Intern doctors are drowning in a health system in perpetual crisis


“I don’t know how you keep going!”

Over the years, this phrase has been used many times as an observation about my professional life. It could be from a taxi driver, driving me home after a 25 hour shift. Or my mom, as I was leaving on a Sunday night to start another 80+ hour week. Or of a patient, whom I admitted at 9 a.m. on Tuesday, who is surprised to see me at 9 a.m. on Wednesday, having not been home in the meantime.

As a Non-Consulting Hospital Physician (NCHD) in Ireland, you enter the medical profession expecting that you will work hard and excel. The road is steep, the stakes are high, the learning curve – enormous. You start the job assuming that if you put your heart, passion and energy into the role, you will continue to help people.

“That’s how it’s always been” and similar phraseology has crippled NCHD progress for decades

What you never anticipate is that you will enter a system that is so demanding that it expects volumes of work and patterns impossible for a human to achieve. You don’t expect to be both a full-time doctor and a full-time apologist for a system in perpetual crisis. You don’t expect the guilt that comes with caring for a patient, knowing you’re too exhausted to do so safely or with empathy.

The situation for NCHDs, who make up around three-quarters of doctors in Irish hospitals (from newly qualified interns to just before consultation), has been made unnecessarily difficult for years. Lists so brutal that a doctor can start work at 4 p.m. on Friday and finish at 9 a.m. on Monday. A workforce so thin that NCHDs are frequently asked to reduce annual leave, sick leave and work while sick. A system, which works doctors into the ground, then sues them.

The ripple effect for patients is undeniable. The vast majority of us have or will be patients at some point in our lives. Have you ever felt uncertain about a diagnosis upon discharge from a hospital? Have you ever felt like your doctor walked past you before you had a chance to ask questions, process the results? I promise this was not born out of a desire to confuse or ignore. We are drowning.

“That’s how it’s always been” and similar phraseology have crippled NCHD progress for decades. Currently, NCHD contracts last no more than a year, which, in addition to creating seemingly unnecessary documentation for labor services, leads to deep-rooted feelings of impermanence and disconnection. “Will I still have to uproot my family next year? Will I ever be able to settle down? For at least 10 years before qualifying as a consultant, you are treated as temporary staff, although you often never leave HSE employment.

External commitments? Dependent parents? Forget that. There is no child care or home care service in the world that provides 24-36 hour shifts. Do you move every year? Good luck maintaining a relationship, finding child care, or exiting the rental market. Irish patients cannot hope for an improvement in their healthcare service while we drive our workforce out of Ireland (or out of the profession) with these impossible demands.

All of this could almost be surmountable, if you had enough time to rest. It seems somewhat hypocritical to preach the importance of sleep to your patients, when you begin to work, prescribe and operate without having any.

NCHDs are no longer prepared to put up with these barriers to delivering effective care. Irish patients and our healthcare workers deserve better

According to vital research conducted by Dr. Niamh Humphries and her team over the past four years as part of the Hospital Doctor Retention and Motivation Project, significant dissatisfaction with deteriorating job quality, long working hours and the poor balance between work and private life leads to the emigration of doctors. I know of four doctors last week who left Irish shores to work overseas indefinitely. It is heartbreaking and frustrating that they are not there to look after our families, our friends, our communities here in Ireland.

If we can protect NCHDs from unsafe shifts, if we can guarantee payment for hours worked and leave entitlements. If we can recognize that they are human beings, like everyone else; then we might have a chance to retain the exceptional workforce we have created and protect the health of the population.

NCHDs are no longer prepared to put up with these barriers to delivering effective care. Irish patients and our healthcare workers deserve better. Our “#standup4NCHDs” campaign seeks meaningful engagement on the above issues urgently, for patients and for staff.

The Irish medical organization called an emergency meeting of NCHDs across the country, members and non-members, on April 11.

Dr Rachel McNamara is a member of the IMO NCHD Committee


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