Unfilled specialised medical consultant roles and an over-reliance on overworked, internationally trained graduates for non-consultant hospital doctors are among key risks to patient safety identified by the Medical Council.
The council, which is the regulatory body for the medical profession, sets out the risks to healthcare for the first time in its workforce intelligence report that breaks down the make-up of the medical register and explains why doctors are leaving the health system.
More than a third of all clinically active doctors are on the general register, which is a key risk to patient safety because consultant and specialist roles are not being filled and “a considerable proportion” of non-consultant hospital doctors are required to perform the duties of consultants.
The report found that the majority of non-consultant hospital doctors are trained overseas and that the health system overly relied on these doctors who reported being “overworked, undervalued, experiencing discrimination and unable to access specialist training.”
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“Aside from the individual impact on the doctors, the treatment of international medical graduates has serious implications for patient safety,” the council said.
In another risk identified by the regulatory body, more than a quarter of doctors reported working more than 48 hours a week, in breach of the European Working Time Directive.
“This has further serious implications for patient safety,” the council said.
Acute doctor shortages within the Irish health system, especially at skilled and experienced consultant level, was affecting quality of care and undermining patient, the regulatory body said.
The council found that a quarter of doctors who withdrew from the medical register last year cited family or personal reasons, while 17 per cent left because of limited career progression opportunities, an increase from almost 15 per cent the previous year.
Dr Suzanne Crowe, the council’s president, said the risks were evident with unfulfilled consultant posts, continual growth in the general division of the medical register and a medical workforce that “continues to experience burnout, bullying and working excessive hours”.
“The responses from those withdrawing from the register tell a story and if we don’t accept, acknowledge and act on the deficiencies of our workforce now, patients will ultimately suffer,” she said.
Overall, 21,680 doctors retained their place on the medical register in 2021, with 18,424 or 85 per cent being clinically active. Of those, 53 per cent were men and 47 per cent women.
Some 2,605 new doctors joined the register, an increase of 14 per cent on the previous year. This comprised 1,717 international graduates and 888 Irish graduates.
Just under half of all non-consultant hospital doctors occupied non-training roles, while 62 per cent of doctors reported working more than 40 hours a week.
Of 982 voluntary withdrawals from the register, 848 doctors outlined their reasons for leaving, which included a lack of appreciation, the personal impact from working excessive hours and a lack of management or clinical supervision support.
“These points were emphasised as significant challenges to doctor morale and their capacity to deliver safe, quality patient care, therefore compromising patient safety,” the council said.
The cost of professional indemnity insurance and registration, an inflexible registration model and health reasons associated with the Covid-19 pandemic were among other reasons cited.
Leo Kearns, chief executive of the council, said that among its recommendations in the report was the establishment of a healthcare workforce strategy in the short term “to address recruitment, retention, distribution and supply challenges.”
He said a big area of concern was the “extremely high number of doctors” in the general division of the register, the continue growth of which had been largely unplanned.
“It also reflects our disproportionate reliance on international medical graduates, who then have no career pathway or progression available to them. This in turn leads to high levels of voluntary withdrawal and emigration,” said Mr Kearns.
