Underlying the report of the Medical Manpower Forum is the sense that the quality of medical care in Irish hospitals is under serious threat and must be corrected.
That threat lies partly in the over-reliance on trainee doctors and partly in an unsatisfactory quality of training.
This in turn is related to insufficient consultant posts, with the result that a generation of Irish doctors - notably, those in their 30s - has been lost to hospitals abroad.
The use of non-consultant hospital doctors, including trainee doctors, is set to change radically for two reasons. The first is that over the next few years NCHD working hours will gradually be reduced to 48 hours a week and this will mean a loss of NCHD cover.
The second big change in NCHD numbers will flow from the Medical Council's introduction of an exam for non-EU doctors seeking temporary registration here for training purposes. The number of such doctors coming into the State has already fallen as a result. These shortfalls will be made up in two ways, the report suggests. One is to cap the number of NCHD posts at their present level and to create extra consultant posts instead. This will keep greater numbers of fully trained hospital doctors in the system and will improve the quality of service to patients.
It may also keep Irish doctors here. There are relatively few fully trained hospital doctors in Ireland in their thirties, the report notes. They are working abroad, partly because they have little prospect of returning to a consultant post here. A major boost in consultant posts could change this trend.
But the approach to training will also have to change, the report warns. In a 1995 survey, 50 per cent of NCHDs who responded described their training as "less than good".
It advocates a shorter period of training and links for training purposes between Irish hospitals and hospitals in the UK and United States. This, the forum appears to suggest, would enable Irish doctors to do some training abroad without becoming detached from the Irish system.
More part-time and job-sharing consultant posts are advocated, particularly to enable more women to become consultants. But it believes prejudice is damaging women's chances. To overcome this it suggests training in non-discriminatory interview techniques, equal opportunities guidelines and positive action programmes.