As students fight for fewer places, the future of the health service is threatened. James Fitzgerald reports.
The number of places for Irish students training to be general practitioners here needs to increase by at least half within four years just to keep the current numbers of doctors in practice, according to the chairman of the Irish College of GPs.
Dr Eamon Shanahan says that with around one-third of GPs expected to retire in the next 15 years and increasing numbers of doctors opting to work part-time, the pressure to provide an effective service around the State is getting more intense.
"The situation in Ireland at the moment is that we have 98 training places for GPs. We are trying to increase that to 150 places in the next three to four years," says Shanahan.
"That will just about meet turnover of existing GPs. It will not allow for any increase," he says.
Shanahan added that one of the factors is an increasing feminisation of medicine and that more women look for part-time contracts than men as they are looking for "a better work/life balance". It is thought that while the gender breakdown for doctors is around 60-40 men to women at present, this will have reversed within 10 years.
"The problem is our medical system is being run on a shoe string," says Shanahan who is a GP in Farranfore, Co Kerry. "There is an analogy about comparing the Irish health system to a liver. The liver has an enormous capacity to absorb damage. It can be 90 per cent damaged and still function but lose another 1 or 2 per cent and it will completely shut down. The Irish health system is in danger of shutting down."
General practice is not the only sector that is under pressure. According to the findings of a ministerial working group headed by Prof Patrick Fottrell, former president of NUI, Galway, the number of places for Irish and other EU medical students in the State should be more than doubled and the number of non-EU students trained here should be reduced.
For more than 25 years, the Irish/EU student entry has been capped at 305 places per year. The Fottrell report, which is about to come before Cabinet for discussion, recommends that this be increased to 725. Although it has not yet been published, the report has already received considerable support from within the medical profession.
"The single biggest problem is the number of spaces for medical students," says Finbarr Fitzpatrick, secretary general of the Irish Hospital Consultants' Association. "Anything that doesn't recognise that is a waste of time," he says.
It seems most medical and educational groups acknowledge this need.
The problem is, however, that students from outside the EU are, in effect, subsidising the training of Irish GPs and all medical faculties depend on overseas students to fund what is a hugely expensive area of our education system.
Some 80 per cent of students at the Royal College of Surgeons in Ireland (RCSI) are from outside the EU. In an average graduating class of 190 students, just 40 are Irish. Non-EU students will pay €36,000 for their tuition this year compared with €6,800 for Irish students, most of which is paid via grants from the Higher Education Authority.
While the RCSI has a disproportionate number of non-EU students, all medical schools take a large amount of foreigners, in effect to help subsidise the others. Any reduction in the number of overseas students to cater for Irish places has significant ramifications for universities and colleges.
Prof Alan Johnson, dean of RCSI's faculty of medicine and health sciences, believes a new financial model is needed to tackle the shortage.
So either more non-EU students are accepted at the same time as taking in more Irish students or, more realistically, the State will have to come up with the funding.
"Exchequer funding for medical students is too low and there are too many places for non-EU citizens. That has to change," says Fitzpatrick.
"Don't forget, if you increased the number of places for entry in October 2006, it would take 10 years for that to change on the ground for GPs and 17-20 years for consultants. The sooner the Government recognises this and does something, the better," he adds.
As the class of 2005 Leaving Certificate students tore open their results last month, there were hundreds of disappointed potential doctors who, despite achieving excellent grades, did not get into their chosen course of medicine. Around one in 10 of Irish school-leavers who have medicine as their first choice on the CAO form get enough points.
As tough as this is, most within the business do not feel an interview system is the way forward, saying that if there were more places, the points would come down.
"I don't think interviews are a better idea," says Dr Suzanne Cronly, an anaesthetics senior house officer at Dublin's Coombe hospital, who has just come through the Irish medical training system at Trinity College.
"I don't know that you can make objective decisions in a group of 17 or 18-year-olds as to who would make good doctors. It does open the door to nepotism, also," she says. Dr Cronly feels that with so many foreign doctors coming through the system it makes class sizes bigger, which can dilute the effectiveness of teaching when it moves to the hospitals.
"There is not necessarily a shortage of doctors but there is a huge amount of foreign doctors," she says. "Part of that is due to the fact that Irish doctors are leaving to continue their training elsewhere like the US or Australia."
Writing in The Irish Times last week, Prof John Crowe, vice-president of the Royal College of Physicians in Ireland, said: "This is a highly societal issue for Ireland and the Irish Government has a responsibility to ensure that the State produces enough doctors to meet the national need. Priority must be given to providing medical education for Irish students ahead of providing education for students from other countries without whose fees Ireland's medical schools could not continue to exist."
The Department of Health confirmed that the Fottrell report was currently up for debate. "They [Health Minister Mary Harney and Education Minister Noel Dempsey] will be considering the group's recommendations and will bring something specific before the Cabinet," says a department spokesman.
As the Fottrell report is pondered in the Departments of Health and Education and presented to Cabinet, there will be some tough decisions to make with the profession crying out for change. Ultimately, it seems, the Department of Finance will have the final say.