Staff Shortages

DrIndy

From the Irish Times

SHORTAGES OF junior doctors may soon result in a number of hospitals having to close their emergency departments or limit their opening hours, it was claimed yesterday.

The Irish Association for Emergency Medicine (IAEM), which represents consultants working in emergency medicine, said some hospitals have severe difficulties recruiting non-consultant hospital doctors (NCHDs), sometimes referred to as “junior doctors”, to staff their emergency units.

Some units, it added, are consistently unable to fill shifts with doctors of the necessary experience to safely manage patients.

“While this problem is at its most acute in Naas General Hospital; Portiuncula Hospital, Ballinasloe; Mayo General Hospital, Castlebar; Kerry General Hospital, Tralee; and Letterkenny General Hospital, almost every emergency department in the country has been unable to recruit its full complement of medical staff,” it said in a statement.

“Where there are alternative emergency departments in reasonable proximity, it may now be necessary for hospitals that cannot safely staff their emergency departments to close or limit their opening hours.

“Arrangements will have to be made to transfer patients elsewhere outside these hours. While this may appear to be a disproportionate response to the problem, the reality is that some of these emergency departments cannot be guaranteed to provide safe care for patients,” it added.

The number of junior doctors applying for posts in hospitals across the State which fell vacant in January dropped by more than half in some instances, when compared with a year earlier.

The drop in applications has been attributed to a change in visa requirements for non-EU doctors, as well as the fact that more Irish-trained junior doctors seem to be emigrating.

Dr James Binchy, of the IAEM, said there were junior doctor shortages across a range of specialities but the situation was most critical in emergency departments. Around one-fifth of junior doctor posts in emergency medicine were vacant, he said.

He stressed the recruitment embargo was not the issue. It was the fact that Irish doctors were going abroad for better work and training conditions and also the fact that it was now more difficult for overseas doctors to get registered here. In addition a lot of posts were no longer recognised for training and doctors therefore had to be fully registered to apply for them.

Junior doctors rotate between jobs every six months and the next rotation begins on July 1st, by which time the IAEM says it fears the situation will have deteriorated further. The IAEM says it is imperative the Health Service Executive (HSE) decides now where it is going to provide safe 24-hour emergency services for the population.

If some emergency departments have to be closed or have their opening hours restricted, the emergency departments that will have to attend to their workload must be given the infrastructural and staffing facilities to provide a safe service, Dr Binchy said.

The HSE maintained it is fully aware of the staffing situations in hospital emergency departments in some parts of the country and was working closely with individual hospitals to address their needs in this area.

It said a recruitment drive for a new intake of NCHDs is under way “and a number of other initiatives are being considered to specifically address the situation to ensure that hospital emergency departments continue to offer a high level of care to all patients”.

It is putting in place “a number of processes to address the issues presenting on a short-, medium- and long-term basis”, it added.

http://www.irishtimes.com/newspaper/ireland/2010/0407/1224267828000.html

Interesting stuff - the HSE is going to have to face up to the fact that they need to make drastic alterations in their current plans for staffing their hospitals - improve training places, increase consultants and reduce hours in conjunction with renumeration.

People are walking with their feet currently.

Traumadoc

It may be suiting HSE agenda....Close "smaller" hospitals. eg Portlaoise which sees more patients than Tullamore in their A&E unit, but it will be closed.

The shortage of service provision will only be for a couple of years.
With closure of hospitals, non appointment of new consultants (69 last year in total) and double the number of graduates, there will be ironically unemployment among medical graduates.

sam34

the chickens are coming home to roost for the hse


they have treated doctors like crap, worked them in terrible, illegal conditions and not protected their training

the worm has turned, and people are leaving in their droves

the_syco

sam34 wrote: »

the worm has turned, and people are leaving in their droves

Seems less of a "can't get in" than "leaving", maybe?

Visa rule causes shortage of doctors in Irish hospitals

Irish hospitals face a shortage of doctors because new visa arrangements are deterring non-EU doctors from coming to Ireland, the Irish Medical Organisation (IMO) has warned.

The doctors' organisation, which will hold its annual general meeting in Kerry from tomorrow, has written to the Department of Justice seeking changes to visa arrangements introduced last July.

Since then, doctors wanting to work in Ireland must have their visa renewed with every new contract of employment. Previously, it was standard practice to issue and renew visas for two-year periods.

Dr Chris Luke, consultant in emergency medicine at Cork University Hospital, said ''a perfect storm'' was brewing and expressed concern that emergency departments would be forced to close due to staff shortages.

The situation is expected to worsen in the second half of the year when the Health Service Executive fully implements shorter working hours for doctors and hospital funding deteriorates.

The IMO said the changed legislation was particularly difficult on non-consultant hospital doctors (NCHDs) or junior doctors, whose contracts are usually issued for six-month periods.

An audit carried out by the Royal College of Physicians in Ireland found that non-EU doctors accounted for more than half of all NCHDs working in Irish hospitals.

In its submission to the Department of Justice, the IMO proposed a reversion to the previous arrangement, or a system whereby non-EU doctors working in Ireland would be given two-year visas after they had worked in the country for a year.

Shirley Coulter, senior industrial relations executive with the IMO, said non-EU doctors were critical to the Irish health system and should be incentivised to work here.

The IMO said there was evidence of a significant fall in the number of applications for NCHD posts that began on January this year, ''with a large number of doctors either not choosing to come to Ireland or leaving here to work in Britain, Australia, New Zealand and the USA''.

Consultants across the country have reported shortages of hospital doctors in different specialities, with emergency medicine particularly badly affected.

Article courtesy of The Evening Echo newspaper.

Dr Galen

yes your right sam. I heard today of another really talented Reg leaving the country in July. The brain drain of NCHDs is speeding up too, lots of SHO level people are also on their way. I'm beginning to worry a little tbh.

RobFowl

I'm really concerned as well. In primary care young newly qualified GP's cannot find decent quality employement and are starting to leave as well. Where all these new quaduates are going to work is anyones guess.

sam34

the_syco wrote: »

Seems less of a "can't get in" than "leaving", maybe?

both, really.

but more and more, irish graduates are leaving for better training and better conditions.

Jane5

http://www.irishhealth.com/article.html?id=17120

I particularly like this bit-made me laugh out loud!

Ms O'Sullivan said Minister Harney and the HSE must address the factors that have led to the shortage of NCHDs. "
"While we can’t prevent Irish trained doctors from going abroad we have to ensure that terms and working conditions are not a disincentive to remaining in this country."

What terms and working conditions would those be then?

Would that be the illegal shift lengths and working hours with dangerous sleep deprivation? For pregnant women also with no exceptions? Or the recent abolishment of the training grant? Or the expectations that NCHDs will do the work of two or three when someone is off sick despite the fact that it isn't even possible to be in that many places at one? Would it be the constant moving house and relocation? The being put on emergency tax every 3-6 months when you start in another new place, despite working for the same damn HSE the whole time? Would it be managements refusals to get locums whe NCHDs are ill? or EVER? The constant reapplying for jobs, interviewing, never sure where you will be or what is going to happen?

Not to mention the lack of any support, the unique situation in Ireland where for some reason doctors are expected to take all bloods, give all IV drugs, do frickin' ECGs for f*ck sake, as opposed to say, Kazakhstan or somewhere where doctors diagnose and plan treatment and carry out complex procedures and surgery, like they are supposed to.

I'm actually amazed there are any docs here at all. Now that the bad old days of unpaid overtime are back, I think the wards will have only friendly 'ol Dr. Tumbleweed come July.

the_syco

Jane5 wrote: »

Would that be the illegal shift lengths and working hours with dangerous sleep deprivation? For pregnant women also with no exceptions? Or the recent abolishment of the training grant? Or the expectations that NCHDs will do the work of two or three when someone is off sick despite the fact that it isn't even possible to be in that many places at one? Would it be the constant moving house and relocation? The being put on emergency tax every 3-6 months when you start in another new place, despite working for the same damn HSE the whole time? Would it be managements refusals to get locums whe NCHDs are ill? or EVER? The constant reapplying for jobs, interviewing, never sure where you will be or what is going to happen?

Agreed. The 6 month contract thing truly baffles me.

maninasia

But why is the situation like that. Is it becaused medical unions don't want to lose control (by not allowing nurses/technicians to do routine tasks)? Because doctors don't want to reduce pay? Having a highly trained doctor is useless if he is too tired or too slow or has too many patients to deal with. Less training..more hands on deck.

There are lots of graduates, lots of posts that need filling...what is the cause?

drzhivago

maninasia wrote: »

But why is the situation like that. Is it becaused medical unions don't want to lose control (by not allowing nurses/technicians to do routine tasks)? Because doctors don't want to reduce pay? Having a highly trained doctor is useless if he is too tired or too slow or has too many patients to deal with. Less training..more hands on deck.

There are lots of graduates, lots of posts that need filling...what is the cause?

Can assure you many proposals made by IMO over the years to devlove some of the work which doesnt need a doctor to do to other sand this is in fact Government Policy if you read HAnly Report, Buttimer Report, TAsk Force on MEdical Staffing, and finally the 2001 report on Working Hours of NCHDS


Much of the work described is done by others 9-5 but it is at nights and weekends when these people are not around and there are skeleton crews of doctors that this becomes a real acute issue and dangerous in fact as doctors get distracted doing this and the doctoring falls to the wayside

How can that be you ask, well the one focussed on doctoring is the doctor, these other tasks knock on to nursing duties, ward admin duties, how the lab functions so all these other groups will keep reminding you about this work that needs to be done so you lose focus on concentrating on the medicine

I remember my first weekend working almost 20 years ago having to take blood in the whole, hospital because the phlebotomists (blood takers) were not employed at weekends. Took nearly 8 hours and because it was not done efficiently it knocked on to how the lab worked as they had to keep staff late, the irony was both a lab worker and nurse mentioned that they both do this at various times during the week and were more proficient but couldnt possibly do it at weekends in case my union objected!!!!!!!!

mise23

Just recently I received emails from two separate international locum agencies trying to recruit nchds to work in Ireland. The emails were almost identical and full of the most blatant lies I have ever seen in print i.e. claimed that you were guaranteed to work only 39 hours a week, that the HSE was the best thing since sliced bread and that Ireland had a state of the art health service. Unsurprisingly there was no mention of non-nationals having to reapply for a visa every 6 months.
Unfortunately I didn't keep copies as my first reactions were wtf followed by a swift click on the delete button.

MrCreosote

Another day, another article in the Irish Times about shortages:

http://www.irishtimes.com/newspaper/health/2010/0427/1224269144650.html

Anybody have any first-hand experience of doctor shortages? Like- I'm working in wherever and we are 2 SHOs short on my roster?

Vorsprung

Jesus they're missing the point bigtime. Have incentives to keep the Irish doctors you've paid through medical school to stay in Ireland, instead of spending more money on recruitment agencies to get non Irish trained guys in.

If they want an excuse to piss away money I'd be more than happy to give the HSE my bank account details.

Narkius Maximus

MrCreosote wrote: »

Another day, another article in the Irish Times about shortages:

http://www.irishtimes.com/newspaper/health/2010/0427/1224269144650.html

Anybody have any first-hand experience of doctor shortages? Like- I'm working in wherever and we are 2 SHOs short on my roster?

I can tell you that in July coming, there will be 3 unfilled surgical sho spots out of 6. That's a 1/3 call down to a 1/2 if holidays are allowed. Chances are it's going to filter upwards, so there are going to need regs/sprs inhouse, and there's only 4 of them, 3 of which will be quite senior in their training and not keen to do onerous in house call. Let's see if the HSE are going to live up to the new contract and their responsibilities for patient and doctor health and well being.

I've also heard that there are a lot of medical positions still unfilled. Get ready for a 12hr a&e wait time!

dissed doc

MrCreosote wrote: »

Another day, another article in the Irish Times about shortages:

http://www.irishtimes.com/newspaper/health/2010/0427/1224269144650.html

Anybody have any first-hand experience of doctor shortages? Like- I'm working in wherever and we are 2 SHOs short on my roster?

Yes - we are now emergency and urgent referrals mostly, and routine appointments have stopped. Full time consultants have been replaced by 1 or 2 day a week locum posts (which can remain unfilled for a long time due to the low pay).

Chunky Monkey

People ask me will I be going back to Ireland when I graduate and I tell them not a hope in hell. For many reasons but of course this is pretty much the main one.

Though I wouldn't stay here either. Came on to a morning shift a couple of weeks ago and during handover was told that one of the patients had been agitated and up all night. Nurses asked doc to prescribe sleeping tabs or sedative (can't remember which) but dr couldn't come as he was only doctor on for the entire hospital (around 850 beds and he was an F2). Apparently this wasn't due to staff taking off sick etc, this is how it is every night. O_o

Narkius Maximus

Chunky Monkey wrote: »

People ask me will I be going back to Ireland when I graduate and I tell them not a hope in hell. For many reasons but of course this is pretty much the main one.

Though I wouldn't stay here either. Came on to a morning shift a couple of weeks ago and during handover was told that one of the patients had been agitated and up all night. Nurses asked doc to prescribe sleeping tabs or sedative (can't remember which) but dr couldn't come as he was only doctor on for the entire hospital (around 850 beds and he was an F2). Apparently this wasn't due to staff taking off sick etc, this is how it is every night. O_o

In the UK? First I thought F1/F2 were pretty much day jobs. Second, was the whole point of modernising medical careers (MMC) in UK to move to a 24hr service in UK with appropriate levels of staff. An F2 could not be the 'only' doctor in an 850 bed hospital. Perhaps he/she was covering wards as the junior. Thirdly, sleeping tabs are for nurses, not for patients who are agitated and should have a proper medical review:D:D

Chunky Monkey

That's what I thought but apparently not. I went to a training day last week where the blood transfusion matron openly admitted that we're quite backwards here compared to a lot of other trusts in the country.

Was talking to another nurse who is good friends with a junior doctor from another EU country...apparently he was being forced to work well beyond the 48 hr per week limit (often doing 12 hour shifts) and not getting paid for it so he has left the UK, he couldn't stand it anymore.

Should probably talk to some docs directly though shouldn't I (not saying I don't believe the nurses though, they're pretty cool here)

The MMC has pretty much gone to pot. There's a revised version of Tomorrow's Doctors (haven't read it yet though). They're also still changing the F1 application. Some schools are trialling it this year (wouldn't be surprised if ours is one of them) with a view to implementing it everywhere by 2013 (when I graduate hopefully!) if it goes okay.....

Echani

I think this problem is going to be compounded by the new EU regulations being implemented this year that ranks all non-EU citizens, whether first in the class and trained in Ireland or not, below all EU citizens when applying for Intern positions. For my college, it means that a lot of extremely bright candidates who may have otherwise stayed in the country for another year will be prioritizing their US / Canadian / Australian applications.

Chunky Monkey

Echani wrote: »

I think this problem is going to be compounded by the new EU regulations being implemented this year that ranks all non-EU citizens, whether first in the class and trained in Ireland or not, below all EU citizens when applying for Intern positions. For my college, it means that a lot of extremely bright candidates who may have otherwise stayed in the country for another year will be prioritizing their US / Canadian / Australian applications.

:eek:

Wonder whether RCSI are going to include that in their next prospectus...

Narkius Maximus

Echani wrote: »

I think this problem is going to be compounded by the new EU regulations being implemented this year that ranks all non-EU citizens, whether first in the class and trained in Ireland or not, below all EU citizens when applying for Intern positions. For my college, it means that a lot of extremely bright candidates who may have otherwise stayed in the country for another year will be prioritizing their US / Canadian / Australian applications.

This point was actually discussed at grand round where I work this morning. The whole thing is ridiculous. I feel sorry for Non-EU students studying in Ireland, who for the most part pay serious fees for the pleasure of stuying in Ireland and then will now be shown the door with very little likelihood of returning to practice because they will find it difficult to get registration for SHO/Reg vacancies. Ireland of the welcomes!!!

Second issue raised was that in 2012, there will be more graduates than intern posts, with no real plans to increase intern positions. Couple this with declining numbers of SHOs filling vacancies, the HSE's express desire to lower the number of NCHD spots, and the stupidight and shortsightedness of the medical council's draconian new registration/visa requiremens for non-EU docs, one can forsee a situation where there will be a huge manpower issue in a couple of years.

If this wasn't reality you would laugh. Think I might lend them my specs.

Traumadoc

In a few years there will be NCHD unemployment.

With reconfiguration the numbers of NCHD jobs will decrease. While the number of Irish graduates will more than double.

Chunky Monkey

Narkius Maximus wrote: »

This point was actually discussed at grand round where I work this morning. The whole thing is ridiculous. I feel sorry for Non-EU students studying in Ireland, who for the most part pay serious fees for the pleasure of stuying in Ireland and then will now be shown the door with very little likelihood of returning to practice because they will find it difficult to get registration for SHO/Reg vacancies. Ireland of the welcomes!!!

Second issue raised was that in 2012, there will be more graduates than intern posts, with no real plans to increase intern positions. Couple this with declining numbers of SHOs filling vacancies, the HSE's express desire to lower the number of NCHD spots, and the stupidight and shortsightedness of the medical council's draconian new registration/visa requiremens for non-EU docs, one can forsee a situation where there will be a huge manpower issue in a couple of years.

If this wasn't reality you would laugh. Think I might lend them my specs.

But that's exactly what happened in the UK. Just recently. What is it with the Irish having to reinvent the square wheel.