Sir, – The details of medical consultant specialists not being on the “specialist register” might seem esoteric. It is far from being so.
When patients are admitted to hospital, we are sick and in pain. We expect the HSE has employed a medical consultant to treat us that is fully trained as a specialist; for example a surgeon, a psychiatrist, etc. In at least 65 cases nationally (and it is likely there are many more) this is not the case. Often we may not even be informed.
The then-government rightly stipulated from 2008 onwards that all doctors appointed as medical consultants must have verifiably completed three to four years of extra training to become a medical specialist. It then reduced the salary for those specialist-trained consultants who are new entrants to posts compared to their already appointed colleagues.
At the same time, the HSE has (against its own rules) set up a less arduous route to becoming a consultant “specialist” by employing doctors in some cases through locum agencies that cost the taxpayer many multiples of a “normal” salary. There is no requirement for these doctors to spend the extra time and training involved in becoming a fully trained specialist. After a number of years they automatically become entitled to a “contract of indefinite duration”, which for patients means they will be employed as consultants without being trained as specialists.
There is therefore a de facto two-tier system for consultants to become medical “specialists” in the Irish health service, and patients do not generally know whether their consultant is trained as a specialist or not.
Those doctors who have gone to the trouble of completing specialist training continue to leave Ireland to work abroad (of five doctors in specialist training with me only one reluctantly remains in Ireland.) The unpalatable truth is that working conditions and salaries in other countries are far superior. Meanwhile, consultants who are involved in training specialists are in a minority, and do so frequently in their spare time and are increasingly frustrated at training colleagues for export.
Is there a solution? Patients should matter. We deserve better. The HSE should stop employing non-specialist trained doctors as consultants immediately. It should tell patients which consultants are trained specialists. The Government should implement the 2008 consultant contract in full and end the unfair and self-defeating two-tier salary for new consultants. It should immediately improve funding for the training colleges and incentivise trained consultant specialists to be trainers.
If the current system continues, there is the potential for significant clinical risk, and the perpetuation of a two-tier “yellow pack” system of employing consultants to treat our families. – Yours, etc,
Dr KIERAN MOORE,
Consultant Paediatric
Psychiatrist,
Ros Mhic Thriúin,
Co Cill Chainnigh.