainees saw themselves practising in Ireland for the foreseeable future.

The IMO has canvassed opinions from a group of 77 consultants and NCHDs currently working in other jurisdictions, 97 per cent of which stated that they were not aware of any initiatives by the HSE or Department of Health that aim to recruit and retain doctors in Ireland.

 

Reduced salaries and resources

Eighty seven per cent stated that the pay disparity between existing consultants and their future colleagues, since the 2012 consultant pay cut, had influenced their decision not to return to a medical post in Ireland.

The IMO commented on the new entrant consultant 30 per cent salary rates cut: “The decision to unilaterally impose such a swingeing cut to new entrant consultant pay has played a substantial part in the present recruitment crisis, by not only creating a pay disparity between practitioners who perform the same work, but by further dismantling what little trust practitioners had in the government to uphold their terms and conditions.

“In addition, a side effect of this decision has been to ensure that, on balance, female Consultants, who tend to be younger than their male colleagues, will earn considerably less than those male colleagues”.

The pressure of working under significant salary cuts, while maintaining a high level of service with reducing resources, have been identified as key retention blockades.

Poor hospital medical staffing, low levels of bed capacity (in 2016, bed occupancy rates in Ireland had risen to 97 per cent), and widespread surgery cancellations were also alluded to as detracting from the HSE’s attractiveness as a prospective employer.

The report stated: “We are finding it difficult to recruit consultants, and when they are recruited, they are finding it ever more challenging to do their job”.

According to staff turnover figures from the HSE, 36 of the 279 consultant posts that were vacated in 2016 were due to retirement, while 39 per cent resigned and 46 per cent had their contracts expire.

The overall turnover rate for HSE consultants was 8.9 per cent last year, while, comparatively, NHS England was at 6.1 per cent.

 

Bad reputation

Dr. Rhona Mahony, current Master of the National Maternity Hospital, Holles Street, in her presentation at the IMO’s Doolin Memorial Lecture noted that “the HSE is perceived to be “a toxic employer”

The IMO alluded to the organisation’s research, where 27.7 per cent of female NCHDs, 13.2 per cent of female consultants, 10.4 per cent of GPs, and 5 per cent of community health and public health doctors surveyed reported being bullied on the basis of their gender during the last two years. Twenty one per cent of female NCHDs reported being sexually harassed in the workplace in the same time period

The report stated: “Numerous cultural issues that act as a barrier to recruitment and retention within the HSE have often failed to be meaningfully addressed by the organisation’s initiatives. Bullying, harassment, and sexual harassment appear to remain common features of medical practice in Ireland, despite efforts to curtail their impact and prevalence”.

It was recommended that significant gender disparities within individual fields should not be continued with unchallenged, as predominance of one gender over another in leadership may risk the production of cultural barriers to practice in specific areas, and could attribute to a perception of bias.

The State’s history of failing to honour consultants’ contracts was the report’s concluding criticism, as it has led to “protracted disputes that have fed into a lingering sense of alienation among the medical profession”.

The report claimed that a majority of its consultant members are working up to twenty hours a week above their contractual commitment, often without any additional remuneration.

The report went on to state that such conditions have increasingly led to the organisation seeking third party intervention, in a bid to secure contractual entitlements, such as Sunday and other premium payments, and for access to compensatory rest provisions for consultants.

It concluded by cautioning that recruitment and retention issues will only end if the “disingenuous disregard shown to legitimate grievances and concerns raised by doctors” comes to a halt.