Mandate graduate doctors do 5 years in Ireland post qualification?

ProfessorPlum · 20-03-2015 01:51AM

ScumLord wrote: »

I have a friend who was in a car crash and he was left sitting until they heard he was covered by the other drivers insurance and they sent him in for a load of tests because of the insurance,

I'm sorry, but that is pure bullcrap. No one working on the front line in A&E derives direct benefit from a patient's health insurance. Your 'friend's' story just doesn't add up.

Lucas Castroman · 20-03-2015 01:52AM

ScumLord wrote: »

So they don't charge insurers for medications used? They wouldn't do things like use up leftover budget before year end?

I talking specifically about foreign student doctors. Do they pay student doctors? Any time I've been in the public hospital doctors always had one or two in toe, so they're all paid for medical staff?

I don't see how their more selective. They treat people who can pay but I don't think they cherry pick who they're going to treat. The private hospital I went to had an A&E, it just wasn't open 24/7.

How can I be misinformed by what I experienced?

So they don't charge insurers for medications used? They wouldn't do things like use up leftover budget before year end?

Well the nature of private health insurance is that they cover the cost of treatment. The suggestion that doctors go wild in public hospitals prescribing treatments which are not required for the sake of profit is simply incorrect.

You're telling me the tired A+E doctor rubbed his hands with glee when he saw you and prescribed 3 antibiotics so the insurance company could charge more for your treatment? If yes, you'r more delusional than I feared.

I talking specifically about foreign student doctors. Do they pay student doctors?

Medical students don't receive a salary. Your initial accusation was public hospitals were making a fortune off employing qualified foreign doctors which you have conveniently forgotten and cannot substantiate.
Hence misinformed.

I don't see how their more selective. They treat people who can pay but I don't think they cherry pick who they're going to treat. The private hospital I went to had an A&E, it just wasn't open 24/7.

If you're unstable/critically ill you will get transferred to a public hospital as private hospitals generally don't have the resources and also these type of cases are not cost beneficial for them. Try going to the Blackrock clinic A+E after being in a car accident.

zl1whqvjs75cdy · 20-03-2015 08:16AM

If we went down this road we'd also want to look at keeping PhD students here for a time after graduation. I'd estimate that once I finish my PhD I'll have cost the state the guts of 150k, but there are relatively few jobs here in my field so I will probably end up leaving which is a real shame. Least doctors will always have jobs here, even if they are worked half to death.

jon1981 · 20-03-2015 10:11AM

donkeyoaty0099 wrote: »

If we went down this road we'd also want to look at keeping PhD students here for a time after graduation. I'd estimate that once I finish my PhD I'll have cost the state the guts of 150k, but there are relatively few jobs here in my field so I will probably end up leaving which is a real shame. Least doctors will always have jobs here, even if they are worked half to death.

I guess the difference between medical doctors and PHDs is that the HSE is a critical service and is the main employer of graduate doctors here , it is understaffed (apparently debated here) and we losing good percentage of graduate doctors upon qualification.

I don't see any other public service crying out for a supply of such a niche skill set.

I've no real sympathy for anyone that does a PHD in Arts or philosophy who can't get a job.

jon1981 · 20-03-2015 10:25AM

seamus wrote: »

Most don't leave because they want to specialise in some obscure medicine or do the latest high-tech research. Most leave because they can go somewhere that they work 50 hour weeks for good pay and get treated like a human being.

This reason has been mentioned so many times on this thread. So without putting in practices to keep doctors here, such as making it part of the course that they do a number of years here in Ireland post qualification, what is the answer?

This seems like a vicious cycle to me, not enough junior doctors -> students see the chaos in the health service and are thinking no this is not for me i'm outta here -> junior doctors continue to be under pressure...and on and on

conorhal · 20-03-2015 10:51AM

seamus wrote: »

On the face of it, yes, perhaps. But then you run the risk of a lot of other problems - hospitals full of junior doctors who have their head somewhere else and are going through the motions. Junior doctors who are incompetent and want to leave the profession completely but have this 5 years hanging over their heads.

Rather than having the desired effect of keeping good doctors in Ireland, you just make the quality of staff worse and effectively prevent good doctors from immigrating to Ireland.

Perhaps the aim should be to address the reasons why so many doctors leave or want to leave. Primarily criminally long working hours with no overtime and chronic understaffing of junior doctors in hospitals.

Most don't leave because they want to specialise in some obscure medicine or do the latest high-tech research. Most leave because they can go somewhere that they work 50 hour weeks for good pay and get treated like a human being.

There's a couple of problems with you critique, you won't be keeping imcompetent doctors in a post, or are our medical schools passing and qualifying people that are not competent?

Secondly, good doctors aren't immigrating to Ireland, some pretty shockingly bad ones are. Like Irish doctors, the cream of the crop in Pakistan, India and Africa are looking for jobs in America, Australia and the UK. At best we get the third rate of the third world.

Where you are absolutely correct is the fact that working conditions have to improve. We also need more doctors, it's baffling as to why we are not funding more places.
I would also sweeten the pot to soothe the sting of a mandatory 5 years of service, if you are a medical student I would ensure that you were provided free accomodation, that you were subject to no fees whatsoever and you got a 5 grand annual grant if your grades met a certian standard. This would cost millions, but whats a few million compared to the cost of the millions the government spends in stuff we don't critically need? I'd also give students the option to emigrate on graduatiion, but they would be subject to the cost of their own training and accomodation if they wished to do so.

Taco Chips · 20-03-2015 10:56AM

jon1981 wrote: »

This reason has been mentioned so many times on this thread. So without putting in practices to keep doctors here, such as making it part of the course that they do a number of years here in Ireland post qualification, what is the answer?

This seems like a vicious cycle to me, not enough junior doctors -> students see the chaos in the health service and are thinking no this is not for me i'm outta here -> junior doctors continue to be under pressure...and on and on

I think making proper, structured and high quality training schemes would go a long way. Theres too much arsing around with job changing and too much of a junior doctors time is wasted on inappropriate, non educational tasks. You can go to places like US/Oz/UK and get specialty training completed in 5-7 years versus at least 10+ here. This is 5-7 years of high quality, rigorous education and accreditation instead of shuffling trainees out to service posts in low quality peripheral hospitals because theres no one else that wants to work there. Training needs to be more hands on, starting in medical school. The US has the right idea here where students are given more autonomy and responsibility over patients, with a very clear and defined hierarchy in place that ensures people aren't left stranded in their training.

Junior Dr contracts last for 6 months at a time in one hospital site as it is. This means every few months they're moving hospitals, towns, cities to the next post. How are people supposed to rent? To settle? Theres no stability. If you're a young doctor applying to schemes in Dublin/Cork/Limerick, thats where you want to spend your time training, set up a family and live. You don't want to be punted off to a rural centre at different stages where the conditions and education are often worse or non existant.

There have been steps to implement this in some specialties with 'run through' schemes such as Anaesthesia, Surgery and EM but there are still problems. There are proposed culls of trainees in these schemes at certain time points along the scheme. So if you're 3-4 years deep into one area of training and you're part of the cull, then what? Start again in a new specialty? Resign yourself to never completing your training? Ridiculous idea.

Then at the end of all this there is constant fiddling and cheating by management of timesheet in an effort to underpay juniors of overtime hours. Allowances for training, exam expenses and relocation have been cut. It used to be the case that people could at least tolerate all of the poor conditions because the wage made up for it, but now not even that remains. So you have poor training, low quality hospitals that you have little choice to work in and shortchanging of pay. The number one reason medical students and doctors are emigrating are because of the training and conditions available in other places.

ScumLord · 20-03-2015 11:07AM

ProfessorPlum wrote: »

I'm sorry, but that is pure bullcrap. No one working on the front line in A&E derives direct benefit from a patient's health insurance. Your 'friend's' story just doesn't add up.

It can be an unwritten policy to charge as much as possible to people with insurance. While individual doctors won't benefit, they would know it benefits the hospital to get as much out of insurers as possible.

Lucas Castroman wrote: »

Well the nature of private health insurance is that they cover the cost of treatment. The suggestion that doctors go wild in public hospitals prescribing treatments which are not required for the sake of profit is simply incorrect.

How do you know it's incorrect? I'm working off my experience and the experience of friends. It's anecdotal but what proof have you it that it doesn't happen? How do you explain the private hospital being cheaper for the same care? It was much better care by every account but the end result was the same.

Medical students don't receive a salary. Your initial accusation was public hospitals were making a fortune off employing qualified foreign doctors which you have conveniently forgotten and cannot substantiate.
Hence misinformed.

I meant foreign student doctors, a simple mistake on my part.

If you're unstable/critically ill you will get transferred to a public hospital as private hospitals generally don't have the resources and also these type of cases are not cost beneficial for them. Try going to the Blackrock clinic A+E after being in a car accident.

What's that got to do with anything.

conorhal wrote: »

There's a couple of problems with you critique, you won't be keeping imcompetent doctors in a post, or are our medical schools passing and qualifying people that are not competent?

Secondly, good doctors aren't immigrating to Ireland, some pretty shockingly bad ones are. Like Irish doctors, the cream of the crop in Pakistan, India and Africa are looking for jobs in America, Australia and the UK. At best we get the third rate of the third world.

If Ireland can't produce incompetent doctors why do you think foreign colleges would produce incompetent doctors?

Icemancometh · 20-03-2015 11:12AM

steddyeddy wrote: »

On a separate issue three antibiotics is far too much. No wonder antibiotic resistance is on the rise.

Pretty much every hospital admission for cellulitis is treated with dual antibiotics, and I've seen resistant cases where a third antibiotic is added in for anaerobic cover. Although more generally, cases with three antibiotics should usually only be handled with microbiology involvement.

More generally for this thread, I've worked in a few different public hospitals. Much to patients' disappointment, the only difference I've seen private insurance make, is accessing private or semi-private rooms. The consultants need to know because of the 25% of work on private patients rule, but its never made a bit of difference to me or anyone else on the team.

conorhal · 20-03-2015 11:15AM

ScumLord wrote: »

It can be an unwritten policy to charge as much as possible to people with insurance. While individual doctors won't benefit, they would know it benefits the hospital to get as much out of insurers as possible.

How do you know it's incorrect? I'm working off my experience and the experience of friends. It's anecdotal but what proof have you it that it doesn't happen? How do you explain the private hospital being cheaper for the same care? It was much better care by every account but the end result was the same.

I meant foreign student doctors, a simple mistake on my part.

What's that got to do with anything.

If Ireland can't produce incompetent doctors why do you think foreign colleges would produce incompetent doctors?

I suspect the massively disproportionate representation of foreign doctors in fitness to practice hearings might give you a clue.

ProfessorPlum · 20-03-2015 11:16AM

ScumLord wrote: »

It can be an unwritten policy to charge as much as possible to people with insurance. While individual doctors won't benefit, they would know it benefits the hospital to get as much out of insurers as possible.

You really have no notion about our health service, do you?

zl1whqvjs75cdy · 20-03-2015 11:20AM

conorhal wrote: »

I suspect the massively disproportionate representation of foreign doctors in fitness to practice hearings might give you a clue.

Got a link to those stats? Not having a go just be interested to see them

take everything · 20-03-2015 11:26AM

Taco Chips wrote: »

I think making proper, structured and high quality training schemes would go a long way. Theres too much arsing around with job changing and too much of a junior doctors time is wasted on inappropriate, non educational tasks. You can go to places like US/Oz/UK and get specialty training completed in 5-7 years versus at least 10+ here. This is 5-7 years of high quality, rigorous education and accreditation instead of shuffling trainees out to service posts in low quality peripheral hospitals because theres no one else that wants to work there. Training needs to be more hands on, starting in medical school. The US has the right idea here where students are given more autonomy and responsibility over patients, with a very clear and defined hierarchy in place that ensures people aren't left stranded in their training.

Junior Dr contracts last for 6 months at a time in one hospital site as it is. This means every few months they're moving hospitals, towns, cities to the next post. How are people supposed to rent? To settle? Theres no stability. If you're a young doctor applying to schemes in Dublin/Cork/Limerick, thats where you want to spend your time training, set up a family and live. You don't want to be punted off to a rural centre at different stages where the conditions and education are often worse or non existant.

There have been steps to implement this in some specialties with 'run through' schemes such as Anaesthesia, Surgery and EM but there are still problems. There are proposed culls of trainees in these schemes at certain time points along the scheme. So if you're 3-4 years deep into one area of training and you're part of the cull, then what? Start again in a new specialty? Resign yourself to never completing your training? Ridiculous idea.

Then at the end of all this there is constant fiddling and cheating by management of timesheet in an effort to underpay juniors of overtime hours. Allowances for training, exam expenses and relocation have been cut. It used to be the case that people could at least tolerate all of the poor conditions because the wage made up for it, but now not even that remains. So you have poor training, low quality hospitals that you have little choice to work in and shortchanging of pay. The number one reason medical students and doctors are emigrating are because of the training and conditions available in other places.

Good post.
Too many people don't know the ridiculous stuff that goes on for NCHDs. You get it in no other profession. People should really inform themselves before spouting populist crap.

ScumLord · 20-03-2015 11:45AM

ProfessorPlum wrote: »

You really have no notion about our health service, do you?

What makes you such an authority?

tony007 · 20-03-2015 11:49AM

steddyeddy wrote: »

On a separate issue three antibiotics is far too much. No wonder antibiotic resistance is on the rise.

steddyeddy, MD.

jmayo · 20-03-2015 11:56AM

Guy:Incognito wrote: »

How long does it take to be qualified, 7 years?You're basically making medicine a 12 year course then.

Ehh if you think that someone is a fully functioning doctor after the basic 7 years in college you are mistaken.
They have to do number of years residence, or whatever it is called here, in hospital as experience.
For other major discplines such as surgery or anaesthesia they would be training up to 12 years anyway.

FalconGirl wrote: »

When my uncle was dying, one of my cousins friends was a doctor in the ICU. She came into the rest room area and was chatting away to us and told us she was moving onto her 26th hr of duty and said its quite regular. Insane:eek:

This is somthign that always bugs me.
A truck driver can only work so many hours straight and has to have mandatory breaks, same with a pilot.
Yet a doctor can be working for days.
Some kind of lunacy there.

ProfessorPlum · 20-03-2015 11:57AM

ScumLord wrote: »

What makes you such an authority?

Do you have anything of substance to add? At all?

diograis · 20-03-2015 12:02PM

Kinda off point but the most expensive course in my college is dentistry, not medicine. Pretty sure its the same for Trinity. So technically it's the second most expensive course :P

ProfessorPlum · 20-03-2015 12:08PM

diograis wrote: »

Kinda off point but the most expensive course in my college is dentistry, not medicine. Pretty sure its the same for Trinity. So technically it's the second most expensive course :P

According to NUIG, the government payment for an undergrad medical student is less than €33,000 over the 6 years. So it's not really a huge issue for tax payers to be calling for indentured servitude. Now Dentists - aren't they all loaded?........

jon1981 · 20-03-2015 12:09PM

diograis wrote: »

Kinda off point but the most expensive course in my college is dentistry, not medicine. Pretty sure its the same for Trinity. So technically it's the second most expensive course :P

I caveated that with "probably"

Although you're probably splitting hairs with the cost difference

Taco Chips · 20-03-2015 12:11PM

ProfessorPlum wrote: »

According to NUIG, the government payment for an undergrad medical student is less than €33,000 over the 6 years. So it's not really a huge issue for tax payers to be calling for indentured servitude. Now Dentists - aren't they all loaded?........

Added to that most medical schools are stuffed with non EU students paying full whack fees around €33,000+ per year. Over 5-6 years! As well as all of the graduate entry medical students also paying full amounts. Medical schools in universities are probably one of the most profitable wings of the whole system. Makes the whole "make them stay and pay back what they owe" even more laughable an idea than it is already.

ScumLord · 20-03-2015 12:11PM

ProfessorPlum wrote: »

Do you have anything of substance to add? At all?

All you've done is make statements that don't seem to be based on anything other than your own assumptions. Unless you're an A&E doctor, or a hospital auditor you can't say anything with certainty. I've always found that people that talk in certainties about things they have no actual experience in tend not to be worth talking too.

I gave my experience and my friends experience. You've done nothing but throw insults around. You've given nothing to back up your argument other than you assume you must be right and resort to insults when you've run out of argument.

You've added nothing of substance and try to hide the fact by pointing fingers and accusing others of your own failings.

tony007 · 20-03-2015 12:16PM

ScumLord wrote: »

All you've done is make statements that don't seem to be based on anything other than your own assumptions. Unless you're an A&E doctor, or a hospital auditor you can't say anything with certainty. I've always found that people that talk in certainties about things they have no actual experience in tend not to be worth talking too.

I gave my experience and my friends experience. You've done nothing but throw insults around. You've given nothing to back up your argument other than you assume you must be right and resort to insults when you've run out of argument.

You've added nothing of substance and try to hide the fact by pointing fingers and accusing others of your own failings.

Do you not think that you were on 3 antibiotics for a reason?

ProfessorPlum · 20-03-2015 12:22PM

ScumLord wrote: »

All you've done is make statements that don't seem to be based on anything other than your own assumptions. Unless you're an A&E doctor, or a hospital auditor you can't say anything with certainty. I've always found that people that talk in certainties about things they have no actual experience in tend not to be worth talking too.

I gave my experience and my friends experience. You've done nothing but throw insults around. You've given nothing to back up your argument other than you assume you must be right and resort to insults when you've run out of argument.

You've added nothing of substance and try to hide the fact by pointing fingers and accusing others of your own failings.

I didn't think it was necessary to add my CV to a boards debate. Everything I've said is true and factual, and based on my own experience of working in the health service (yes, in A&E - now called ED by the way) and the experience of literally hundreds of my friends, colleagues and family members. You on the other hand base your assertions on anecdotal evidence and third party - blatantly false - 'experiences'. I haven't insulted anyone. The truth hurts sometimes.

ScumLord · 20-03-2015 12:31PM

ProfessorPlum wrote: »

You on the other hand base your assertions on anecdotal evidence and third party - blatantly false - 'experiences'. I haven't insulted anyone. The truth hurts sometimes.

I'm basing my opinion on the fact the public hospital charged me more for roughly the same amount of care. I say roughly because the private hospital visit included an MRI, I had clean sheets and proper food amongst other things.

How is the supposedly more expensive private hospital able to come in cheaper than the public hospital? Did they just make a mistake with the antibiotics? Is it right to give a person more antibiotics than they need?

There's nothing anecdotal about the bill.

Duggy747 · 20-03-2015 12:36PM

Do a weekend course and become a faith healer instead :pac:

jon1981 · 20-03-2015 12:44PM

Guy:Incognito wrote: »

Nothing, as long as you do it for all courses. Why single out medicine?

I've no problem with people paying for their college education, I was questioning the practicalities of the 5 year idea. As in, how do you physically stop them just leaving and not doing the 5 years.

Sure many professions do this. I know of a person doing a 3 year post grad in Psychology in the UK and one of the conditions of the course is that that person must work in a hospital there for 3 years, likewise people I know doing a post grad in teaching funded by the UK government, likewise that person has to work in a school there for a number of years. You leave, you pay back the fees.

There is nothing illegal about this proposal if implemented correctly. I'm not proposing imprisonment!!

Jezek · 20-03-2015 12:48PM

ScumLord wrote: »

I'm basing my opinion on the fact the public hospital charged me more for roughly the same amount of care. I say roughly because the private hospital visit included an MRI, I had clean sheets and proper food amongst other things.

How is the supposedly more expensive private hospital able to come in cheaper than the public hospital? Did they just make a mistake with the antibiotics? Is it right to give a person more antibiotics than they need?

There's nothing anecdotal about the bill.

the fact is, antibiotic therapy can't be boiled to down to the number of antibiotcs you received. One vs three means nothing at all. You need experience and a lot of knowledge to interpret antimicrobial treatment. Even if the single antibiotic worked, you don't know if it was the correct one to use. Of course this is is a complicated issue. It really doesnt boil down to if you got one or three antibiotics.

And then you talk of overstaffing in the ED, but you expain that a lot of these people were students. That's not staffing. The students dont work there, they don't change your management at all. They are only learning.

Taco Chips · 20-03-2015 12:52PM

jon1981 wrote: »

Sure many professions do this. I know of a person doing a 3 year post grad in Psychology in the UK and one of the conditions of the course is that that person must work in a hospital there for 3 years, likewise people I know doing a post grad in teaching funded by the UK government, likewise that person has to work in a school there for a number of years. You leave, you pay back the fees.

There is nothing illegal about this proposal if implemented correctly. I'm not proposing imprisonment!!

The proposal is unworkable for a variety of reasons that have already been mentioned. Doctors are highly skilled, highly educated professional graduates not sheep to be heralded into a pen. If proper restructuring of the training and working conditions was implemented to say, follow the Oz/UK/US models then there would be less reasons for them to leave in the first place. Doctors get better training, better qualifications at home and can practice better medicine. Win win for everyone.

At the same time however there is a strong tradition for Irish doctors to spend some portion of their training abroad, to gain important highly specialised skills and knowledge that is only available in places like the US, Canada etc... This is actually extremely important because Ireland just isn't big enough to see some of the rarer diseases in clinical settings.

steddyeddy · 20-03-2015 01:41PM

Icemancometh wrote: »

Pretty much every hospital admission for cellulitis is treated with dual antibiotics, and I've seen resistant cases where a third antibiotic is added in for anaerobic cover. Although more generally, cases with three antibiotics should usually only be handled with microbiology involvement.

More generally for this thread, I've worked in a few different public hospitals. Much to patients' disappointment, the only difference I've seen private insurance make, is accessing private or semi-private rooms. The consultants need to know because of the 25% of work on private patients rule, but its never made a bit of difference to me or anyone else on the team.

Which is a treatment scientists have been disagreeing with for years. Stating the common practice doesn't make it acceptable. Could you give the scientific reasoning for three antibiotics. Clinical microbiologists are needed with every antibiotic prescribed IMHO.

Mandate graduate doctors do 5 years in Ireland post qualification?

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