Sir, - Junior hospital doctors have every right to be angry and resentful about the often inhuman hours that they work. And the general public should be gravely concerned that our front-line hospitals are staffed by overworked and increasingly demoralised junior doctors who have to deliver 24-hour care to your relatives and mine. But other questions need to be asked: Why is it that, at a time when professionals in other disciplines are flocking back to Ireland, young Irish doctors are leaving in alarming numbers? And why is it that hundreds of posts at registrar and senior house officer level rarely attract any Irish graduates in our many small hospitals around the country? It is clear that the issue of long hours is not the sole reason why the brightest and best Irish doctors are abandoning the Irish hospital service.
Chief among the well founded complaints of junior hospital doctors are:
Inadequate supervision, training and mentoring in their early post-graduate years.
Being coerced into performing inappropriate and exploitative duties - portering, routine blood-testing, fetching and carrying routine x-rays and lab tests, battling with the bureaucracy of inefficient hospital departments and even servicing the private practices of some consultant supervisors.
The low credibility among trainees of many home-grown specialist training programmes.
Active discrimination against women graduates who, despite constituting 70 per cent of our medical school output, are forced to prematurely abandon the remorseless and inhuman hospital doctor treadmill. As a result, we have the shameful statistic that only 6 per cent of consultants in medicine, surgery and obstetrics are women - a senseless loss of talent.
Lack of a proper career structure and over-reliance on an entirely antiquated hierarchical consultant structure which effectively denies bright young doctors permanent posts in the health service before their late thirties.
The unattractiveness of working in a hospital system, unique to Ireland, that has far too many redundant small hospitals.
To the lay person this seems a barely believable situation. Yet, it would seem the solutions are simple:
1. Train these extraordinarily bright, motivated and dedicated young doctors in fast-track, high-quality, internationally recognised training programmes that are adequately resourced.
2. Humanise working conditions.
3. Eliminate exploitative practices.
4. Create substantive attractive permanent career posts in the public hospital system at an earlier age.
And that is what needs to be done.
But the junior hospital doctors will encounter a formidable array of institutionalised opposition, with many vested interests represented. A parsimonious Department of Finance will want to retain cheap labour. The Government of the day, irrespective of party, will resist progressive manpower changes because they might threaten the viability of outmoded and increasingly unsafe small hospitals in sensitive electoral areas. Not only that, but there are strong vested professional interests within the medical establishment that are resistant to progressive change - on the age-old basis that "it is in the master's interest to prolong the training of the apprentice".
That is why it is important for the public at large to understand the background to this imminent crisis that could fundamentally undermine our health service for a long time to come. The junior hospital doctors need the support of the lay public to redress their legitimate grievances, but more importantly, to contribute to the beginning of a radical reform of manpower in the public hospital system. - Yours, etc.,
Prof M. X. Fitzgerald, Professor of Medicine, University College Dublin, and St Vincent's University Hospital, Dublin 4.