'Doctor shortage could close services'

Hospital consultants have warned that A&Es may have to cut back their opening hours and patients may have to be transferred from smaller to larger hospitals as a result of a significant shortage of junior doctors, which is expected to kick in on July 1.

The Irish Hospital Consultants Association (IHCA) has warned that hospitals could have up to to fewer 600 fewer junior doctor posts from July 1, which will seriously affect the provision of services, particularly in smaller hospitals and in the specialties of A&E, anaesthetics, obstetrics and paediatrics.

"What we are facing is a significant curtailment in the ability of A&Es, anaesthetic and obstetric departments to provide for their patients," IHCA President Dr Paul Oslizlok said.

He said if sufficient numbers of trainee doctors are not on site after July 1, patients may, for example, arrive at some A&Es and find there are not enough doctors to look after them.

Traditionally, junior doctors change their hospital posts every July. However, this year, there has been a major fall-off in applications for junior doctor posts in hospitals around the country.

Dr Oslizlok said there were likely to be at least 300 junior doctor vacancies from July 1 and the number could end up being double that. There are around 4,800 junior doctor posts in total in the hospital system.

He said one of the the reasons for the shortfall was that the HSE had decided to reduce by around 1,200 the number of junior doctor training posts. He said posts that had their training element removed from them would be less attractive for doctors to apply for.

Another factor, Dr Oslizlok said, was that that  as a result of contractual changes recently agreed, there had been major cuts in overtime payments available to juniors.

He said the shortage could result in patients having to be transferred from smaller to larger hospitals to access vital care, and these larger hospitals were already under severe pressure.

To date the response of the HSE to what had been a well-flagged crisis has been disorganised and ineffective, Dr Oslizlok added.

IHCA Secretary General Finbarr Fitzpatrick said the HSE was still recruiting for posts due to be filled on July 1 and has spoken about hiring doctors from Eastern Europe and South Africa to fill the service gaps.

He warned that A&E service in some of the smaller hospitals might limit their hours to nine-to-five.

The IHCA said that at Our Lady of Lourdes Hospital in Drogheda, there have been difficulties in finding enough anaesthetists trainees to provide a service for the hospital. There could, it said also be problems with the provision, for example, of emergency caesarean section services in obstetric units.

The Association says under the new Medical Practitioners Act, hospitals are obliged to provide a sufficient number of junior doctor posts with a guaranteed training and service element.

However, the HSE's latest move, it says, means that there could now now be many doctors working in non-training hospital posts who cannot go on the new trainee register under the Act.

The IHCA says these doctors will be on the general division of the medical register. They will be free to practise in hospitals without having their competence formally certified, and will be unsupervised by consultants.

Dr Oslizlok warned that there are not enough consultants around the country to fill the gaps left by the junior doctor shortage. He said the hundreds of extra consultant posts promised once consultants negotiated a new contract had not materialised.

Mr Fitzpatrick said we are as far away as ever from the "pipe-dream" of a consultant-delivered service promised in the Hanly report a number of years ago.

The IHCA is to meet Health Minister Mary Harney on Wednesday to discuss the hospital staffing crisis. It is likely to press for the number of recognised training posts to be revised upwards.

See also 'HSE facing new financial crisis'

[Posted: Mon 14/06/2010]