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
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