"Going forward, looking back" - NB IMO Meeting February 6th - see 1st post

pansophelia

I'm not sure if I'm linking this properly, but this is an excellent, articulate piece in the Medical Independent about depression among NCHDs and the contribution of current working conditions in worsening this disease.
We're in a sorry state.
http://www.medicalindependent.ie/blog-post.aspx?title=going_forward_looking_back

MOD NOTE

Guys I'm sure many of you are following this on Facebook.

IMO/facebook group have organised the following meeting:

Meeting re: Current NCHD Issues

Radisson Hotel, Golden Lane, Dublin

Wednesday 6th February 2013

8pm

Vorsprung

Agree, widely linked to on Facebook too.

I only heard about these tragic deaths a few weeks back. Think it's worth an email to James Reilly with a request that he comment. **** it, might send it to all my TDs too.

Thanks for posting.

pansophelia

Vorsprung wrote: »

Agree, widely linked to on Facebook too.

I only heard about these tragic deaths a few weeks back. Think it's worth an email to James Reilly with a request that he comment. **** it, might send it to all my TDs too.

Thanks for posting.

That's a good idea - there's a huge sense of powerlessness among NCHDs, but it's time we realised that unless we try to change things, noone else is going to. I'm not great at taking action myself, but I'm getting really tired of being angry all the time, about a situation that be changed.

Vorsprung

This is what I sent my TDs (the tanaiste amongst them) and James Reilly. Look it's not flash, and if I asked about long working hours I thought I'd get the usual BS of EWTD implementation difficulties. It's past 1am, I'm just home from work and I'm tired!

Dear sirs/madam,

I'd be grateful for your comment and feedback on the tragic deaths of two young non consultant hospital doctors in recent months.

I'd like to draw your attention to this article by Dr Anthony O'Connor which alludes to those tragics deaths, and to comments posted below, including remarks by the parents of one of those involved.

For too long, there has been a blatant disregard when it comes to the working conditions of non consultant hospital doctors, to the detriment of their health and the health of their patients. It beggars belief that this continues while other modern health systems around the world (such as Australia, where I worked for some years) can accomodate reasonable rosters while doctors here continue to work 72 hours routinely. The exodus of junior doctors created by this and other factors will continue until you address these issues.

My question for you is as follows:

Do you accept that the mental and physical health of NCHDs is impaired by long working hours?

I look forward to hearing from you,

I'll let you know if I get anything back.

take everything

Brilliant article.
To think that work had any role in these suicides makes me sick.
Work should be enriching not some kind of penance.
And as he says, back to business as usual the following week by the media and the HSE is just further sickening.
Stupid fcuking country.

take everything

Actually that stuff about breaking a leg not being so bad was eerily familiar. Remember thinking like that at least once as an intern.
Crazy stuff.
Never again if i can help it.

opinion guy

Link is borked - looks like server overloaded - this crowd seriously need to sort out a proper server

pansophelia

opinion guy wrote: »

Link is borked - looks like server overloaded - this crowd seriously need to sort out a proper server

Can't seem to relink it, but just have a look in medicalindependent.ie, then look up Dr. Anthony O'Connor

ThatDrGuy

Vorsprung wrote: »

This is what I sent my TDs (the tanaiste amongst them) and James Reilly. Look it's not flash, and if I asked about long working hours I thought I'd get the usual BS of EWTD implementation difficulties. It's past 1am, I'm just home from work and I'm tired!



I'll let you know if I get anything back.

Great piece as usual by Anthony. I have been emailing and talking to TDs about this subject for quite a while. They dont care. I even cornered the good Dr Varadkar one day who told me that unless the training bodies or the IMO made a stink about it, they were going to continue to ignore it. This is how things work in this country.

Xeyn

ThatDrGuy wrote: »

Great piece as usual by Anthony. I have been emailing and talking to TDs about this subject for quite a while. They dont care. I even cornered the good Dr Varadkar one day who told me that unless the training bodies or the IMO made a stink about it, they were going to continue to ignore it. This is how things work in this country.

Rcsi couldn't care less as long as they can continue to fleece trainees for exams and courses etc.
I suspect there is a symbiotic relationship with hse to try get as many service years out of nchd's as possible.

EWT simply is not possible with the numbers in Ireland. Not by a long shot. Unless they close down a lot more services or improve training to entice doctors to stay this is not going to change.

HSE have been flouting these rules despite facing sanctions threats over the last few years.
There are few who care about the plight of NCHDs and fewer who are willing to stand up for them.

nerrad01

Xeyn wrote: »

Rcsi couldn't care less as long as they can continue to fleece trainees for exams and courses etc.
I suspect there is a symbiotic relationship with hse to try get as many service years out of nchd's as possible.

EWT simply is not possible with the numbers in Ireland. Not by a long shot. Unless they close down a lot more services or improve training to entice doctors to stay this is not going to change.

HSE have been flouting these rules despite facing sanctions threats over the last few years.
There are few who care about the plight of NCHDs and fewer who are willing to stand up for them.

its crazy because if the IMO actually cared and would spend the smallest amount of cash, they could have a PR field day letting the public know the facts about the conditions that nchd`s are operating under.....who in their right mind would want to get treated by someone who has barely slept for 36 hours!!

and if the government wont take action go above their heads straight to the European courts...but no no its ok to let the general public think all doctors earn consultancy salaries! the sooner they implode the better!

his_dudeness

The public don't care.

To run an EWTD compliant medical service would smash employment ceilings and likely cost more than the fines they already pay, otherwise it would've been implemented already.

Doctors make great advocates for their patients; **** advocates for themselves. That isn't going to change unless ALL DOCTORS say "No more".

chanste

I really like Anthony O'Connors column in MI. He expresses in a far more elegant way my own thoughts on these issues than I ever could.

One of the points which he made about how newspapers like the Irish Independent can move on within a week to giving out about the €97m on overtime to be spent on NCHDs truly disgusts me, and as I mentioned in another thread it seems the IMO was busy with other matters last year while the reputation of the doctors in Ireland were taking attacks on all fronts with no reply.

nerrad01

his_dudeness wrote: »

The public don't care.

To run an EWTD compliant medical service would smash employment ceilings and likely cost more than the fines they already pay, otherwise it would've been implemented already.

Doctors make great advocates for their patients; **** advocates for themselves. That isn't going to change unless ALL DOCTORS say "No more".

the only way for a strike to work is to have the public on your side, if doctors carried out a strike now there would be zero public support due to all grades of doctors being lumped in with consultants!!

pansophelia

I don't really think this has anything to do with EWTD anymore though. This is an unsafe working environment - dangerous to doctor's health (not to mention that of members of the public). All this talk of EWTD just obscures the whole underlying issue, especially since most members of the public don't really understand it.
I agree that it would be difficult to run the service that is run at the moment with less hours, but it would be entirely possible. It requires a bit of creativity, a close analysis of current working arrangements and supply and demand, but it is doable. Obs/Gynae in several of the major hospitals has switched to max 24 hour shifts (which in my mind is still too much), Paeds is largely max 24 hour call shifts, so why can't Medicine follow suit?

his_dudeness

nerrad01 wrote: »

the only way for a strike to work is to have the public on your side, if doctors carried out a strike now there would be zero public support due to all grades of doctors being lumped in with consultants!!

For doctors to strike will immediately put the public against us, regardless of their position pre-strike. To find out that noone will be in the Resus department or responding to the Arrest bleep, that would turn the public against Docs.

(Yes, there are lesser types of industrial action but the health service would still work in its own defunct way. The only way for the government to notice is all-out strike)

pansophelia wrote: »

I don't really think this has anything to do with EWTD anymore though. This is an unsafe working environment - dangerous to doctor's health (not to mention that of members of the public). All this talk of EWTD just obscures the whole underlying issue, especially since most members of the public don't really understand it.
I agree that it would be difficult to run the service that is run at the moment with less hours, but it would be entirely possible. It requires a bit of creativity, a close analysis of current working arrangements and supply and demand, but it is doable. Obs/Gynae in several of the major hospitals has switched to max 24 hour shifts (which in my mind is still too much), Paeds is largely max 24 hour call shifts, so why can't Medicine follow suit?

Anesthetics in a lot of hospitals in 24hr too.

UCHG is shift based for medical and surgical at intern and SHO level. (i.e. someone on days, someone else nights, someone else weekends) (Or at least when I was working there)

I entirely agree that it's doable, but it boils down to the desire to change. It doesn't take a functioning trade union to make it work. It just takes doctors to say no.

Ryder

I don't think that the public in Ireland will ever really be on the doctors side, so their support is immaterial.

The whole working hours thong is difficult...shifts seem like the obvious solution but do we really want to be on shift work?....i know I don't. Also for interventional specialities, you need time in theatre. Can't really escape that, and almost no operating gets some out of hours in recent years.

The solution is to be creative. Solutions on a service specific level. Aligning call with service, so that if you're on, you can go home without the guilt of opd/theatre next day. Its not really that difficult....as I said before, the imo I think represent too many grades and have a conflict of interest. The colleges don't see the problem, so don't care

AnthonyOC

Dear boards members


Thanks for your comments and support for my blog posts.


I must say I’m finding the comments people are leaving at the end of it to be somewhat harrowing and difficult (although necessary) reading. We can’t let this lie. I’d be grateful if those of you who are twitter savvy would take a minute or two to tweet your TDs and James Reilly and the HSE to further highlight this situation.

The hashtag I’m using is #24hoursisenough.

A consecutive hours cap of 24 is an extremely modest proposal but one that could change the lives of many colleagues. It’d be a good start at the very least and a legacy our generation could leave those coming after. I’m finishing up as an NCHD in a few months, so I have very little skin in the game anymore but those of you who are interns and students have a lot to fight for not least the memory of our colleagues.

Thanks again for your support

Anthony

opinion guy

Great work Anthony but 24hrs is too much - nobody should be working over 16 hour shifts absolute max and preferably not over 12

MrCreosote

24 hours is too much but it would be a start. It would have to be 24 hours though, none of the 24 hours on and then stay for the 6 hour ward round rubbish.

As for striking, it's an absolute necessity. I've worked in NZ, and gone on strike once and came close a second time. It is difficult, but once you know it's the right thing to do, you just get on with it. The thing was the strike was over such minor things it'd be laughed at in Ireland- but it was more to show the management that they couldn't just assume they could chip away bit by bit at junior docs' contracts. The difference is that the union was solely for junior doctors and did a good bit of preparation with the media in the months leading up to the strike. Compared to the IMO, they were a breath of fresh air. Like every other doctors' strike studied before and since, the death rate dropped during the strike (in fairness probably mostly due to cancelled elective surgery).

The IMO are the main problem in Ireland- a worse than toothless union representing conflicting groups. They need to go. Personally I don't even mind the HSE- we know they are evil, and their sole function is to screw junior doctors, but we know they're the enemy. The IMO are the worst, pretending to be part of the solution when they just perpetuate the status quo or worse.

Personally speaking, the ludicrous hours are the main reason I left Ireland, and the only reason I didn't come back.

ThatDrGuy

Agree about the IMO being the problem. A union just for NCHDs that can articulate the horrors and enforce change is whats needed.
Great work Anthony but its going to take serious firepower for anything to happen. What do people think about convening a meeting to establish a new group (even if it doesnt have negotiating powers) just to fight for NCHD rights ? The IMO is a dessicated corpse flopping in the wind, all its cash sucked out by the pricks who ran it. More of the same will not lead to change, something new is called for.

Ryder

ThatDrGuy wrote: »

Agree about the IMO being the problem. A union just for NCHDs that can articulate the horrors and enforce change is whats needed.
Great work Anthony but its going to take serious firepower for anything to happen. What do people think about convening a meeting to establish a new group (even if it doesnt have negotiating powers) just to fight for NCHD rights ? The IMO is a dessicated corpse flopping in the wind, all its cash sucked out by the pricks who ran it. More of the same will not lead to change, something new is called for.

a group without negotiating rights is pointless. I'm no longer and nchd or in Ireland, but I would suggest communicating with interested nchds in Facebook and convening an egm of the imo. Organize an action group at that with a timeline to limit hours and strategies for same. The imo are useless but they have a negotiating license and enough member nchds, who were interested enough to come along, could take over and enact change. The problem with the imo isn't so much the imo as the void

opinion guy

Ryder wrote: »

a group without negotiating rights is pointless. I'm no longer and nchd or in Ireland, but I would suggest communicating with interested nchds in Facebook and convening an egm of the imo. Organize an action group at that with a timeline to limit hours and strategies for same. The imo are useless but they have a negotiating license and enough member nchds, who were interested enough to come along, could take over and enact change. The problem with the imo isn't so much the imo as the void

No. The IMO, even if you enacted a coup and took it over would still be fundamentally borked because it tries to represent consultants, nchds, gp's and public health doctors all at once - groups who often times have opposing interests. Simply -> does not compute.

Icemancometh

Ryder wrote: »

a group without negotiating rights is pointless. I'm no longer and nchd or in Ireland, but I would suggest communicating with interested nchds in Facebook and convening an egm of the imo. Organize an action group at that with a timeline to limit hours and strategies for same. The imo are useless but they have a negotiating license and enough member nchds, who were interested enough to come along, could take over and enact change. The problem with the imo isn't so much the imo as the void

I could be wrong, but I believe that describes the IHCA. I believe a similar, NCHD-only organisation is long overdue.

I'm not on twitter, so I instead of tweeting my TDs and Minister Reilly, I wrote them emails. I'll know they'll be ignored, but if we all contact our representatives, it'll make ignoring our concerns that much harder. Ultimately, I can't see any change happening without industrial action, but we have to start somewhere.

dissed doc

his_dudeness wrote: »

For doctors to strike will immediately put the public against us, regardless of their position pre-strike. To find out that noone will be in the Resus department or responding to the Arrest bleep, that would turn the public against Docs.
.

The public are completely hostile to doctors anyway. No-one cares as long as some schmuck is covering 56hrs of on-call.

nerrad01

Icemancometh wrote: »

I could be wrong, but I believe that describes the IHCA. I believe a similar, NCHD-only organisation is long overdue.

I'm not on twitter, so I instead of tweeting my TDs and Minister Reilly, I wrote them emails. I'll know they'll be ignored, but if we all contact our representatives, it'll make ignoring our concerns that much harder. Ultimately, I can't see any change happening without industrial action, but we have to start somewhere.

Yep the IMO is fundamentally broken and they will never get rid of the "im at the top so who cares about the bottom attitude"

An NCHD only union is needed as a matter of life and death literally, be it both doctors and patients

Kwekubo

Something like this was tried a couple of years ago in Britain: Remedy UK was set up to represent NCHDs in the face of perceived inaction by the British Medical Association.

his_dudeness

Icemancometh wrote: »

I'm not on twitter, so I instead of tweeting my TDs and Minister Reilly, I wrote them emails.........

For those that are on twitter, here is a link to a list of all the TDs on twitter as of February 2012.

Ryder

opinion guy wrote: »

No. The IMO, even if you enacted a coup and took it over would still be fundamentally borked because it tries to represent consultants, nchds, gp's and public health doctors all at once - groups who often times have opposing interests. Simply -> does not compute.

I agree, and have said the exact same thing before. But in respect of this particular problem, its the only show in town. This same issue has come up as long as I have been an nchd, and died away on a couple of days....apathy, nobody wanting to jeporadise careers etc. Obviously if people have the time, money and support, a rival organization would be the best, but I think you will struggle with all three. To threaten any kind of industrial action, you need union support

A small group of committed people could force the imo to act on THIS ONE ISSUE, especially now given (you would think) the imos need to redeem itself. Exploit it.

ThatDrGuy

Ryder wrote: »

I agree, and have said the exact same thing before. But in respect of this particular problem, its the only show in town. This same issue has come up as long as I have been an nchd, and died away on a couple of days....apathy, nobody wanting to jeporadise careers etc. Obviously if people have the time, money and support, a rival organization would be the best, but I think you will struggle with all three. To threaten any kind of industrial action, you need union support

A small group of committed people could force the imo to act on THIS ONE ISSUE, especially now given (you would think) the imos need to redeem itself. Exploit it.

That group would have to join the IMO. Pay 700 euro a year to rebuild the
pension fund and pay off the dons at the top. No one I know is willing to go near that corrupt feckless organisation. They had almost no credibility to start with, now I feel ashamed by their very existence. The name is mud and will remain so. Trying to achieve reform of working conditions through the IMO is like trying to achieve political reform through fianna fail. The definition of madness: trying the same thing over and over again expecting a different result. Either give up altogether or try something new : re-enforcing the same failed institutions and polices serves no-one.

Jane5

Hi guys,
This is an issue I have cared about for years. It made me leave Ireland for a while.

http://www.twoweeksonatrolley.blogspot.ie/2008/08/hours-not-depressing-film-about.html

Now I am back I no longer work in a specialty where there is any significant out of hours cover. I never will again.

I have said for years that NCHDs need their own union. I even looked into trying to start one up, but this was back in boom time, and no one cared.

I still think we should try to set up our own union-NCHDs are defecting in droves from the corrupt and ineffective IMO. The iron is hot and we should strike. (And perhaps even strike! )

I disagree that the public would have no sympathy for us. If we bombarded the media with calm, reasonable and factual accounts of NCHD conditions, and made them aware of the huge distinction between consultants and NCHDs (most are not aware of this at the present time), and how the terrible working conditions affect patient care in a myriad of ways, we would have public support. I am sure of it. It would have to be done sensibly with a minimum of naval gazing, but it is possible.

I would be happy to get involved with this in any way that I can. Too much crap has been taken for too long, and if we united, we could put a stop to it. No matter what anyone says.

Vorsprung

If such an organisation were to be set up, how would they go about acting on NCHD's behalf? I heard that the IMO were the only group recognised to act on behalf of most doctors.

opinion guy

Vorsprung wrote: »

If such an organisation were to be set up, how would they go about acting on NCHD's behalf? I heard that the IMO were the only group recognised to act on behalf of most doctors.

How do the ICHA do it ?

ThatDrGuy

Vorsprung wrote: »

If such an organisation were to be set up, how would they go about acting on NCHD's behalf? I heard that the IMO were the only group recognised to act on behalf of most doctors.

Yup. They are also the only group that can act of behalf of consultants. Yet
the ICHA exists ? How strange. Gardai are not allowed a union yet the GRA exists. How strange. Judges are setting up the JRA ? How strange. Its almost like the government have to negotiate with whoever has the power - not whoever has the mandate.

Jane5

Absolutely right. And we do have the power. If as our very first action we organised a proper campaign to get all NCHDs to cancel their IMO membership, we would certainly have their attention as well as hitting them in the wallet-the only place they care about.

Then, if or when they say, "Oh please guys, we really care about your conditions (your subscription money)" we en masse tell them to get bent.

Then we set up our own union. And we amasse public support for this union. Because, at the risk of sounding like a f*cking Disney film, we do have the power, and one of the reasons is this-we are not yet corrupted. We still just want to train well, work hard, and give good patient care and improve existing standards. People can see this. And people will support this.

But we have to be united. Can we do it?

chanste

I've just started a new thread with a poll to see how many people would be for or against a new representative body. Maybe its just establishing what we already know people are thinking, but I do wonder. If only 10 people bother replying - then getting people moving from boards or something similar could be a lost cause. But if a lot of people reply with support maybe we could co-ordinate something from here.

I'd be happy to send an e-mail out to the final year UL class if there was something worth putting in it, if final year students in other med schools done the same this would be a good first step. Obviously in addition to whatever way established NCHDs could be recruited to a cause.

ThatDrGuy

Dont want to kill the disney buzz. but a bona fide union is not easy to set up. Lots of full time staff, finances and legal stuff required. A
representative organisation is much easier : it can do essentially everything the IMO doesnt bother to do. We could go on to bring it under the wing of another union ( purely for legal protection from industrial action) and go on to hit the HSE hard.

Jane5

Go with that idea first. IF it is authorised to negotiate on behalf of NCHDs like a real union.
But subsequently a real union must be set up. I know it's not easy, but it can be done.
You're telling a bunch of people who routinely work 100 hour weeks that something ain't easy? I'd, um, I'd say we'd manage somehow

ThatDrGuy

Its not easy precisely because they are working 100 hours a week. People dont have time for laundry nevermind unions.

Jane5

ThatDrGuy wrote: »

Its not easy precisely because they are working 100 hours a week. People dont have time for laundry nevermind unions.

Sorry. No more defeatist attitude. That is exactly why this horrendous set of conditions has lasted as long as it has. I am not working 100 hours a week. I am happy to contribute and organise things if people are on board.

Even if you are working 100 hours this week. Take five minutes of that 100 hours to cancel your IMO membership. That is all you have to do this week. Cancel it. Cancel your standing order/direct debit and whatever else you have to do to ensure that the IMO gets no more of your money.

Then, if you have another 5 minutes, come onto boards.ie, into the Health Sciences forum, and tell us you cancelled!

But if you only have five minutes, cancel your direct debit. That is step number one. That is all you have to do this week. Nothing else. Work your 100 hours and look after yourself and your patients.

Part of looking after them will be cancelling your membership, as by propping up an organisation that does not look after your interests you are maintaining a status quo that harms both you and patients.

Vorsprung

Mod note

Guys can I just give a quick reminder not to post anything that might be interpreted in such a way that might cause legal issues for boards.ie!

The topic carries with it some amount of emotion, but I'd ask you to bite your lip/typing fingers before using words such as "corrupt" etc.

Cheers

Jane5

Thanks mod, sorry!

AnthonyOC

Guys an update

Thanks to Niall_Kelly another doctor on twitter for his work, between us we have tweeted all TD's, senators and MEPs. It's getting it out there at least

Luke ming flanagan ‏@lukeming
@niall_kelly read it. Very worrying. Will bring up in Tuesday's private members business.

Lucinda Creighton ‏@LCreighton
@niall_kelly @simoncoveney @lukeming @LCreighton Thank you. These cases are tragic and I hope we can prevent furture such tragedies.RIP

RTs from Willie O'Dea, Pearse Doherty and Brian Stanley

ThatDrGuy

Ive emailed (again) Dublin, Kildare, Wicklow TDs .

SleepDoc

Vorsprung wrote: »

Mod note

Guys can I just give a quick reminder not to post anything that might be interpreted in such a way that might cause legal issues for boards.ie!

The topic carries with it some amount of emotion, but I'd ask you to bite your lip/typing fingers before using words such as "corrupt" etc.

Cheers

The IMO won't take legal action for the most flagrant breaches of contract and employment law, let alone for justified accusations of incompetence etc against it on an internet forum.

sillymoo

The journal have run a story around this this morning. Finally some publicity.

kellogscoffey

sillymoo wrote: »

The journal have run a story around this this morning. Finally some publicity.

Just saw it there, having read this thread last night, funny coincidence

MrCreosote

Here's the journal bit:

http://www.thejournal.ie/readme/working-conditions-hospital-so-bad-no-sleep-column-761636-Jan2013/

Reminds me of another thing. It's much worse now than it was when I was doing these hours. At least then we got paid for the hours we worked and there was the faint hope that the EWTD in a few years might actually be enforced (I know- crazy thinking)

So for the seniors who say it was worse in my day- they're wrong.

Vorsprung

SleepDoc wrote: »

The IMO won't take legal action for the most flagrant breaches of contract and employment law, let alone for justified accusations of incompetence etc against it on an internet forum.

Oh I well know! But we're not going to leave ourselves with our pants around our ankles if they have a change of heart.

sapere_aude

I just cancelled my IMO membership. Money that does more for me by staying in my pocket.

Hard to see light at the end of this tunnel!

Jane5

Thank you, sapere aude, and well done on cancelling! That's almost a grand you can spend on your training since they negotiated away your training fund! And it is one less person contributing to a union that does not represent the members that pay its salaries and ginormous pensions.

ANYONE ELSE DO THEIR HOMEWORK TODAY?