Second Opinion: On the face of it, medical manpower planning might seem a simple enough exercise. We know the make-up of our population and have a fair appreciation of their health needs.
For example, we can accurately predict the number of people who will develop a stroke, breast cancer or appendicitis during 2005 and the number who will go through the year with cerebral palsy, diabetes and arthritis. We know about the type of medical care that people will need, both in hospital and in the community. You'd therefore think we could predict the number of doctors, nurses, therapists, etc that are needed to run an effective health service and so could get on with training these people.
If only life were so simple! For many years, Ireland has miscalculated its health manpower needs and has produced too few doctors. We now need about 800 medical graduates a year but since the late 1970s, the annual intake of EU citizens into our five medical schools has been capped at just over 300.
To make up for the current shortfall, we recruit large numbers of overseas doctors. About half of the 4,000 non-consultant medical staff in Irish hospitals come from outside of the EU, mostly from developing countries. The resulting "brain drain" is nothing short of scandalous with the Irish health service being propped up by large numbers of doctors from some of the world's poorest and most disease-ridden countries.
How did we in Ireland manage to get our medical manpower calculations so wrong? To be fair, the whole area is so complex and dynamic that future manpower needs are difficult to predict. For one thing, the demand for healthcare has greatly increased, in part due to population growth and increased life expectancy. Consumer expectations are higher and this is reflected in greater demands on service. The work practices of doctors have also changed. Nowadays, few are willing to put up with the very long hours that were taken for granted a generation or two ago. More doctors are working part-time and taking career breaks or early retirement.
Medicine is also becoming increasingly feminised with females now taking up 64 per cent of new places in Irish medical schools. At certain stages in their lives, many female doctors have to juggle their careers with child bearing and child rearing. The net result of all of these changes is that we now need many more doctors (about 50 per cent more, according to some estimates) to tackle the same workload as doctors of old. While these factors are apparent in many countries, others are peculiar to Ireland. For example, about a third of Irish medical graduates have traditionally gone overseas for postgraduate training and fail to return. Ireland is therefore the victim as well as the perpetrator of a medical "brain drain".
The shortfalls in medical manpower are being felt in some areas more than in others. There are particular concerns about recruitment to general practice, which needs about half of all medical graduates. A recent survey showed that only 15 per cent of all Irish graduates (and 8 per cent of males) have general practice as their first career choice. While there are many reasons for this situation, a lack of exposure to general practice at medical school is among the most important.
For historical and political reasons, medical schools concentrate their clinical teaching in the major hospitals and most students spend only a week or two of their five or six-year course in the general practice setting. A medical training that is almost exclusively hospital-based not only fails to prepare students for a possible career as a GP but gives the tacit message that community-based medical practice is somehow a less worthy career option than hospital-based medicine.
As part of its efforts to promote the reform of medical education, the Medical Council of Ireland, which regulates all aspects of medical education, has repeatedly called for greater exposure to primary care and general practice in medical school curricula. The new medical school at the University of Limerick will respond to this, with all students in its four-year graduate entry programme spending a full six months (25 per cent of their clinical experience) in the primary care and general practice setting. With an annual student intake of 120 students, the UL medical school will go some way to addressing Ireland's current medical manpower problems.
Furthermore, its student selection processes and curriculum will ensure it produces doctors who are particularly well prepared to meet the current and future health needs of Irish society.