New Medical Council Report calls for action on excessive working hours, resourcing issues, workplace bullying, consultant vacancies, doctor training numbers and greater focus on doctor wellbeing

Medical Workforce Intelligence Report breaks down the number of doctors across the health care system and looks at the impact of the COVID 19 pandemic

Key findings:

• 23,558 doctors on medical register at end of 2019
• 84.6% of doctors registered reported being clinically active in Ireland
• 78% of NCHD training roles were held by Irish graduates
• 3 out of 4 of those in non-training NCHD roles were doctors with medical degrees from outside of Ireland
• 1,135 doctors left the medical register in 2019 citing reasons including lack of support, excessive hours and resourcing issues
• Nearly two thirds of new doctors on the register in Ireland received their medical degree outside of Ireland
• 57.7% of doctors self-reported working more than 40 hours a week, 25.7% working more than 48 hours a week
• For every four Irish graduates registering for the first time, seven international graduates also registered

Friday, 4th December 2020: The Medical Council today launched the Medical Workforce Intelligence Report for 2019 – 2020, a key annual study providing essential information regarding the make-up of the Irish medical workforce and why doctors remain within or depart from our health system.

The data describes the continued trend of a growing General Division and attrition resulting from lack of access to training, poor working conditions and natural retirement.

While the report also presents an increase in intern posts, as a direct result of COVID-19, a collaborative effort is required to support an under-resourced and highly-pressured health service. Doctors’ wellbeing is paramount and as evidenced, burnout has a significant impact on patient safety.

In June 2020, 21,190 doctors retained their place on the Medical Council’s register, with 85% (17,926) reported being clinically active in Ireland.

• of this group, just over 50% were on the Specialist Division;
• 20% reported to be NCHDs not in training;
• close to 60% self-reported to be working over 40 hours per week.

The report highlights a number of issues of concern for the Medical Council such as doctor burnout, bullying issues and doctors working in excess of the European Working Time Directive.

The data also reveals that the health service currently relies on a large cohort of doctors who completed their medical education outside the EU, many of whom do not feel valued either personally, societally and monetarily in their workplace.

Voluntary withdrawals:

In 2019, there were 1,135 voluntary withdrawals from the register, a decrease of 21.8% from 1,453 in 2018, and the first decrease since 2014.

• 382 doctors who left the register in 2019 were graduates of Irish medical schools;
• 25% left the Specialist Division;
• The majority of these doctors planned to practise medicine in another country (69.9%);
• 100 doctors planned to stop practising altogether;
• 84 retirements in 2019; 57 doctors, representing 8.1% of respondents in 2020;
• 16.2% of those choosing to leave the register cited limited career progression in 2019; 14.8% in 2020;
• 26.6% family/personal reasons for withdrawal 2019; 25.1% in 2020.

Figures for 2020 show that, as of August 2020, 862 doctors had voluntarily withdrawn their registration from the Medical Council’s register. The majority of those leaving the register wished to practise medicine in another jurisdiction. However, some of those voluntarily withdrawing stated they were leaving the register due to personal reasons resulting from implications of the COVID 19 pandemic.

Some doctors who left the register stated they were not returning to practice in Ireland due to poor working conditions in comparison to the country in which they are currently practising, and experienced doctors qualified outside of the EU could not access formal training programmes. These challenges impact directly on patient and professional safety.

Jantze Cotter, Director of Professional Competence, Research and Ethics with the Medical Council said, “The purpose of this report is to provide intelligence about the medical workforce in Ireland to enhance patient safety and better support good professional practice among doctors.”

“It is a vital source of medical workforce planning data which can be used to inform medical education and training programme enhancements; recruitment and retention strategies; and policy relating to provision of health care in Ireland.”

“Provision of safe, quality patient care is challenged, as doctors report; working in poorly resourced services, working in excess of the European Working Time Directive hours, poor pay and burnout. “

“This results in ongoing attrition of Irelands highly trained and experienced medical workforce.”

“The patterns highlighted in previous reports are repeating themselves in 2019 and 2020. Only a commitment of collective, coordinated and planned action across stakeholders will produce solutions,” concluded Ms Cotter.

Medical Council President, Dr Rita Doyle, said “Despite the unprecedented nature of the past year for the Irish health system, the conclusions of this report provide a valuable insight into how the medical workforce needs to be supported and developed."

“Looking at the trends over the past few years, it’s certainly a positive development to see withdrawals from the register decreasing, however, much works remains to be done on making Ireland an attractive long term prospect to our colleagues who completed their medical education outside the EU, and would like to specialise here in their chosen field."

“Recent changes to legislation to remove the barrier to access training for non-EEA qualified doctors is very welcome but more needs to be done and training places need to be increased so we can fill vacant consultant roles,” concluded Dr Doyle.

Medical Council CEO, Mr Philip Brady, said “The primary role of the Council, as the regulatory body for the medical profession, is to protect the public in its dealings with medical practitioners.

“Strong, sustainable and fair health systems, responsive to the needs of the public, are essential to the health and wellbeing of a population. This report, presents data that can be used to support effective planning to develop and retain a strong and sustainable medical workforce.”

“The analysis of the registration and voluntary withdrawal data gives rise to concern about the safety of both patient and medical professionals. Action and engagement are required to really effect felt change for doctors” concluded Mr Brady.

Direct quotes from doctors:

Impact of COVID

• “I had to be repatriated due to the COVID-19 pandemic to be with my family.”
• “I am unsure about my future working plan. My priority currently is to be back to our home country. This is for my family to be in a more supportive environment due to the ongoing Covid19 risks and potential second wave. I am making this voluntary withdrawal reluctantly and I hope to practice in Ireland again in the future.”
• “I am moving back to Australia as I only intended to work in Ireland a short time for the experience, plus Covid has made plans more difficult”
• “I was planning to return to work in Ireland as a [role]. However the combined effects of Brexit and Covid-19 mean that this option is now unrealistic. I am therefore now planning to remain in the UK.
• “Covid-19 management in Australia means I am not allowed to travel overseas, hence I am unable to work in Ireland till the travel situation is stable.”
• “I had retired, went back on the register for Covid but was not needed. No reason to remain on register now”
• “am over 60, have some health issues and am retiring as i no longer feel comfortable working in the Covid climate we are currently in.”
• “I need to hold the training due to COVID 19 pandemic issue as my country government advised us to hold the training and go back to our country
• “In view of Covid and my underlying health issues, I am unable to continue working in an acute hospital/medical setting.”

Conditions and pay

• “Poor working conditions - hours, workload, support Pay”
• “Poor employer support, poor options for progression, poor pay, poor conditions.”
• ‘I am disappointed with the lack of Pay scale parity for Consultants. My co-trainees with lesser qualifications and experience have been awarded a higher salary. Despite a HSE circular that affirms the right of Consultants from other EU countries to be paid at par, I was denied this right and offered a much lower salary. I have hence no option but to sadly move away from practicing medicine in Ireland, till this issue is resolved in favour of equality.

Resourcing, progression, wellbeing and working conditions concerns

• “Many of the reasons above apply - no flexible training, poor staffing of hospitals, many non-core activities with poor IT systems, feel I can progress further abroad”
• “The treatment of all healthcare professionals by the government and the serial mismanagement of the health system on political grounds. Too many non-core tasks, understaffing’
• “The amount of bullying and disrespect I had to witness, the poor attitude to work out of hours by Consultants and lack of support of junior staff made I have never experienced in any other country I have worked. Lack of permanent Consultant posts. This all made me feel too uncomfortable to continue.”
• “Lack of permanent Consultant posts and career progression Disrespect and bullying of junior doctors in unbearable Poor treatment and bullying of locum staff”
• “I've suffered enough”.
• “It is completely unreasonable to expect Doctors to work over 90 hours in a week and then provide no time to recover!! Doctor's are not robots. I am fully expecting to ultimately retire from medicine very shortly at 32 years of age due to the expectations placed on us but i know that i want to at least give this profession another chance working somewhere else.”
• “I feel undervalued and overworked at home. I did not want to become burnt out. So I moved to Australia in February to gain more experience and work in a more supported environment.”
• ‘In New Zealand the job is better supported, fewer non-core tasks, more training, more course funding, better working hours, better staffing levels, and I get to avoid the contempt and disrespect you get from the Irish hospital system.’

Report recommendations:

• Increasing training numbers in a planned and considered way – reflecting findings of 2020 NDTP report.
• Looking after our doctors and their wellbeing by addressing systemic issues, poor resourcing, excessive working hours, bullying, task transfer and filling consultant vacancies are crucial to ensure patient and professional safety in practice.
• Exploring a flexible registration model that better reflects the practice of medicine and minimises unnecessary controls is imperative.
• The COVID-19 pandemic has forced rapid but positive practice change and developments including, but by no means limited to, widespread use of electronic prescriptions and the diverse practice of telemedicine. Building the foundations for this and supporting with appropriate guidance is necessary to protect patient and professional safety going forward.

ENDS

A copy of the full report can be found here.

A copy of the summary report can be found here.

A copy of the infographic can be found here.