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Working abroad

A staggering 60% of the current cohort of interns have left, or are in the process of leaving, Ireland, says Dr Alan Corbett, one of the organisers of the National Intern Conference and Social (NICS) held in Cork in June. Here he provides a round-up of the conference

The core concept behind the National Intern Conference and Social (NICS) is brilliantly captured in this quote taken from a message Dr O’Connor sent to NICS, which took place on 28 June in the Brookfield Centre, UCC, Cork.

For too long the vast untapped potential of new doctors as agents for change within our health service has been unrecognised by both clinical and executive management. This is a mistake. As the very front line of hospital in-patients’ interaction with the medical service you have a unique insight and a valuable contribution to make. 

The conference attracted a fantastic line-up of guest speakers who gave talks on medical technology and innovation, and the humanities in medicine, and provided wonderful insights into careers in expedition and sports medicine. The primary aim of NICS 2014, however, was to provide a national forum to discuss pertinent issues affecting interns, NCHDs and the healthcare system. The main focus was emigration.

For too long the vast untapped potential of new doctors as agents for change within our health service has been unrecognised by both clinical and executive management. This is a mistake. As the very front line of hospital in-patients’ interaction with the medical service you have a unique insight and a valuable contribution to make.
Dr Anthony O’ Connor, The Medical Independent columnist, Letter to NICS

A staggering 60% of the 2013/2014 cohort of interns have left, or are in the process of leaving, Ireland. The emigration of Irish NCHDs is not a new phenomenon, and the reasons for our departures are vast. Travelling and taking a “gap year” are high on the agenda of some of my colleagues, but for many more including myself, emigration is a last resort. Understandably we are attracted by the significantly better work–life balance available overseas. However, we are being actively encouraged to leave by the ongoing failure of many hospitals to implement the European Working Time Directive, nonapplication of contractual entitlements and falling income levels.

Brain drain

In recent years this mass exodus has begun to have a great impact on the efficiency and stability of the healthcare service. The IMO’s industrial relations officer Eric Young, who participated in the NICS panel discussion, described this year’s situation as a “staffing crisis”, as more than 200 NCHD posts were left vacant this July. Falling levels of NCHDs are detrimental to the health service and patient care is affected at all levels with increases in the already long hospital waiting lists, and the possibility of a reduction in emergency department opening hours. This also leads to increased stress for the doctors who remain. NICS 2014 sought solutions from both a panel and audience members.

Keynote speaker Senator Colm Burke is acutely aware of the issues NCHDs face and has written extensively of the need to “stop talent haemorrhage from the medical system” and the fact that “the treatment of young doctors by the HSE is causing an escalating crisis”. Patients are best cared for by doctors that are secure and happy in their work, trained to the absolute highest standard, healthy of mind and body, adequately rested, mentored and fulfilled in their vocation.

One brave GEM (graduate entry medicine) in the audience spoke openly of the financial pressures they had faced during the year. Trying to fund their ACLS course or pay the re-registration for the IMC added huge strain to their budget and stress to their personal life. GEMs are spending an average of €1,300 on monthly loan repayments and still need to fund rent and all other living expenses while earning approximately €2,000/month after tax. Senator Burke is presently engaging with GEMs from all over Ireland to seek solutions to this problem and I encourage anyone interested in sharing their experiences to email him at: colm.burke@oir.ie.

It is wonderful to see that NCHDs are becoming more vocal about problems. It is noteworthy from the discussions at NICS and follow-up discussions on the “Enough is Enough…” group on Facebook that all NCHDs actually find the current process of funding postgraduate exams and awaiting a refund troublesome. The existing process is one of many minor issues we face. Others raised at NICS include the mountain of paperwork which must be regularly tackled when changing rotations and moving between hospitals. When all of these minor issues are stacked up we have a leaning tower pointing more and more NCHDs to vote with their feet and book one-way flights.

NICS highlighted for me that finding solutions is easy but implementing change is difficult. Why? Basically it is not anyone’s responsibility. This is what really needs to be worked on. Implementing solutions to administrative and human resources issues, for example, should not be the responsibility of doctors. We certainly need to be involved and vociferous in discussions, but the accepted solutions need to become someone else’s responsibility. Fining hospitals is not the answer, firing individuals who fail to deliver is.

Looking forward

There is some good news, however. Dr Anthony O’Connor’s article “Going forward, looking back” was published in the Medical Independent in January 2013. It is clear to see from this inspiring piece that great strides have been made by committed groups of NCHDs and consultants over the past 18 months, and despite the negatives highlighted above there has been great progress, which new doctors in particular should benefit from. I think the words of Dr O’Connor best conclude why it is so important we all contribute and continue this great work.

If you are interested in applying for a position on the National Intern Conference Committee for NICS 2015 please email: nationalinternconf@gmail.com and visitwww.nationalinternconf.com.

I wish you all the best for a challenging, insightful and exciting first year as a doctor.

Many doctors at the beginning of their careers, having trundled through the education system with distinction, expect a benign third party such as an employer or a regulator or a college to act on their behalf. While such agencies are useful allies, if I can pass on just one bit of advice it is that you will come to realise that it is only through unity, courage, solidarity and common purpose that you can truly hold those in authority to account and protect the interests of yourselves, and by extension, your patients. This is why gatherings such as this one are of such critical importance as you begin to set the agenda for the rest of your careers. 
 
Dr Anthony O’Connor, The Medical Independent columnist, Letter to NICS

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