Irish trainee surgeons nurse home thoughts from abroad

Most trainee surgeons who leave Ireland to improve their skills will end up returning home, in spite of significant pay reductions here, according to the president of the Royal College of Surgeons.

Prof Paddy Broe says a lack of resources to support surgeons in their work is the real factor which might lead many to emigrate permanently.

The Department of Health’s recent move to drastically cut salaries for newly appointed consultants has prompted much talk in the medical community of emigration. Amid fears of a “brain drain”, it has been claimed trainee consultants who traditionally go abroad to learn new skills before taking up posts in Ireland may instead buy a one-way ticket away from the problems of the Irish health service.

However, Broe says the real problem for consultants who don’t get the resources they need is that they end up “sitting around” because of a lack of support staff and theatre time. “If the carrot is not there in the end for working in the Irish system and they see the system is as dysfunctional as it is, they’ll just go anyway.”

He says there is also concern in the profession about “constant media-bashing of consultants”, in particular relating to pay, which could destroy the current mentorship model used in their training.

Emigration was certainly on the mind of those attending the annual Millin meeting at the Royal College of Surgeons, which devoted an entire session to the experiences of Irish surgeons abroad.

Broe says the college will continue to encourage its students to travel despite the risk that some might be lost forever to the health system here. “We’re an island nation and we can’t do big-volume, specialised surgery, so we need our trainees to go abroad.”

Career in Glasgow

Staying away from Ireland was something of a “no-brainer” for Prof Paul Horgan, who is head of surgery at the University of Glasgow.

Having studied in Galway and Dublin and lectured in Trinity College, he took up a position in the Scottish city and developed a specialty in colorectal cancer.

The expectation was that he would return to Ireland at that stage, but no similar post was advertised here and he felt “I was getting past my sell-date” to do so.

So Horgan decided to make what has turned out to be a successful career in Glasgow, which has its advantages. A new consultant contract meant “I got 30-40 per cent more for doing 30-40 per cent less work” and private work was clearly divorced from public practice. Meanwhile, his children got a good Scottish education and season tickets to Celtic Park.

Surgeon James Geraghty is one of those who came back, with no regrets. Now a consultant at St Vincent’s Hospital, his first posting was in Nigeria, where for two years he laboured under challenging conditions in a small rural hospital with 250 beds and four doctors.

Strict governance

After a spell in Glasgow, he completed his senior registrarship in Dublin before heading to Wisconsin for a fellowship. There followed moves to the European Institute of Oncology in Milan and the Nottingham Breast Institute for Geraghty, his wife and four children.

In Milan, there was no on-call work and strict governance of private sector activity, he says. In Nottingham, the private sector was equally non-existent. “It was something you didn’t talk about, you were almost apologetic leaving to do some private work.”

Negative coverage

Returning home, Geraghty says he felt like “the bee’s knees”, sure he would bring back lots of new information and insights. “But I found that Ireland was already there. The standards of clinical care and academic training were of the highest quality.”

The downside was having to do on-call, “the dominant force within surgical practice”, and the bed pressures in the Irish health system.

The amount of media coverage of his profession also came as a “huge surprise” after Italy and the UK. “Despite the fact that we have the highest quality of consultants, the media coverage was mostly negative.”

Geraghty says medics currently contemplating a move abroad to improve their skills must reckon with the possibility that “you may stay in the place you go to” rather than returning home. Working in continental Europe can be difficult, he warns, because of the language issues.

The advantages of working in a system that is far better funded than the Irish health system were all too apparent in Helen O’Grady’s presentation. A colorectal surgeon working in Yorkshire, O’Grady says that in three years’ work she has never had to cancel an operation because of the lack of a bed.

She works a one-in-13 rotation, meaning she works just four weekends a year, for which she gets extra time off in lieu; this is much less than she would have to do in an Irish hospital.

“The work is much more protocol-driven, management are much more involved and you are constantly being asked to get patients in quicker because there are fines for underperformance on targets,” she says.

Yet home is where the heart remains, she says. “There’s definitely a pull to come back to Ireland. Still, I’m close to home, I come back often and there is a regular rotation of trainees from Ireland in the hospitals where I work. And I’m not sure the setup I have exists in Ireland.”

John Byrne, currently at Beaumont Hospital, is one of those highly trained doctors who is about to leave, and wonders whether he will ever come back. Next year, he takes up a post at a hospital in Toronto.

“It’s not about the pay, it’s about the working environment,” he says. Sometimes we feel like pawns in a political game. The fact that we’re highly paid professionals makes us an easy target.”