Doctors should be paid more to work in provincial hospitals, conference told

Doctors should be paid more to work in provincial hospitals which are otherwise “facing the abyss”, a conference on reducing risk in surgery has been told.

In addition, doctors with onerous responsibilities and on-call hours should be paid more than their part-time equivalents, according to Prof Peter Murchan, a colorectal surgeon at South Tipperary and Waterford hospitals.

Prof Murchan told the conference at the Royal College of Surgeons in Ireland (RCSI) that some small facilities – known as model 3 hospitals – had become a "sore" for the HSE and new measures had to be considered to tackle the problems they faced.

Located in 17 smaller towns and cities across the State, their bed capacity relative to population is below the national average and surgeons working there were in “real fear” of litigation issues.

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Spending

Most are staffed with a “paltry” number of surgeons, who tend to have to be on-call frequently. Prof Murchan said he has worked a one-in-three on-call rota for 14 years and prior to that he was on-call every second night for eight years.

He said the HSE capital plan has earmarked €3 billion in spending on hospitals in the greater Dublin area and while this money was well intentioned and much needed, that type of investment was also needed in model 3 hospitals.

The best-performing doctors coming out of medical schools should be sent to the lowest-ranking hospitals for a period, he suggested, just as the most promising US basketball stars are drafted into the least-performing teams at the start of their careers.

Prof Murchan said the doctors’ common contract was a nonsense. In the US, he pointed out, many doctors move from the big cities to work in mid-western locations for double the salary.

Questionable practices

Dr Cliona Murphy, chair of the Institute of Obstetricians, criticised "questionable practices" in the legal profession where lawyers "touting for business" make "dramatic announcements" based on incorrect information, thereby encouraging people to take cases and frightening them about the risks of birth.

Some 36 per cent of obstetric trainees have been involved in a legal case, she said, and this figure was likely to increase.

While individual Irish medical negligence awards range up to €23 million, Norway operates a no-fault compensation scheme with a total cost of €25 million, she pointed out.

Dr Murphy said current research suggests perinatal asphyxia accounts for just 6 to 8 per cent of cerebral palsy cases and even in this group underlying factors may put the infant at risk. Prenatal events are thought to be responsible for 75 per cent of all cases yet all of the Irish cases are “thought” to be due to delivery factors.

A diagnosis of cerebral palsy was “devastating” and “life-changing” for children and families and the awards made compensated for less than a full life. “Blame has to be apportioned so the family can get resources but what about the unlucky cases who have nowhere to get the resources.

“Obstetricians have to accept that that is the system but we really have to think about this.”