‘Medical workforce needs to be supported and developed’ — Council

A continued trend of a growing General Division and attrition resulting from lack of access to training, poor working conditions and natural retirement emerge from data in the latest workforce report by the Medical Council.

Joint action of all stakeholders was required to safeguard patient safety and retain Ireland’s highly trained and experienced medical workforce, urged the Medical Council in its Medical Workforce Intelligence Report 2019-2020 launched today (December 4).

While the Council saw an increase in intern posts as a direct result of Covid-19, it remained consistent in its messaging that collaborative efforts were required to support an under-resourced and highly pressured health service.

The picture painted by data from the Medical Workforce Intelligence Report 2019-2020 indicated a growing register totalling 23,558 doctors at the end of 2019.
While the majority of doctors who retained registration were; clinically active, working in Ireland, and Irish graduates, more than one in five of these doctors in 2019 were graduates of basic medical programmes completed outside the European Union (EU).

The Council report highlighted ongoing trends of insufficient training places and continued reliance on overseas trained doctors who filled service posts.

Almost 80 per cent of non-consultant hospital doctor (NCHD) training roles were held by Irish graduates; three out of four of those in non-training NCHD roles were doctors with medical degrees from outside of Ireland.

The report outlined that nearly two-thirds of new doctors on the Register of Medical Practitioners received their medical degree outside of Ireland. For every four Irish graduates registering for the first time, seven international graduates also registered.

In June 2020, some 21,190 doctors retained their place on the register, with just under 18,000 reporting being clinically active in Ireland; of this group, just above 50 per cent were on the Specialist Division and 20 per cent reported to be NCHDs not in training.

In 2019, there were 1,135 voluntary withdrawals from the register, a decrease of 21.8 per cent from 1,453 in 2018, and the first decrease since 2014.

Figures for 2020 showed that, as of August, 862 doctors had voluntarily withdrawn their registration from the Medical Council’s register.

The majority of those leaving the register wished to practise medicine in another jurisdiction. However, some of those voluntarily withdrawing stated they were leaving the register due to personal reasons resulting from implications of the Covid-19 pandemic.

Some doctors who left the register stated they were not returning to practise in Ireland due to poor working conditions in comparison to the country in which they were currently practising, and experienced doctors qualified outside of the EU could not access formal training programmes.

Over a quarter of registered doctors self-reported working more than 48 hours a week and 57.7 per cent of doctors self-reported working more than 40 hours a week, according to the report.

“Despite the unprecedented nature of the past year for the Irish health system, the conclusions of this report provide a valuable insight into how the medical workforce needs to be supported and developed,” said Dr Rita Doyle, President of the Medical Council.

“Looking at the trends over the past few years, it’s certainly a positive development to see withdrawals from the register decreasing, however, much works remains to be done on making Ireland an attractive long-term prospect to our colleagues who completed their medical education outside the EU, and would like to specialise here in their chosen field.”

“The analysis of the registration and voluntary withdrawal data gives rise to concern about the safety of both patient and medical professionals. Action and engagement are required to really effect felt change for doctors,” added Medical Council CEO Philip Brady.

The report also identified some issues of concern for the Medical Council such as doctor burnout, bullying issues and doctors working more than the European Working Time Directive.

Meanwhile, a report addressing burnout carried out by the Medical Protection Society (MPS) on “Breaking the Burnout Cycle”, previously urged that every doctor in Ireland should have access to someone trained to recognise burnout and offer support. It recommended that this could be achieved by all Health Service Executive (HSE) organisations and private providers appointing a ‘Wellbeing Guardian’ by 2022, with a similar dedicated person working with GP surgeries and smaller clinics locally.

It also called for doctors’ wellbeing to become a key performance indicator (KPI) in all organisations.

A snapshot survey of MPS members in Ireland had shown that 91 per cent of doctors did not have someone at work responsible for staff wellbeing, and almost 60 per cent did not feel encouraged to discuss wellbeing issues at work.

Three-quarters of doctors surveyed in Ireland by the MPS said they would always go into work, even when they were too unwell, fatigued or stressed to be productive.