The travelling doctor

Dr.NickRiviera

Hi all,

As a returning Irish trained (international) medical graduate who was forced to work abroad due to lack of internship posts in Ireland (at the time) I would like to offer my experiences to any that may have an interest.

Whether its just out of curiosity or you genuinely want to hear about what its like to work outside Ireland (experience mainly of New Zealand/Australia), I am happy to share. Likewise your experiences working in the HSE would be warmly welcomed.

It's an exciting time for myself as the challenge of reintegrating into the HSE after gaining experience abroad will be very interesting. From what I gather it's an interesting time for all NCHDs as genuine efforts into resolving the issues the HSE have faced over the last few years although slow, remain a firm step in the right direction.

Look forward to some interesting discussions!

Regards,

Dr Nick

51533823

Hi Nick,

A few questions for you:

What are the chances of getting a training post in Aus/NZ? In relation to GP training posts I've seen something about a 10 year moratorium in Aus. Is this the same in NZ?

Would love to hear your thoughts as I hope to head that direction on graduation.

Thanks

take everything

Hi Nick.
Can you outline how Ireland compares with Aus/NZ in terms of:

Hours
Workload
Proper supervison/training.
Are you too busy chasing after some xray report, say, to learn anything like in Ireland, or are the roles more distinctly clinical.

You can only speak for surgery yeah?
But maybe you could comment on Medicine as well.

Dr.NickRiviera

51533823 wrote: »

Hi Nick,

A few questions for you:

What are the chances of getting a training post in Aus/NZ? In relation to GP training posts I've seen something about a 10 year moratorium in Aus. Is this the same in NZ?

Would love to hear your thoughts as I hope to head that direction on graduation.

Thanks

All the guys I know got onto the GP training scheme in NZ within 2-3 years post graduation. It is competitive but nowhere near as competitive as Ireland or Australia. I believe since there are far greater doctor shortages in New Zealand than Australia that would probably be why. A very considerable number of Kiwis emigrate to Australia for several reasons and so opportunities become available for others who would like to settle or train in NZ.
As for a period of 10 years. I am not certain if that is even entirely accurate for Australia or perhaps that only applies to certain urban districts, however as I am not sure I cannot comment. In NZ there is no such period...period.

Hope that helps

Dr.NickRiviera

take everything wrote: »

Hi Nick.
Can you outline how Ireland compares with Aus/NZ in terms of:

Hours
Workload
Proper supervison/training.
Are you too busy chasing after some xray report, say, to learn anything like in Ireland, or are the roles more distinctly clinical.

You can only speak for surgery yeah?
But maybe you could comment on Medicine as well.

Ok. I have worked in both surgical and medical rotations so I can speak about both although more about surgical. I'll try to keep it general for now.

1. Hours:
Obviously the more senior you get the more the responsibilities and hours working are needed. In Ireland there is a 48h/week work limit as outlined by EU law. This is clearly never met in most cases and we have all heard about doctors working >100h/week. Overtime is often not paid which makes it worse.
In NZ your pay scale is determined by the bracket of hours you work per week. For example <40h, 41-50, 51-55, 56-64 and 65+ Each would have a increase in salary depending on how long you worked. Every single hour above this is paid promptly without question at a pre-negotiated scale set by the Doctors Union.

2. Workload
I found that workload can be busy at times but almost never oppressive. There are always other doctors who are having a quiet day or two and they often are happy to come aid you when you are struggling. This is always reciprocated of course when the tables have turned. Suffice to say that the workload would always average out as less than you would be handling in Ireland. A 35 patient load on one House officer would be deemed 'Madness' whereas in Ireland that would be a norm. I've been lucky to have 2 whole weeks over the last year when all my bosses were off so I had no patients at all...I kept myself busy though helping others that were enjoying the 'madness'

3. Training/supervision
Excellent. If you are keen and show interest you will be trained and taught on any area that interests you. I often had private tutorials other than the official ones set by the medical council on common hospital clinical issues. Consultants are more than happy to have you scrub in with them and assist on procedures. There is protected teaching time during the week and that's not for trainee's either.
As things are usually not as busy as in Ireland you will get far more one on one chances with seniors to practice and learn new skills.

Bloods, Radiology and all general management of the patient is part and parcel of any junior doctors life. Learning to prioritize and manage the chasing of results is a very important task and in itself is a learning opportunity. As you become more senior that task is delegated to your juniors so consider it a right of passage that we all go through. I personally managed to program my IPAD to be able to access the hospital network at anytime so I had all the results at hand pretty much whenever I needed them.

In summary the general consensus from myself and my classmates that moved to NZ/OZ is that you work fair hours and loads and retain a great quality of life compared to Ireland. The money is competitive and the training is excellent if you are keen. You never chose to become a doctor for wealth or to be bitter and miserable. Balance is strongly advocated and encouraged.

Hope that helps!

51533823

Dr.NickRiviera wrote: »

All the guys I know got onto the GP training scheme in NZ within 2-3 years post graduation. It is competitive but nowhere near as competitive as Ireland or Australia. I believe since there are far greater doctor shortages in New Zealand than Australia that would probably be why. A very considerable number of Kiwis emigrate to Australia for several reasons and so opportunities become available for others who would like to settle or train in NZ.
As for a period of 10 years. I am not certain if that is even entirely accurate for Australia or perhaps that only applies to certain urban districts, however as I am not sure I cannot comment. In NZ there is no such period...period.

Hope that helps

Thanks for the great info.

I'll be coming from a graduate entry program here in Ireland and so will have a good share of debt on graduation. How are the wages in NZ for junior doctors in the first two years and then later while on a GP training scheme?

Many thanks!

Rick Dagless

Dr.NickRiviera wrote: »

Hi all,

As a returning Irish trained (international) medical graduate who was forced to work abroad due to lack of internship posts in Ireland (at the time) I would like to offer my experiences to any that may have an interest.

Whether its just out of curiosity or you genuinely want to hear about what its like to work outside Ireland (experience mainly of New Zealand/Australia), I am happy to share. Likewise your experiences working in the HSE would be warmly welcomed.

It's an exciting time for myself as the challenge of reintegrating into the HSE after gaining experience abroad will be very interesting. From what I gather it's an interesting time for all NCHDs as genuine efforts into resolving the issues the HSE have faced over the last few years although slow, remain a firm step in the right direction.

Look forward to some interesting discussions!

Regards,

Dr Nick

Hi Dr. Nick.

It's very early days but I'm giving serious thought to training in the US/Canada after intern year. Have you any experience of N. America? NZ/Oz sound appealing but would it be easier to get a residency in N. America?

Thanks

Dr.NickRiviera

51533823 wrote: »

Thanks for the great info.

I'll be coming from a graduate entry program here in Ireland and so will have a good share of debt on graduation. How are the wages in NZ for junior doctors in the first two years and then later while on a GP training scheme?

Many thanks!

Wages are competitive with Ireland especially when you factor in living costs, transport, rent etc not forgetting quality of life. The exact wages are all published online. Depending on hours ultimately and what run you are on you would be looking significantly more potential to save/pay debts etc. All the time maintaining a balanced life and negating the starts of a gastric ulcer...
Personally, I had a loan to pay back in Ireland from my college days too so I was able to pay that, pay rent for a 3 bedroom villa on a hill with ocean views, V6 3.0L car (petrol isnt cheap!), and go out for dinner 3-4 times a week and still save about 1/3 of my earnings without breaking a sweat. Hopefully that helps

Dr.NickRiviera

Rick Dagless wrote: »

Hi Dr. Nick.

It's very early days but I'm giving serious thought to training in the US/Canada after intern year. Have you any experience of N. America? NZ/Oz sound appealing but would it be easier to get a residency in N. America?

Thanks

Hey,

I'm afraid I cannot comment accurately about N.America and residency programs. Half my uni year returned back there and they all seem to be doing well. Residency programs are gonna be tough anywhere you apply. Some tougher than others.

The general feel of the N.American program is that if you can get on it you are pretty sorted and will be looking at a fast track system of getting into a specialty. The hours are crazy and the pay is very low compared to europe/nz/oz. However it does increase exponentially and you will become a consultant much faster than the other regions after which your salary would dwarf those of the rest of the world.

However from my own experiences with working with fellows from N.America vs Irish fellows...(at least 5-6) you can't compare them. Irish win hands down. Just because you become a consultant faster doesn't necessarily make you a better doctor. The whole hardship process of your junior years in Ireland/Australasia serves an important purpose, you will be far better rounded overall.

So best advice would be to create as many options for yourself eg sit USMLEs and apply for several intern programs. The Internship issue that I had when I graduated in 2009 seems to still be a huge issue for International grads in Ireland. I doubt this will be changing anytime soon...

Hope that helps!

briankirby

Thanks a lot Dr Nick for this thread.
Can i ask,did u average about 50 hours a week as an sho over there?I believe in the uk some weeks u do 80 hours and others u have a few days off.

Also,how old can a doctor be if they want to do their specialty training in NZ?
As in,is there a cut off age?
Thanks

Dr.NickRiviera

briankirby wrote: »

Thanks a lot Dr Nick for this thread.
Can i ask,did u average about 50 hours a week as an sho over there?I believe in the uk some weeks u do 80 hours and others u have a few days off.

Also,how old can a doctor be if they want to do their specialty training in NZ?
As in,is there a cut off age?
Thanks

Hey,

To answer your questions. On average it would be around 50-55 hours/week. Really depends on what specialty you are on. Surgical usually does more hours than medical. Pretty sure this is worldwide. ED has its own roster system so if you work over the weekly cap you are given a few days off so that you may still be within the weekly hour limit.

There is no age limit on specialty training that I am aware of. If you are interested in a particular area and show commitment in that field you stand a good chance to get on.

I just met a couple of doctors returning from NZ on the flight back to Dublin and we all agreed what an awesome deal working there was. It's almost like a paid holiday was one of the comments said. That kind of sums it all up really...

briankirby

Wow,sounds fantastic.
Good work hours/conditions,good pay,support,progression and sun every day.
Begs the question
Why are u guys coming back?:eek:
Cheers for your reply

Dr.NickRiviera

Ya I've been asking myself the exact same question since I moved back. Oh well, starting new job in 9 hours and I look forward to the 'challenge' of working for the HSE and testing my resolve and determination. NZ was a working holiday...I'm sure to find out soon enough. Will keep you posted on how the slaughter goes lol

Dr Nick

RobFowl

Good luck in the new post Dr Nick
hope it works out well. be interested to see how they compare!
(Never actually worked as a nchd here, came back as a trained GP)

Dr.NickRiviera

OH...MY...GOD...

First week done. I am too wrecked to even begin to describe. 36 hour shift on call working straight without 1 min of sleep...and in for theatre in the morning post call. I was warned...

Suffice to say...If you can hack it over here...you can hack it anywhere in the world...

Any NCHD that works here would be basically on holiday working in NZ/OZ...I really can't believe what I just experienced. And I still have a whole weekend on call to look forward to...

Interesting observation tho...almost 99% of interns are Irish...almost 99% of consultants are Irish...almost 90% of NCHDs are foreign...hmmm

All that said...This is what I signed up for and I genuinely love every second of it. Digging deep...

'I firmly believe that any man's finest hour, the greatest fulfillment of all that he holds dear, is the moment when he has worked his heart out in a good cause and lies exhausted on the field of battle-victorious.' (Vince Lombardi)

And yes...the HSE is a field of battle...

opinion guy

Lol was waiting for a post like that.

All that said...This is what I signed up for and I genuinely love every second of it. Digging deep...

The Force is strong in this one.

I wager 4 cuatros on the newcomer......

take everything

Dr.NickRiviera wrote: »

OH...MY...GOD...

First week done. I am too wrecked to even begin to describe. 36 hour shift on call working straight without 1 min of sleep...and in for theatre in the morning post call. I was warned...

Suffice to say...If you can hack it over here...you can hack it anywhere in the world...

Any NCHD that works here would be basically on holiday working in NZ/OZ...I really can't believe what I just experienced. And I still have a whole weekend on call to look forward to...

Interesting observation tho...almost 99% of interns are Irish...almost 99% of consultants are Irish...almost 90% of NCHDs are foreign...hmmm

All that said...This is what I signed up for and I genuinely love every second of it. Digging deep...

'I firmly believe that any man's finest hour, the greatest fulfillment of all that he holds dear, is the moment when he has worked his heart out in a good cause and lies exhausted on the field of battle-victorious.' (Vince Lombardi)

And yes...the HSE is a field of battle...

36 hr shifts should be a thing of the past according to the EWTD if i'm not mistaken. Was quite disappointed that my current job ignores this as well (in fairness my job is quite cushy compared to surgery but still).
Post-call (trying to get the new admissions straight in your head etc) as you say is the real killer.

opinion guy

take everything wrote: »

36 hr shifts should be a thing of the past according to the EWTD if i'm not mistaken. Was quite disappointed that my current job ignores this as well (in fairness my job is quite cushy compared to surgery but still).
Post-call (trying to get the new admissions straight in your head etc) as you say is the real killer.

What planet are you living on that you thought 36hours shifts were gone ?
Its still normal for surgical shos and registrars to work sat morning to mon evening inclusive for heavens sake. That's about 60 hours plus. In one go. That's "normal" practice. In most hospitals in the country.
Some disciplines do more. I've heard of people coming on duty Friday morning and leaving Monday

briankirby

Thanks a lot for the update dr Nick.
Most public servants work 36 hours in an entire week.36 hour shift is ridiculous.
Opinion guy,this may be a rhetorical question but if u refused to work more than your contracted hours,what would the consequences be?
I cant think of any other profession where this would be deemed acceptable.
If i ever do med,ill be leaving for the uk or NZ very quickly

opinion guy wrote: »

What planet are you living on that you thought 36hours shifts were gone ?
Its still normal for surgical shos and registrars to work sat morning to mon evening inclusive for heavens sake. That's about 60 hours plus. In one go. That's "normal" practice. In most hospitals in the country.
Some disciplines do more. I've heard of people coming on duty Friday morning and leaving Monday

take everything

What planet are you living on that you thought 36hours shifts were gone ?

Easy there. Where did i say they were gone. Of course they're here still (I did one last night FFS). What i said was before starting this job i hoped they adhered to something resembling a 24 hr max (EWTD) thing like they do in other places i have worked. They didn't.

Its still normal for surgical shos and registrars to work sat morning to mon evening inclusive for heavens sake.

I haven't done surgery since internship (and yeah saturday morning to monday at 5 was a weekend then) but i'm not sure if this is actually true generally still. I was of the impression this was largely gone (to resemble something vaguely like EWTD). Anyone from surgery/internal medicine want to say what a weekend involves for them?
Anyway, all the last few jobs i've done, i never worked longer than 32 hours or so.

That's about 60 hours plus. In one go. That's "normal" practice. In most hospitals in the country.

Dunno if it is any more.
Varies with specialty but anyone else here still work longer than 35 hours regularly?

Some disciplines do more. I've heard of people coming on duty Friday morning and leaving Monday

Really. That was a weekend years ago. but now? Still? Really?

opinion guy

take everything wrote: »

I haven't done surgery since internship (and yeah saturday morning to monday at 5 was a weekend then) but i'm not sure if this is actually true generally. I was of the impression this was largely gone (to resemble something vaguely like EWTD). Anyone from surgery/internal medicine want to say what a weekend involves for them?
Anyway, all the last few jobs i've done, i never worked longer than 32 hours or so.

Dunno if it is any more.
Varies with specialty but anyone else here still work longer than 35 hours regularly?

Really. That was a weekend years ago. but now? Still? Really?

I'm not talking about interns here - shos & registrars. This was still the case last time I talked to a surgeon which was a few months back maybe

take everything

opinion guy wrote: »

I'm not talking about interns here - shos & registrars. This was still the case last time I talked to a surgeon which was a few months back maybe

Interns, shos, whatever.
What i'm saying to you is the last time i did a weekend from Saturday to Monday at 5 was as a surgical Intern (and the SHO did the same, and the reg- but he got to stay offsite a bit of course). But that was a few years ago. I was under the impression this has changed. Maybe it's because of specialty but what i'm saying is since then, i haven't done this kind of weekend shift. The longest i've worked is maybe 35 hours.
I know people who still work Saturday and Sunday and Mon to 5 but is this still the norm? I'd be interested to know if others do still work 60-70 hour shifts regularly.

opinion guy

take everything wrote: »

Interns, shos, whatever.
What i'm saying to you is the last time i did a weekend from Saturday to Monday at 5 was as a surgical Intern (and the SHO did the same, and the reg- but he got to stay offsite a bit of course). But that was a few years ago. I was under the impression this has changed. Maybe it's because of specialty but what i'm saying is since then, i haven't done this kind of weekend shift. The longest i've worked is maybe 35 hours.
I know people who still work Saturday and Sunday and Mon to 5 but is this still the norm? I'd be interested to know if others do still work 60-70 hour shifts regularly.

I make a point of asking any docs I meet about this. And I meet a few. I can tell you with more surety than the HSE or the IMO that this is the norm for surgical services in most hospitals.

See this is part of the problem here. When folks like you get up the ladder you lose touch with whats going on on the ground floor. SpR's and Consultants simply don't concern themselves which such menialities. Never mind the fact that most of what interns and shos's at least do is non medical work.
Hence the mass exodus.

take everything

opinion guy wrote: »

I make a point of asking any docs I meet about this. And I meet a few. I can tell you with more surety than the HSE or the IMO that this is the norm for surgical services in most hospitals.

See this is part of the problem here. When folks like you get up the ladder you lose touch with whats going on on the ground floor. SpR's and Consultants simply don't concern themselves which such menialities. Never mind the fact that most of what interns and shos's at least do is non medical work.
Hence the mass exodus.

I'm not up the ladder.
I'm probably just lucky to have worked in areas/jobs with shifts no longer than 32 hrs . I completely agree that doctors at SHO level are often treated appallingly. And that a lot of what they do is, as you say, bull****, time-consuming non-clinical stuff.

lonestargirl

take everything wrote:

I haven't done surgery since internship (and yeah saturday morning to monday at 5 was a weekend then) but i'm not sure if this is actually true generally still. I was of the impression this was largely gone (to resemble something vaguely like EWTD). Anyone from surgery/internal medicine want to say what a weekend involves for them?

The surgery reg job my husband just finished was Sat morn to Mon evening weekend call, Q4 all in house. This was in Dublin.

lonestargirl

Quote fail = iPhone

opinion guy

lonestargirl wrote: »

The surgery reg job my husband just finished was Sat morn to Mon evening weekend call, Q4 all in house. This was in Dublin.

How did he feel about that ?

j.mcdrmd

briankirby wrote: »

Most public servants work 36 hours in an entire week.36 hour shift is ridiculous.

I cant think of any other profession where this would be deemed acceptable.

opinion guy wrote: »

I can tell you with more surety than the HSE or the IMO that this is the norm for surgical services in most hospitals.

See this is part of the problem here. When folks like you get up the ladder you lose touch with whats going on on the ground floor. SpR's and Consultants simply don't concern themselves which such menialities. Never mind the fact that most of what interns and shos's at least do is non medical work.

Is there a cultural problem here, what would not be acceptable in any other job is accepted in medicine?

RobFowl

j.mcdrmd wrote: »

Is there a cultural problem here, what would not be acceptable in any other job is accepted in medicine?

I think you have hit the nail on the head here. So many generations of docs have done these sort of hours it's seen almost as a rite of passage. That said some surgical schemes do seem to need long shifts to allow senior nchds to get the nessecary experience.

lonestargirl

opinion guy wrote: »

How did he feel about that ?

From a work element he finds it ok. We were in the US for a while where the hours are longer overall (you go home after call but can work weeks and weeks with that 24 post call period being your only time off). We have an 18 month old and when he was on all weekend we would come out and visit for coffee on the Sunday morning so that he could see his dad.

RobFowl wrote: »

I think you have hit the nail on the head here. So many generations of docs have done these sort of hours it's seen almost as a rite of passage. That said some surgical schemes do seem to need long shifts to allow senior nchds to get the nessecary experience.

There is also the sense of responsibility that most doctors feel to their patients. Many would find it hard to leave if they know that people still need them.

opinion guy

RobFowl wrote: »

That said some surgical schemes do seem to need long shifts to allow senior nchds to get the nessecary experience.

I've heard this said. But whats the evidence ?

lonestargirl wrote: »

From a work element he finds it ok. We were in the US for a while where the hours are longer overall (you go home after call but can work weeks and weeks with that 24 post call period being your only time off). We have an 18 month old and when he was on all weekend we would come out and visit for coffee on the Sunday morning so that he could see his dad.

Ok he finds it ok. But does he think it should be like that ?

j.mcdrmd

RobFowl wrote: »

I think you have hit the nail on the head here. So many generations of docs have done these sort of hours it's seen almost as a rite of passage. That said some surgical schemes do seem to need long shifts to allow senior nchds to get the nessecary experience.

That makes it sound eerily like hazing to me. Surely it is time for the culture to change.

Reports on here suggest that there is a good work/life balance in New Zealand and Oz, does this mean that they are useless doctors there?

There are nchds of all levels doing 36+ hour shifts. When does a nchd become a senior nchd, I thought nchds were referred to as 'junior doctors' all their working lives unless they become consultants?

RobFowl

j.mcdrmd wrote: »

That makes it sound eerily like hazing to me. Surely it is time for the culture to change.

Reports on here suggest that there is a good work/life balance in New Zealand and Oz, does this mean that they are useless doctors there?

There are nchds of all levels doing 36+ hour shifts. When does a nchd become a senior nchd, I thought nchds were referred to as 'junior doctors' all their working lives unless they become consultants?

The culture is slowly changing but the work life balance as an nchd is poor.

The term juniors doctor can be a bit misleading as it covers newly qualified interns as well as registrars who have done all their postgrad exams and are simply waiting for a consultant position to become available .

MrCreosote

lonestargirl wrote: »

There is also the sense of responsibility that most doctors feel to their patients. Many would find it hard to leave if they know that people still need them.

That sense of vocation has been abused by the HSE for years as a way to avoid putting in place pretty simple changes to allow more humane working conditions.

j.mcdrmd

MrCreosote wrote: »

That sense of vocation has been abused by the HSE for years as a way to avoid putting in place pretty simple changes to allow more humane working conditions.

I agree with this 100%

Slow change to problems as serious as this are only an excuse.

j.mcdrmd

RobFowl wrote: »

The culture is slowly changing but the work life balance as an nchd is poor.

The term juniors doctor can be a bit misleading as it covers newly qualified interns as well as registrars who have done all their postgrad exams and are simply waiting for a consultant position to become available .

But I have always thought that if it is rotten you cut it out.

They seem to be producing doctors in New Zealand and Oz without the hazing culture. Are they not up to scratch?

opinion guy

MrCreosote wrote: »

That sense of vocation has been abused by the HSE for years as a way to avoid putting in place pretty simple changes to allow more humane working conditions.

Now hold up here. Don't go blaming it all on the HSE. The consultants have their hands in maintaining the status quo. Particularly when it comes to rosters

j.mcdrmd

opinion guy wrote: »

Now hold up here. Don't go blaming it all on the HSE. The consultants have their hands in maintaining the status quo. Particularly when it comes to rosters

Very good point, the HSE would not have gotten away with treating the nchds so badly without the compliance of consultants.

Vorsprung

I came back from Oz in March, was there for about 2.5 years. Loved every minute of it. Had a great work life balance, did ED mostly and worked 4 days a week, 10-12 hour days. We had protected teaching time, which was led by enthusiastic consultants, who were rostered for teaching by the 2 Directors of Emergency Medical Training (DEMTs) - every ED in Oz with ED trainees has at least one such person.

Since coming home, I've stayed in ED but not committed to a scheme, just to see what it's like. I've had about 3 hours of training since I've come home. There's no senior support after 6pm, and I've even had other regs suggest I call them instead of calling the boss at night! The lack of staff (doctors, nurses, AHPs) is troubling, seeing people wait 9 hours to be seen is embarrassing and it's added to by the access block. I've seen one surgical SHO do 4 busy calls in a week and look worse than some of the patients they've admitted by the end of it.

Completely agree about the lack of (apparent) support from the bosses for change.

For personal reasons it'll be a while before I head abroad again, may not ever head away. I'm glad to be home to see my mates/family, but I've gone backwards in terms of my career. I might sound bitter - I am!

Rant over!

j.mcdrmd

Vorsprung wrote: »

I came back from Oz in March, was there for about 2.5 years. Loved every minute of it. Had a great work life balance, did ED mostly and worked 4 days a week, 10-12 hour days. We had protected teaching time, which was led by enthusiastic consultants, who were rostered for teaching by the 2 Directors of Emergency Medical Training (DEMTs) - every ED in Oz with ED trainees has at least one such person.

Since coming home, I've stayed in ED but not committed to a scheme, just to see what it's like. I've had about 3 hours of training since I've come home. There's no senior support after 6pm, and I've even had other regs suggest I call them instead of calling the boss at night! The lack of staff (doctors, nurses, AHPs) is troubling, seeing people wait 9 hours to be seen is embarrassing and it's added to by the access block. I've seen one surgical SHO do 4 busy calls in a week and look worse than some of the patients they've admitted by the end of it.

Completely agree about the lack of (apparent) support from the bosses for change.

For personal reasons it'll be a while before I head abroad again, may not ever head away. I'm glad to be home to see my mates/family, but I've gone backwards in terms of my career. I might sound bitter - I am!

Rant over!

Thank you for your honesty, it is in short supply around here. The current working conditions for nchds are disgraceful.

MrCreosote

opinion guy wrote: »

Now hold up here. Don't go blaming it all on the HSE. The consultants have their hands in maintaining the status quo. Particularly when it comes to rosters

This is true.

But it is the HSE that are legally bound to change, and ultimately they are the ones that could change the rosters, regardless of whatever other groups with a vested interest would prefer.

It would make it easier with the consultants on board of course, but why would they do something that would change a pretty sweet deal for themselves.

Dr.NickRiviera

I'm glad for all the interest generated by my initial post. I realize now how naive I was thinking that it can't be as bad as they said. Now I am here the penny has finally dropped and yes I am a little worried that I might have made a massive error in judgement. That said its still early days and I will be in a better position to assess after 6 months of carnage. Stay tuned...

The crux of the issue I feel is that people genuinely have no idea what working conditions are like outside. Therefore they carry on as this is the norm. Reminds me of a documentary I saw about this little 13 year old african girl who used to get raped on a regular basis by several militia soldiers on her route to get water for her village. When asked why or what she thought about it. She replied sure isnt that normal? (I'm serious...was a shocking but true BBC documentary)

I had an interesting conversation with a guy who made a good point. He felt that the junior doctors put up with these conditions because they are afraid to question the powers at be. If they complain or actually try to do something that will have a detrimental impact on their career path. Getting on a training scheme is hard enough. Trying to get on one after being labeled as the doctor who tried to rock the cradle...good luck! I do disagree with this though as god knows doctors put their own health at risk only because they believe its the right thing to do for the patient. I guess that's the leverage the HSE has on us. Our moral/ethical commitment.

These work conditions are illegal pure and simple. It states very clearly on your contract that you may not work for a period of 24h without a 8h rest period. NCHDS are being used and abused and I guess we have a choice to make. We can join the exodus, or we can keep on trucking...or we can rebel.

Someone mentioned that because we do more hours we gain more experience. Possible. Exposure would be directly correlated to experience...only when you are able to retain and process. Not sure about anyone else but I was struggling to talk post 30 hours...

So my question is...and forgive me if this sounds a bit crazy...where is the doctors union???

ps Can someone please send a memo to the colleges to add 'secretarial/administrative skills' lectures to the medical student's curriculum. HSE should advertise 'Surgical SHO vacancy. Require PHD in admin and general secretarial work. Doctors skills would be a bonus'

opinion guy

MrCreosote wrote: »

This is true.

But it is the HSE that are legally bound to change, and ultimately they are the ones that could change the rosters, regardless of whatever other groups with a vested interest would prefer.

It would make it easier with the consultants on board of course, but why would they do something that would change a pretty sweet deal for themselves.

Except its not that simple. The consultants can throw continuity of care at them and tell them its dangerous to break that by implementing EWTD. Whether that's true or not is another matter. But management can't argue with that even if they want to - they'd be putting themselves at liability if they were seen to force change against 'expert' medical advice......even if that is largely biased opinion without an evidence base.

MrCreosote

Dr.NickRiviera wrote: »

So my question is...and forgive me if this sounds a bit crazy...where is the doctors union???

If you're thinking of something like the NZRDA, then nowhere. There's no Irish equivalent.

drzhivago

Vorsprung wrote: »

I came back from Oz in March, was there for about 2.5 years. Loved every minute of it. Had a great work life balance, did ED mostly and worked 4 days a week, 10-12 hour days. We had protected teaching time, which was led by enthusiastic consultants, who were rostered for teaching by the 2 Directors of Emergency Medical Training (DEMTs) - every ED in Oz with ED trainees has at least one such person.

Since coming home, I've stayed in ED but not committed to a scheme, just to see what it's like. I've had about 3 hours of training since I've come home. There's no senior support after 6pm, and I've even had other regs suggest I call them instead of calling the boss at night! The lack of staff (doctors, nurses, AHPs) is troubling, seeing people wait 9 hours to be seen is embarrassing and it's added to by the access block. I've seen one surgical SHO do 4 busy calls in a week and look worse than some of the patients they've admitted by the end of it.

Completely agree about the lack of (apparent) support from the bosses for change.

For personal reasons it'll be a while before I head abroad again, may not ever head away. I'm glad to be home to see my mates/family, but I've gone backwards in terms of my career. I might sound bitter - I am!

Rant over!

I had that thrown at me a few times about going backwards in career

Who cares

It is your career, have you had life experiences you will value, then if answer is yes ***k it, you will work for 40 years

if 10years are spent as NCHD or 15 or like me a bit more then there will be a smaller time as a consultant but if you can pay your bills, have some fun, respect your colleagues and patients then who cares

opinion guy

drzhivago wrote: »

if 10years are spent as NCHD or 15 or like me a bit more then there will be a smaller time as a consultant but if you can pay your bills, have some fun, respect your colleagues and patients then who cares

Is being a consultant all its cracked up to be anyhow ?

You will have a bunch of overworked, undertrained, under-rested, disgruntled nchd's working for you who can f**k up at any time and land you in court.....:pac:

RobFowl

drzhivago wrote: »

I had that thrown at me a few times about going backwards in career

Who cares

It is your career, have you had life experiences you will value, then if answer is yes ***k it, you will work for 40 years

if 10years are spent as NCHD or 15 or like me a bit more then there will be a smaller time as a consultant but if you can pay your bills, have some fun, respect your colleagues and patients then who cares

There are some people who rock the boat and fight for the rights of NCHD's yet suffer career wise as a result.
Those pelople are never forgotten and when they do get their hard earned consultancy you will know that things will start to change from the top down.

Rick Dagless

Dr.NickRiviera wrote: »

Hey,

I'm afraid I cannot comment accurately about N.America and residency programs. Half my uni year returned back there and they all seem to be doing well. Residency programs are gonna be tough anywhere you apply. Some tougher than others.

The general feel of the N.American program is that if you can get on it you are pretty sorted and will be looking at a fast track system of getting into a specialty. The hours are crazy and the pay is very low compared to europe/nz/oz. However it does increase exponentially and you will become a consultant much faster than the other regions after which your salary would dwarf those of the rest of the world.

However from my own experiences with working with fellows from N.America vs Irish fellows...(at least 5-6) you can't compare them. Irish win hands down. Just because you become a consultant faster doesn't necessarily make you a better doctor. The whole hardship process of your junior years in Ireland/Australasia serves an important purpose, you will be far better rounded overall.

So best advice would be to create as many options for yourself eg sit USMLEs and apply for several intern programs. The Internship issue that I had when I graduated in 2009 seems to still be a huge issue for International grads in Ireland. I doubt this will be changing anytime soon...

Hope that helps!

Hi Dr. Nick,

Do you know of any good sites to find info on working in NZ and OZ or even about training schemes over there?

Thanks

Dr.NickRiviera

So just back after a 56 hour call/post call shift. Have to say although I'm a train wreck it's not that bad. I wouldn't want to do it every week but at the same time, I feel quite fulfilled and like I really made a difference. Exposure was awesome too. You don't see anything remotely as insane in NZ!

Might just be endogenous opiates released following the slaughter but I genuinely feel happy.

We may bitch and moan and cry but at the end of the day, push comes to shove, I reckon we would do this for free...lol who am I kidding...grabs calculator to punch in overtime sunday double rates

Dr.NickRiviera

Rick Dagless wrote: »

Hi Dr. Nick,

Do you know of any good sites to find info on working in NZ and OZ or even about training schemes over there?

Thanks

Hi Rick,

Not off hand sorry. I can put you in contact with many doctors out there though who would be happy to put you in contact with whoever you need to get in contact with to find out what you need. PM me in around 6 months or so. Hope your internship is going smooth!

Nick

opinion guy

Dr.NickRiviera wrote: »

So just back after a 56 hour call/post call shift. Have to say although I'm a train wreck it's not that bad. I wouldn't want to do it every week but at the same time, I feel quite fulfilled and like I really made a difference. Exposure was awesome too. You don't see anything remotely as insane in NZ!

Might just be endogenous opiates released following the slaughter but I genuinely feel happy.

We may bitch and moan and cry but at the end of the day, push comes to shove, I reckon we would do this for free...lol who am I kidding...grabs calculator to punch in overtime sunday double rates

Dx: Post-call mania