OPINION: CHRIS LUKE, An A&E consultant has a solution to staff shortages
IN JULY 2005, as a dispirited medical educationalist and clinician, I wrote to The Irish Timesto welcome the recommendations of Prof Patrick Fottrell's group (who were tasked with examining the medical manpower needs of this country), that there be a substantial increase in the number of medical students in Ireland. Their case was that there were too few doctors being trained here to serve our citizens adequately.
At the time, I pointed out that the health service had become dangerously dependent on the global medical manpower market, resulting in an erratic quantity and quality of the doctors recruited. Understandably, I hoped then that we could reverse our strategically disastrous reliance on this fickle supply of physicians.
Remarkably, the powers-that- be in Ireland's health service contrived to make matters unimaginably worse and today, five years later, their laissez-fairestrategy has resulted in many dozens of non-consultant hospital doctor posts remaining empty, particularly at the front line.
This situation is unparalleled in terms of hazard to patients. Its proximate causes include reduction in visa availability for non-EU doctors, withdrawal of official “approval” of hundreds of junior doctor posts, and a steep decline in take-home pay. The root causes, though: indifference, incompetence, and ideology.
The staffing chaos, comparable to our financial multiorgan failure, has evinced a similar historical revisionism, as panic grips the medical, political and managerial authorities. But this disorder is more pressing, and the prognosis is distinctly guarded.
Yet, there is reason to be positive. Immediate treatment of the problem must be radical but we will cope (somehow). The urgent “triple therapy” which I would prescribe involves interns (first-year doctors), a kind of “indenture” and independent nursing. It may be highly unpalatable for some but is relatively affordable and easily available.
In truth, it requires a bold and necessary development of the Fottrell prescription, employing the growing number of medical graduates at the frontline, as was the norm until Bondi Beach proved irresistible and “work-life-balance” made the stability of our health service somewhat, er, subsidiary for many of our young doctors.
Ironically, a kind of medical “indenture” or “bond” system has long been employed in the Australian, as well as the South African and American health systems: this obliges or encourages young doctors to work in unpopular locations for a fixed term, in return for their training or highly lucrative professional contracts.
I would suggest that Ireland’s emergency departments are the contemporary “back of beyond” in medicine and merit a similar fixed commitment by all of our new graduates.
In South Africa, it is known as “community service” and, while unpopular with some, it is mandatory for all doctors and has proven life-saving for the communities to which the doctors are deployed.
The third ingredient of my resuscitative remedy is the growing group of independently operating advanced nurse practitioners (ANPs), who already provide a more satisfactory service than many of our inexperienced “junior” doctors. I am not suggesting that all – or even most – of our hospital doctors be replaced by such ANPs, merely that they have a vital complementary role to play in future healthcare provision.
Finally, long-term rehabilitation will need a truly joined-up approach to the primary needs of the health service, as well as the educational and other secondary functions, which have led to the present derailment.
Chris Luke is a consultant in emergency medicine at Cork University Hospital