DIAGNOSIS
CRITICAL AS DOCTORS FLEE IRELAND
A
new report has found that one in five of our young medics
leaves the country following qualification. Sue
Leonard discovers how the exodus is hitting our
health system
THINKING
ABOUT A CAREER IN MEDICINE? FORTIFY'S ADVICE |
| • |
Your
ability to generate high scores in 3-hour examinations
is no indication as to whether you will enjoy a career
in medicine. You may be good
at it, but that doesn't necessarily mean you will
enjoy it ... |
• |
Success
and happiness (not always the same thing) in medicine
are grounded in having realistic expectations as you
embark on the career. You cannot, CANNOT,
get a real sense of what is going on in medicine
without talking to people and getting your feet wet.
Do a 'shadow' week with a GP, a surgeon, an SHO, a
Registrar. Do whatever you have to, but get this kind
of face-time. Without it, you are relying on your
family's opinion ("Daaarling, you'd be a
maaarvellous paediatrician - you're sooo good with
children.") or re-runs of ER. |
| • |
In
a study conducted in the US some years ago, over 700
18-19 year-olds, all of whom had expressed a clear
career choice, were given the chance to shadow someone
in their chosen profession. Having seen the reality
up close, almost two-thirds of them changed their
minds about pursuing that career. |
• |
It
is fair to say that people with high intelligence
typically have a low tolerance for bullshit. The conflicting
demands placed on doctors in the developed world fall
squarely into the 'Bullshit' column; hence the exodus
out of the profession. |
• |
The
head-on collision between concern for cost and concern
for quality of patient care makes for a brutal
corporate culture. Add in the high-stress
component of life-or-death decision making and long
working hours and it's not a pretty picture. Spend
a night watching the goings-on in a busy Accident
& Emergency / Casualty department and you will
see what we mean. |
|
Dr
Liz Bernard trained in Cork and did her residency
there. Today she is a GP in Swansea. She wanted
to train as a GP in Cork, but she wasn't accepted
for the scheme. And she is just one of many medical
school graduates who have left Ireland.
"I
was really disappointed," says the 29-year-old.
"I'd been in Australia for a year, and wanted
to be near my family and friends. I thought of
working and applying again the following year,
but I knew people who had tried reapplying and
been unsuccessful again. A friend and I applied
to various places in the UK. Both of us were accepted
in Swansea, so we went to Wales together."
Liz
planned to qualify as a GP in Wales and then return,
but now she's not sure she ever wants to work
in the Irish system. "I'm really apprehensive
at the idea," she says. "I feel settled
here and I'm used to the system. The career options
are better here and there's a better working practice.
We have at least five partners, a beautifully
equipped surgery, and a lot of support staff.
My working day is predictable - I don't have to
work any unsocial shifts. Here, all GPs are appraised
regularly, and there are more target-driven national
guidelines.
"The
patient care is better too - it's easy to refer
patients on quickly in an emergency. There's a
huge emphasis on chronic disease management and
on prevention. It's easier working in the NHS.
You can ask a patient to come back and see you
in two or three weeks. If you do that in Ireland
they might think you have an ulterior motive.
Money changes the dynamic."
The situation depresses Liz, because
she would prefer to live in Ireland. "I might
have to compromise, but for the medium term at
least, I'd rather work here," she says.
|
|
Liz is not alone, according
to a study carried out by the Medical Education and Training
Group (MET) which was released this week. Having tracked
Irish medical school graduates, the report found that
one in five of our young doctors leaves the health service
in the Republic, without ever intending to return to it.
That figure didn't include foreign students who were returning
to their country of origin. The findings don't surprise
Professor Muiris Fitzgerald, Dean of Medicine at UCD.
But they worry him profoundly.
"Their main motive
in going abroad is to get advanced postgraduate qualifications,"
he says. And while some training abroad is beneficial
to doctors to further their career, Prof Fitzgerald hates
to see them moving abroad too soon. "A graduate who
wants to become a cardiac surgeon, for example, sees the
training here as sub-standard. He'll leave Ireland early
in his career and spend a longer time abroad. And that's
unhealthy. We are losing our brightest and our best."
So what is the answer?
"We need to throw
money at it. Ireland has to invest in a good robust post-graduate
service. We have to invest in it and fund it."
When the CAO offers came
out at the start of this week, there were worries at the
low numbers of Irish students being admitted to medical
schools here. Of 2,252 Leaving Certificate students putting
medicine as number one on their CAO forms, only 305 are
guaranteed places. Yet we train 515 non-EU students here.
This realisation has led to calls for reform. Many people
want this figure revised so that Irish students are allocated
725 places. They feel only then will we end up with enough
doctors. But such knee-jerk reactions, though understandable,
are not the answer, says Prof Fitzgerald.
"If we didn't take
non-EU fee-paying medical students, we would have to close
the medical schools," he says. "Or else the
government subvention would have to increase dramatically."
At the moment the government
subsidises each Irish medical student for a year to the
tune of an average €8,000 to €9,000. Compare
this to the €34,250 annual fee paid by the non-EU
students of the Royal College of Surgeons in 2004. Or
to the subventions of €36,000 or €40,000 given
to students at Queen's University Belfast or the University
of Glasgow.
"The Fottrell report
set up by the Medical Council found that medicine has
been historically under-invested," says Prof Fitzgerald.
"They said there needs to be major investment urgently."
The MET report highlighted
that 6% of those leaving the Irish Medical Service quit
medicine altogether. Rowan Manahan, managing director
of Fortify Services, a consultancy and career management
firm, has had many career-changing doctors through his
door. He believes that the CAO system is to blame. It
attracts the wrong people to medicine. Hence the dissatisfaction
and career change.
"High achievers
at Leaving Cert level, who once would have gone for pure
maths, classical studies or literature, are entering medicine
because it has acquired a 'currency' value in the points
system," he says. "There is this whole perception
that you should not 'waste your points'. We have to check
potential doctors over; we have to assess if they are
really suitable."
Many people feel that
the entry system for medical school needs changing. This
year Trinity medical students require 585 points - the
highest ever. And it's not much better at UCD. "Twenty-three
of our new uptake have a minimum six A1s," says Prof
Fitzgerald. We're not the only country hoping to reform
the entry system. "It's a worldwide debate, because
there are always at least five or ten people after every
place, but the debate varies," says Prof Fitzgerald.
"In London they feel that the system is socially
biased. They need a baseline of As at A Level, but they
want the 'right chap'. In Ireland the debate is, 'it should
not all be academic', but in other countries, they feel
it would be fairer if it was all based on academic grounds."
With many medical places
going to non-EU students, there's a perception that it
must, therefore, be easy for foreign students to get into
medical school. But this isn't the case. It's highly competitive
for them too, says Prof Fitzgerald.
How do these fee-paying
students rate the training here? "It's a fantastic
training," says Celia Loan, 29, from Nigeria. "I
really enjoyed my time at the Royal College of Surgeons."
Once she'd trained, though, she applied to Britain to
do her residences. But they'd changed the rules and she
ended up staying in Ireland. "I was allocated rotations
in Beaumont and Drogheda," she says. "And since
then, I've been working in paediatrics. I love working
with children." Recently, though, the strain has
been getting to Celia.
"There were things
that I wanted to do with my life that I couldn't do in
that hospital routine," she says. "I wanted
to be able to dance and to have more control over my life."
At present, Celia is working as a locum in GP practices.
She loves having her weekends free, and enjoys the relatively
relaxed pace of life. But what will she do in the future?
"I'm trying to decide what to do next," she
says. "I love being in a GP practice but I do miss
working with children. I love paediatrics. It's difficult.
I'm not sure how long I will stay in Ireland."
original article here
