Prof Deborah McNamara, President of the Royal College of Surgeons in Ireland (RCSI), has recognised the substantial difficulties confronting newly qualified surgeons in their professions. She stresses that the healthcare environment is particularly demanding and could overwhelm the inexperienced.
There is an understanding that the infrastructure of many areas is below acceptable standards, resulting in a sense of solitude for youthful surgeons beginning their clinical professions. The burden of expectations is heavy on them, given the general public’s anticipation of exceptionally high treatment standards.
Prof McNamara periodically acknowledges that it can be hard to provide the kind of care they aspire to. In her primary conversation following her appointment as head in June, Prof McNamara, who serves as a consultant general and colorectal surgeon at Dublin’s Beaumont Hospital, mentions forthcoming obstacles.
The health service is currently experiencing significant organisational and technological modifications, but some facets, like the infrastructure, remain predominantly static. Prof McNamara feels that this could potentially “hinder progress”. She explains, “Many of our surgical centres were conceived and established decades ago, before we even thought about advanced surgical methods like laparoscopy or robotic surgery.”
Prof McNamara reveals that medical personnel have to become creative to surmount such issues, turning workarounds into “a trait” of the medical field.
In particular, IT is an area where this is evident due to substantial reliance on paper-based procedures that lead to unnecessary repetition of processes. Governmental initiatives aimed at introducing digital health records for patients and unveiling a patient application by the year’s end are currently in progress to address such issues.
The issue of staffing within the health sector is a recurring theme. While unions argue that there’s still a shortage in healthcare personnel, the Department of Health assures that considerable employee growth has been recorded over the last four years.
Nevertheless, a persistent struggle exists in recruiting, with a substantial number of newly qualified doctors opting to move abroad for varying durations, with Australia being a primary destination. According to Professor McNamara, the medical profession’s round-the-clock nature often becomes a trigger for younger doctors to seek opportunities overseas.
The professor further elaborates that while attempts to provide better conditions for training doctors could sometimes yield unintended consequences. By reducing the duration of a typical shift, doctors may find themselves covering more weekends.
Interestingly, working abroad could prove beneficial for the healthcare sector. For instance, it’s common for higher surgical trainees to undertake a one or two-year international surgical fellowship post their Ireland-based programme.
Professor McNamara expresses disappointment that, despite Ireland educating and training international doctors who could contribute significantly to the nation’s healthcare sector, those desiring to live and work in Ireland face limitations.
Graduating doctors often move abroad to large population centres, allowing them specialise in niche areas that require a high volume of specific cases. Contrarily, this has yielded positive results for the Irish health service, as many surgeons returning from overseas training contribute as consultant surgeons back home. According to 2019 data, an impressive 80% of such surgeons returned to Ireland, she mentions.
However, there exists another perspective with the Royal College of Surgeons in Ireland (RCSI) attracting over 60% of its student population from overseas. EU students can choose to work in Ireland after completing their qualifications. This choice, however, is not available for those students from outside the EU.
Professor McNamara indicates a major obstacle where some doctors, trained and qualified in Ireland, are unable to practice in Ireland due to employment legislation. Despite meeting the standards of Irish medicine, these doctors find their options limited.
The legislation regarding the medical profession is beyond my range of competency, nonetheless, having professionals with medical degrees from Ireland indeed indicates they’ve met the Irish standards to become healthcare practitioners. Consequently, it seems logical to me that they could be invaluable to our health system. These professionals often rank among the highest-achieving medics in their qualifying year, despite our health service’s inability to retain them.
Simultaneously, she notes that later in their medical careers, Ireland tends to rely on importing doctors from overseas, who have completed their education in a non-English language. “It’s quite peculiar that we’re educating foreign doctors who would undoubtedly benefit our health service. It is regrettable for those who aspire to work here that there isn’t an available avenue to do so,” she comments.
Ireland’s demographic profile is ever-changing, with a growing, ageing, and increasingly diverse population. These changes continually shape the requirements and pressures on the healthcare system. Emergency departments are enduring unmanageable overcrowding; additionally, waiting lists are stubbornly high, exceeding 700,000, with more than two-thirds of these patients waiting longer than the target duration.
In this context, an essential point that often goes unnoticed is the risk to patients on waiting lists. “Just because a patient on a waiting list isn’t as visibly at risk as one in an emergency department doesn’t mean that they are any less important,” Prof McNamara highlights.
Given these circumstances, she holds the opinion that there’s a need to reflect on the ‘division of emergency and planned healthcare’.
Additionally, she mentions that surgical hubs are developing tremendously efficiently and emphasised their crucial role in improving the situation. “However, their focus is primarily on ambulatory outpatients, who require less complex care. As a result, their services aren’t suitable for patients who need specialists or larger hospitals,” she surmises.
Throughout the year, there is a noticeable fluctuation regarding the completion of elective surgeries, she notes. The winter period often sees an upsurge in emergency hospital admissions, which can lead to postponements of elective or pre-planned surgeries.
Until a division is established, she insists that it remains difficult to stabilise the fluctuation, unless there is a significant expansion in facilities. Currently, we are attempting to provide all services in all locations, thereby creating universal demands, she recognises.
Few Irish hospitals concentrate on elective or planned surgeries. Those that specialise in this area have proven to do it proficiently, she claims. While it’s feasible to segregate planned and emergency healthcare, it necessitates proactive measures and sometimes difficult judgements.