Hospitals will this morning begin to put together a contingency plan for dealing with the series of one-day strikes which seem inevitable.
But one difficulty faced by planners is that the hospitals which will be affected by strikes by non-consultant hospital doctors (NCHDs) is still unclear.
Management sources speculate that the Irish Medical Organisation may, for a start at any rate, target those hospitals which have come in for the greatest criticism over overtime payments from NCHDs. That would seem to follow logically from the naming of certain hospitals at the recent IMO conference.
These include St Vincent's Hospital and Our Lady's Hospital for Sick Children, both in Dublin, University College Hospital, Cork, Limerick Regional and UCH Galway.
But another option, they point out, is to pick the biggest hospitals in the State and to hit them with a series of one-day strikes on the basis that this will have the greatest publicity value.
Whatever option is chosen, there is little doubt the first effect of industrial action will be the cancellation of outpatient clinics and of non-urgent (elective) admissions. For some patients it will mean that a wait of, perhaps, years for treatment will be further prolonged.
However, if the strike action is spread around a large number of hospitals the effects on any one hospital may be limited.
But if the limited action envisaged by the NCHDs fails to bring the better overtime deal and shorter hours NCHDs want, the possibility of an escalation of the industrial action will be strong.
Such an escalation would see still longer postponements and might involve a very restricted service in some casualty departments. Managements will be hoping the pressures on casualty departments will be reduced if those who can chose to go to their GP instead.
There are two factors which could seriously affect this cosy scenario. One is that if NCHDs find that a softly, softly approach is getting them nowhere they will have little option but to disrupt hospital services dramatically as the nurses did successfully last year. The other factor is that NCHDs may not be as tightly organised as the nurses.
It is possible that action will escalate in some hospitals and not in others, especially if the doctors in some hospitals feel especially aggrieved or a management takes a heavy-handed approach.
Clearly this will mean further disruption and uncertainty for patients and great difficulty for hospitals. But it also seems likely the doctors have public sympathy on their side and that anger at any disruption will be directed at the Minister for Health, al Mr Martin, who may be about to face his toughest political test yet.
pomorain@irish-times.ie Weblink: www.imo.ie (Irish Medical Organisation)