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Trainees’ working conditions: Statement from RCPI President, Professor John Crowe

The President of RCPI, Professor John Crowe, has issued the following statement on Trainees' working conditions

"The Royal College of Physicians of Ireland is aware of the grave concerns expressed in the media by trainee doctors about their working conditions, hours of work and the impact that this is having on their personal and professional lives, especially in the case of younger trainees.

These are long running issues that have not been adequately addressed and remain unresolved.

In 2011, generalised dissatisfaction amongst trainees with working conditions and career prospects manifested as an exodus from Ireland to what were perceived to be better places to work and train, mainly in the Southern Hemisphere. That 47% of interns left immediately after their internship was alarming enough but more serious is that many of those who have left have no intention of returning. This prompted the Forum of Medical Postgraduate Training Bodies to host a Forum on Retaining Medical Talent in Ireland at RCPI in December 2011. The Forum was attended by the HSE, Department of Health, the Medical Council, the Deans of medical schools and the heads of all postgraduate medical training bodies, as well as 60 trainees.

Two frank presentations to the Forum by a surgical SHO and a final-year obstetrics SpR on their life as trainees made it very clear to all concerned what the problems are and why trainees feel compelled to leave.

I believed that the issues were understood and accepted by all of those in a position to influence change, but regrettably there seems to be little motivation to improve working conditions or reduce working hours. The strongly held perception of many trainees is that there is no interest in their morale, wellbeing or training, that their expertise and professional contribution are not valued and that there is no interest in retaining that expertise as part of future workforce planning for the health service. Furthermore adverse media coverage of trainee doctors, which negatively influences public opinion, is never refuted by their employer.  

A working group from that Forum comprising Trainers and Trainees has met the Minister for Health and while significant progress has been made in areas under the direct and specific control of the Training Bodies, progress otherwise has been frustratingly slow and morale amongst trainees remains poor.

The reluctance of the HSE to engage with these issues may be partially explained by financial constraint but this is ultimately a shortsighted and self-defeating HR policy that not only mistreats idealistic and hardworking young doctors and exploits their vocation but causes significant disaffection in this group of expensively educated and highly motivated young professionals who should be incentivised to stay in Ireland rather than be forced to leave by unacceptable working conditions. Their loss has been has been compounded by great difficulty in recruiting adequately trained doctors from abroad to replace them. Ultimately it is the patient that suffers.

Working as a doctor can provide immense job satisfaction but this can be at a significant personal cost. School leavers considering medicine as a career should be aware that it can be very demanding. Frontline medicine and surgery are not easy career options. Hospital practice can be grueling, emotionally draining and when sleep deprivation and long hours are added, temporarily overwhelming. Most medical graduates learn to cope and become resilient. Being able to cope with heavy workloads and adverse outcomes is an important skill for doctors to acquire. The upside of intensive exposure is the rapid acquisition of experience, and with that, clinical confidence and mature clinical judgement  but there is a balance to be struck.

The interface between student and professional life used to be the start of the intern year but now the acute burden of professional responsibility lands in the first months of being an SHO which may be in a provincial hospital away from all the supports of a teaching hospital. Most graduates who have chosen a career in front line hospital medicine or surgery know what to expect and quickly mature and adapt,but it can be hard. Add 36-hour, high-density shifts, excessive clinical load, non-professional issues such as inadequate support and failure by the employer to pay for hours worked, and the burden becomes too much.

Interns and first-year SHOs require more support than their more senior colleagues. This College has just appointed 18 trainee representatives and plans to have a representative in every training hospital in 2013. An RCPI postgraduate training coordinator has been appointed to Letterkenny General Hospital and RCPI coordinators will be appointed to each training hospital as part of our Exemplar training program. A mentorship service will be available through RCPI to every SHO from late 2013.

Recent and very honest articles in the medical press describing professional and personal difficulties caused by long working hours and excessive workloads experienced by younger doctors in training have been followed by a torrent of supportive commentary online, in print and in broadcast media that are a compelling testimony to what many are experiencing. 

High quality training, respect in the workplace, imagination with regard to job structuring and remuneration for work done cost little relative to the loss of the intellectual resource and skills of our young medical graduates to other health services. Irish patients deserve better and Ireland cannot afford this waste of talent."

John Crowe FRCPI
President of the Royal College of Physicians of Ireland

If you have any questions about this please contact:

Aoife Ní Mhaitiú, Communications Executive
Royal College of Physicians of Ireland
Phone 01 8639 770 | 085 850 0080

Related Links

RCPI Statement on the Implementation of the EWTD, 2009