Dr Mark Murphy, Chairman of the NCHD Committee discusses the expected shortage of NCHDs in July. Below is a transcript of extract from :

PROGRAMME	Newstalk Lunchtime
SUBJECT	Dr Mark Murphy
STATION	Newstalk
DATE/TIME	17.06.2011 - 12.45pm
OUR REF	1106036 – REF: HOC
DURATION	10 Minutes

Jonathan Healy:

Now we’ve been speaking this week about the issue of junior doctors in our hospitals and concern that’s been raised about whether or not we’re going to have enough of them on the emergency wards in particular come the 11th of July, that’s when the traditional changeover happens, but we’ve been told that only five out of the thirty-two emergency departments at hospitals around the country will have enough junior doctors to operate a normal level of service in three week’s time. They have to find additional recruits somewhere but the question we’ve been asking ourselves this week is what’s happening to all the doctors that the universities are churning out, this week in particular because there’s been a lot of graduations around the country. Dr. Mark Murphy is the Chairman of the Irish Medical Organisation’s Non-Consultant Hospital Doctor Committee or Junior Doctors if you will. Mark Murphy, good afternoon to you.

Dr. Mark Murphy: (IMO Non-Consultant Hospital Doctor Committee)

Good afternoon Jonathan, thanks for having me on the show.

Jonathan Healy:

First of all, your reaction to this claim from the Irish Association for Emergency Medicine, that from three week’s time there’s just not going to be enough of you guys on the wards and as a consequence there’s going to be delays and possibly patients being put at risk.

Dr. Mark Murphy:

Yes, it’s an extremely worrying phenomenon, it’s something that the IMO has been flagging for many months and of course we’ve been flagging over the past twenty years. It’s clearly an indictment of the post-graduate training structure that NCHDs go through at the moment and clearly the patients come first and at the moment, I haven’t read the survey but I read the Irish Independent article this morning, and it’s worrying what Dr. McInerney, who’s a spokesperson for the Irish Association of Emergency Medicine, that many of the emergency departments will be short staffed this coming July, but there are many other departments that will be short staffed as well.

Jonathan Healy:

I accept that point but I also say to you that if there is this problem that has been identified and the patient comes first as you’re saying how come so many people are leaving the country, why aren’t they stepping onto the wards?

Dr. Mark Murphy:

Well I’d challenge you in that the statistics, there is a paucity of statistics generally in healthcare, we don’t know how many NCHDs are leaving and similarly we don’t know how many NCHDs we’ll be short in this coming July and that might surprise you, we’re only three weeks away. We’re meeting with the HSE next week with the INMO and ourselves, the IMO, and hopefully the HSE will give us an accurate guide to what hospitals and where these staffing shortfalls will be taking place.

Jonathan Healy:

But Mark the colleges are churning out more doctors than ever before so there’s a problem somewhere.

Dr. Mark Murphy:

Well I suppose generally speaking, because this is a major public health issue, and when a major public health issue comes up it’s very understandable that the media and public look for a culpable party, it simplifies the debate too much I think.

Jonathan Healy:

Okay, can I stop you there, I want to play a clip from The Right Hook yesterday, Chris Luke, who’s an emergency department consultant in Cork, he was on with George, and he was suggesting there needs to be some kind of arrangement where if you were trained in Ireland you’d stay in Ireland for at least six months, suggesting it as some kind of community service which they have in other countries for graduates to stay in the country where they were trained. Let’s have a listen to what he said.

Chris Luke: (ED Consultant – Excerpt ‘The Right Hook – 16.06.2011’)

The patient, i.e. the health service, is on the resuscitation room trolley and is about to expire, so arguments from the likes of Mr. Istiak and Dr. Murphy are, you know, frankly completely irrelevant to the fact that unless some of our young graduates stay and roll up their sleeves and help, perhaps patriotically, you know, unless they stay we are really in serious danger of a collapse.

Jonathan Healy:

That’s Dr. Chris Luke, a gentleman I have considerable respect for, I’m sure you do as well, but he’s saying that these young doctors have a patriotic duty to say okay, look, the system isn’t great but we need to go in there because it’s somebody’s mother, somebody’s grandmother, somebody’s grandfather.

Dr. Mark Murphy:

Okay, there are two ways to look at it. In the short-term view there’s a crisis that’s happening this July but why is it that we have a system that is completely over-reliant on NCHDs? Over the past twenty years every expert group report, every advocate for patient care, has demanded that we actually need less NCHDs. You know that we have four and a half thousand NCHDs, we have two and a half thousand consultants, if you do the basic arithmetic there you’ll understand that almost half of those NCHDs will never get specialist training in Ireland so their only use is, I suppose, is to do the operational day to day issues in the HSE because they’re taking on maybe other healthcare professionals jobs because IT isn’t up to scratch, so we have a system where NCHDs I suppose run our service and every expert group report has advocated that this number of NCHDs should be reduced, that consultants and GPs should double in number….

Jonathan Healy:

And that hasn’t happened?

Dr. Mark Murphy:

No, no, that’s very true, and we still work extremely long hours and this overdependence on NCHDs working long hours, the lack of career progression, because most of us will never get specialist training in Ireland, the lack of consultants, the lack of acute hospital reform, has led to the situation today, as if it’s come upon us suddenly, although it hasn’t, we’ve known about this for the past twenty years, that we’re in a situation now that many doctors who have worked for five/six years are not getting on any training programmes, are deciding to emigrate, and you do know that two thousand of our doctors are non-EU doctors and the working terms and conditions for those doctors in particular, because it’s become increasingly more difficult for those doctors to get onto any programmes, and they’re opting to leave and work in the United Kingdom, in Australia as well.

Jonathan Healy:

Okay Mark, I appreciate and accept that doctors are an ambitious bunch, you know, you get in there, you want to do well, you want to go into a specialty, but I’ve never met a poor doctor, I’ve never met a doctor that’s struggling for cash, we’re in an economy at the moment where people are crying out for jobs and I don’t know why doctors are seeing themselves in a position whereby well look I’m not getting what I want and they’re just leaving, there’s no other area where that’s happening, people who are leaving the country elsewhere are leaving involuntarily yet here we have a profession that are saying well this system is no good for me, I’m off!

Dr. Mark Murphy:

No, that’s not true, what you’re inferring is is that several dozen doctors, after working for a period of one year to four years, have decided that they’re going to emigrate, the vast majority, in the numbers of thousands of doctors, elect to stay in Ireland to work illegal hours for our patriotic duty towards our patients. Now I would prefer to work in a system where I work less hours, where I’m respected, where I get trained in an expedient and excellent manner but I choose to stay here because I love Ireland and that will be the generality amongst NCHDs, so it’s unfair that several dozen doctors are leaving, after working here for several years, I think it’s disingenuous to the argument. I do understand, it’s a commonsense proposal and I understand what Chris Luke is saying…

Jonathan Healy:

Do we need to get past the point Mark?

Dr. Mark Murphy:

…however what doctors want here is to train within five to seven years to reach specialisation in their area of expertise so if Chris Luke is advocating a six month stand alone job that doesn’t offer any training in terms of recognised training for a training post I and the Medical Organisation cannot stand over that, however if he’s advocating that an Irish doctor who’s about to emigrate to do emergency medicine in Australia is given a four year or five year training programme here that doctor would jump at the price, so I put it back on Chris Luke, at the post graduate training bodies, at the HSE, to ensure that there’s an appropriate post graduate channelling of our undergraduates through our chaotic post graduate career to deliver the specialists and consultants that the public deserve.

Jonathan Healy:

Mark, there’s a lot of problems with the health service, there’s a lot of problems with the HSE and management of the HSE and I think that goes to the core of what you’ve been trying to explain to me in the last few minutes. James Reilly obviously is trying to fix this, he’s trying to reform it.

Dr. Mark Murphy:

Okay, so James Reilly wants an excellent healthcare service in fifteen years time, if he does not reform the post graduate training of our non consultant hospital doctors there will be, there will be a shortage of those excellent consultants in ten to fifteen years time. You can ‘t reform one area of the hospital service without looking at every single aspect and the issue of post graduate training for NCHDs is one of the most important in terms of the overall reform of our public healthcare service. I’ve spoken to James Reilly about this issue and he remembers well his day of going around as a non-consultant hospital doctor, being a gopher in the hospital, performing roles and tasks that really he shouldn’t do, and I think if we reduce our reliance on non-consultant hospital doctors, expediate (as said) the training of non-consultant hospital doctors, increase the consultant numbers, I think we can deliver a better health service in ten/fifteen years time.

Jonathan Healy:

Okay, so the point that you’re making is that we’re possibly stockpiling problems for the future as well. Dr. Mark Murphy, Chairman of the Irish Medical Organisation’s Non Consultant Hospital Doctor Committee, thanks for talking to us Mark.

Dr. Mark Murphy:

Cheers.

Jonathan Healy:

I have to say very mixed opinions coming in on text. We have the second wealthiest consultants and GPs in the world but junior doctors are treated like dirt in this country, says one texter. Anna says all doctors and lawyers were subsidised through college by the public to the tune each of €230,000. Well you can make the point that everybody that goes through college is really subsidised because we don’t have third level fees apart from the registration charge. Another texter says, doctor shortage, something is not making sense. Why doesn’t anyone know what’s going on? Why doesn’t somebody ask the graduates who are recognised around the world after they do a stint in accident and emergencies here? I suppose there’s no question about the quality of the doctors we’re turning out but the question is why they are not staying on. And another texter says I’m an NCHD, I’d no intention of leaving Ireland when I qualify but after a year of regularly working thirty-six hour shifts straight, without sleep, I felt I had no choice, I was physically, emotionally and mentally drained and could not continue working in this country. We cannot continue working these crazy shifts, it would not be tolerated in any other country. Had no intention of leaving Ireland that texter says, so obviously someone who is on the way out of the country having had their fill of the HSE.