Better work conditions sole solution to hospital-doctor shortage

If the Irish health system is to recover from the pandemic, reduce hospital waiting lists, ensure timely access to healthcare and deliver on Sláintecare reforms, it will need to strengthen its medical workforce.

To expand its medical workforce, the Irish health system will need to recruit and retain hospital doctors and encourage the return of Irish trained doctors from abroad. It will need to ensure that the jobs available are attractive to those qualified to fill them.

The Hospital Doctor Retention and Motivation research project, with funding from the Health Research Board, has spent the past four years researching the working lives of hospital doctors to consider how best to encourage doctor retention and return.

This is what they told us about working in the Irish health system in 2021.

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They explained that the pandemic has intensified already-difficult working conditions and that both non-consultant hospital doctors and consultants now struggle to manage long working hours, onerous on-call commitments and a work/life balance heavily skewed in favour of work.

They spoke about the challenge of working in a health system that feels understaffed and under-resourced. Having too few staff relative to the workload impeded their wellbeing, increased their levels of burnout and reduced morale.

Respondents also struggled with the knowledge that they could provide better patient care if their hospitals were better-staffed and better-resourced.

They found it hard to be the public face of a health system under strain, to regularly apologise to patients particularly for their long wait for healthcare, as this doctor explains, “What keeps me up at night is . . . people not having access to timely care.”

Having too few staff relative to the workload impeded their wellbeing, increased levels of burnout and reduced morale

Doctors also spoke about challenging relationships at work, particularly with hospital administration, with human resources and hospital management. For non-consultants, this related to their vulnerability as temporary employees who regularly move hospitals. Non-consultants spoke about being underpaid for their work, either in terms of being placed on an incorrect pay scale or in terms of being underpaid for the overtime they worked. As temporary employees, they found it difficult to resolve problems within the short timeframe of their contracts, which sometimes dissuaded them from raising concerns.

Feeling undervalued

For consultants, there was a feeling that interacting with hospital management was a frustrating experience and of limited value in bringing about change. This dissuaded them from initiating change at a hospital level, as one doctor explained: “I’ve said all that before. No one would listen. Nothing changes. So, that leads to disengagement . . . just say nothing because, you know, saying stuff gets you nowhere. . . and it just makes you feel bad. . . you don’t change anything but you just get all het up about it and that’s, that’s really exhausting.”

Both non-consultant hospital doctors and consultants felt undervalued by the Health Service Executive and held out very little hope for health system improvement. While they were deeply unhappy with many aspects of the Irish health system, they also appeared resigned to it. Although they knew that they could provide better care if better-resourced to do so, they had accepted that this was unlikely to happen. Instead, they resolved to do their best for the patient in front of them.

Respondent hospital doctors appeared to waste considerable time and energy struggling with difficult working conditions, inefficient systems and challenging workplace relationships. Gaining access to appropriate care for their patients or initiating even minor improvements at hospital level involved engaging in “hand-to-hand” combat with the system.

Policymaker surprise

Should it really be this difficult?

Our research findings overall revealed a medical workforce that is struggling rather than thriving and which is in urgent need of additional staffing, resources and support.

Findings revealed a medical workforce struggling rather than thriving and in urgent need of additional staffing, resources and support

Although shocking, we are unsurprised by these findings. They echo the stories that hospital doctors have told us since 2018, of a health system within which extreme working, work/life imbalance and poor wellbeing have become normalised.

Policymakers, however, are often surprised at our findings. This disconnect between policymakers and frontline hospital doctors is problematic and impedes change.

As we navigate this latest wave of the pandemic and look to strengthening our health system post-pandemic, we must remember that our health system is only as strong as its workforce. We need to put hospital doctors at the centre of our medical workforce policies and strategies going forward if we are to learn from our mistakes.

In order to fill the 837 vacant consultant posts and further strengthen the medical workforce through recruitment, retention and return emigration, the Irish health system must first strive to improve the working conditions of Ireland’s hospital doctors.

Niamh Humphries and John-Paul Byrne are researchers at the Royal College of Surgeons in Ireland Graduate School of Healthcare Management. Dr Jennifer Creese is a researcher at the University of Leicester. The Hospital Doctor Retention and Motivation Project interviewed 51 Irish-trained doctors in Australia about their decision to emigrate; surveyed 1,070 hospital doctors in Ireland about their working conditions; and interviewed 48 hospital doctors about working through the first wave of the pandemic. Most recently between July and December 2021, it conducted a remote ethnography with 28 hospital doctors. This involved interviewing each doctor twice and engaging them in a WhatsApp conversation about their working conditions over a 12-week period