The 'public hospital only' employment contract on offer from the HSE appeals to clock-punching, detached, disengaged automatons and not the trainee consultants expected to fill the posts, argues one of them, Dr Ronan Cahill
The insistence of the Minister for Health and the Health Service Executive (HSE) to press ahead aggressively with introducing a new category of consultant into Irish hospitals means attention now focuses on who will occupy these posts.
Although the issue of financial reward had hardly been broached at the recent negotiations between the HSE and the medical trade unions, the generous nature of the salary on offer has been advanced into the public arena by Mary Harney. Obviously it is envisaged to be, in itself, sufficient incentive for those aspiring to the role of hospital consultant to continue their efforts towards this goal.
However, the attainment of this position can no longer be considered the ambition of those nearing the end of surgical training and non-consultant hospital service.
The cohort of surgical trainees capable of applying for a consultant post either at this point in time, or in the near future, is comprised of a body of workers who have spent at least 10 years in full-time public hospital service. These senior specialist trainees function capably as the senior decision-makers described in Government reports, and they spend their days, and often nights, working directly at every point of patient contact in a hospital without distinction or regard for the health insurance status of the individuals requiring their care.
The training aspect of their jobs has been with the explicit intent of becoming consultants "fit for their purpose" in Ireland. As a direct result of the HSE's vision of what a consultant surgeon should be, those at the end of their training schemes are now considering if, and not how, they will renew their involvement with Irish healthcare.
What should be an automatic decision to seek an "upgrading" of status from being a temporary employee contracted annually without job security or tenure to becoming a permanent hospital specialist no longer appears in any way an attractive proposition.
In informing their decision, these trainees have to reflect upon their own direct experience of the progress, or lack of, the HSE has made on the many issues affecting our public hospitals. Effective accident and emergency triage and processing systems as well as timely bed management and placement of the long-stay patient population in acute care facilities have proven impossible to implement.
Furthermore, rather than addressing public care resource and capacity issues, the Government has chosen to allow private operators to capitalise on the problem of excessive elective waiting times by means of the National Treatment Purchase Fund. The result of these and other initiatives is a demoralised, chaotic public hospital system that is not attractive to those considering whether to re-engage with public hospitals at higher, permanent levels, whether they are based in this country or abroad.
By raising the issue of who would be attracted to a career by salary alone, Ms Harney comes to the nub of the issue. The terms of the contract offered comprise an administrator's view of what hospitals require that does not tally with the perspectives of exceptionally innovative, educated, aspirational healthcare professionals, and therefore do not act as an inducement for public service recruitment.
They will, however, prove attractive to clock-punching, detached, disengaged automatons whose ambition is levelled at achieving a reasonable monthly salary. The assumption that the Irish Medical Organisation and the Irish Hospital Consultants' Association may be trying to undermine the new initiative by trying to persuade their members not to apply is made defunct by the fact that the highest achievers and most dedicated of potential applicants in this country do not in fact want the jobs on the proposed terms.
An industrial action or even strike on behalf of a profession is a noble means of registering protest. Walking away from the whole sorry mess of a system seems the more likely course for the contemporary generation of disapproving, disaffected would-be consultants.
In short, in response to the imminent advertisement of new consultant posts, those nearing the end of their training will choose not to continue in public service. A considerable annual salary will not blind the Irish higher surgical trainee to the associated terms and conditions that apply. And consider this: those at earlier points in their training will not even have the option of public work after such ill-conceived condensed expansion.
This is not a threat to the intended process, it is the inevitable outcome.
Ronan Cahill is a senior specialist registrar in general surgery at Cork University Hospital and a member of the Irish Higher Surgical Group, a subgroup acting under the auspices of the Royal College of Surgeons in Ireland and representing 140 medics nearing the conclusion of their training as consultants