Doctors on the ground say 200 GPs annually should be getting trained
The Medical Council has launched the Medical Workforce Intelligence Report for 2016/2017.
This report takes a deep-dive into the demographics of those retaining and withdrawing from the register, with a view to informing workforce planning and ultimately improved patient safety in Ireland.
According to the report there are 58 GPs in county Carlow. In 2017, there was one GP for every 1,000 people, with a total of 58 GPs in the county.
This results in longer patient lists, longer waiting times for appointments and increased pressure on doctors.
Of the 2,830 voluntary withdrawals recorded 1,846 practitioners (65.2%) completed the voluntary withdrawals form which outlines doctors’ reasons for voluntarily withdrawing.
· 53% of this group were aged 35 and under, with the majority male, on the General Division and planning to pursue medicine in another jurisdiction.
· 25% left the Specialist Division while 66% left General Division of the register.
· 15% of those choosing to leave the register cited limited career progression; 25% family/personal reasons for withdrawal and 34% unspecified other reasons for doing so.
37% of doctors leaving the register stated they were moving to the UK to practise medicine, 19% to Australia and 27% to another jurisdiction.
The main reasons cited in the report for doctors leaving the register are: the expectation to carry out non-core tasks; lack of respect by senior colleagues; lack of flexible training options, underpinned with an ability to learn more abroad; lack of employer support; workplace understaffing and the hours expected to work, in the context of the European Working Time Directive.
This trend affects not just doctors in a hospital setting, but also those based in the community.
President of the Medical Council, Dr Rita Doyle said “Ireland’s education and training of doctors is internationally recognised, however, recruiting and retaining our pool of highly qualified Irish trained doctors is proving challenging.”
“This is leading to an overreliance on overseas trained doctors, which is escalating as evidenced in this report. The cultural challenges within the Irish health system, which are highlighted in the report, also need to be addressed in tandem with an increase of health practitioner supply. Otherwise, retention will remain a growing issue.” concluded Dr Doyle.
Medical Council CEO, Bill Prasifka said “The Workforce Intelligence Report is essential in that it provides an accurate update on the calibration of doctors in the health system in Ireland, information on doctors that retain their registration and more significantly the numbers, and reasons, of doctors leaving the register.”
“The report contains significant and sometimes concerning insights, which need to be addressed collaboratively amongst policymakers, educators, planners and employers.” concluded Mr Prasifka.
In 2016, there were 2,714 doctors who enrolled on the Medical Council Register for the first time. Most new entrants to the register were on the general division and educated outside of Ireland. Countries including Egypt, Sudan, Pakistan and Romania and the United Kingdom cumulatively contributed more new entrants to the Irish register of medical practitioners than Ireland did.
In 2017 for every two hospital consultants, there were three NCHDs on the register. The majority of doctors were Irish graduates, however over one quarter of all doctors on the register were graduates of basic medical programmes completed outside the EU (29.3%). 19,600 doctors with an average age of 44.53 years retained their registration. 88.9% of these doctors were on the general and specialist divisions of the register.
58% of doctors invited to retain held Irish basic medical qualifications with two-thirds of those qualified in another jurisdiction coming from the UK, India, Sudan and Pakistan. 79.3% of all NCHDs who were not in a training scheme were graduates of international medical schools.
Jantze Cotter, Director of Professional Development and Research said “the Medical Council is committed to supporting developments that foster patient safety and will continue to work alongside stakeholders to effect change. What is evident from the data in this report is that only through a collaborative approach can we address the problems highlighted. This report and the data contained will be critically important to a number of actions for change highlighted in Sláintecare.”
The report highlights six recommendations for action:
· Long-pursued amendments to the Medical Practitioners Act 2007 will improve equality within the system for international medical graduates in NCHD non-training service roles, impacting directly on the accessibility of formal training for those who have completed their basic medical training in contexts outside of the Irish system.
· While the “Medical Education in Ireland: A New Direction” report by Fottrell (2006) set out medical targets that have now been met, recruitment of international medical graduates still outweighs that of Irish graduates in the system. It is timely that this pre-recessionary document is reviewed following substantial workforce change.
· To match international practice and move to a stronger model of healthcare delivery and leadership, a move to more consultant-delivered care must be put in place. These consultants should be on the specialist division of the register.
· Examination and consideration of the potentiality of a well-supported permanent doctor grade in the health service, in the context of extensive workforce change, to include an emphasis on consultant delivered care, with a view to replacing the short-term contractual nature of non-training posts may effect significant change in the system.
· Innovative solutions which have been adopted in other countries must be assessed and explored for use in an Irish context to facilitate retention. Appropriate solutions must be both identified and implemented.
· Systemic, meaningful change for both doctors and patients will not be truly felt without challenging current models and cultural structures in healthcare. Truly supporting doctors to self-care, reflect and access supports to bolster their wellbeing in a system that currently often challenges it is a key activity that can only serve to support doctor and patient safety and is mutually beneficial to all stakeholders in the Irish health service.
The Medical Council maintains the Register of Medical Practitioners - the register of all doctors who are legally permitted to carry out medical work in Ireland. The Council also sets the standards for medical education and training in Ireland. It oversees lifelong and learning and skills development throughout doctors' professional careers through its professional competence requirements. It is charged with promoting good medical practice. The Medical Council is also where the public may make a complaint against a doctor.