Overwork, vacancies and poor treatment of foreign medics put patients at risk, Medical Council warns

Patient safety is threatened by a number of key issues doctors face – including failure to fill hundreds of hospital consultant and specialist positions, overworked junior staff and poor treatment of foreign medics here, the Medical Council has warned.

The regulator of the medical profession has highlighted how resident hospital doctors fulfill the duties of senior hospital advisers in a new report.

In addition, there is a dependency on international medical graduates to sustain the services, the council said.

It added that the majority of young doctors are trained abroad and do not have access to specialist training in Ireland.

“The healthcare system relies too much on these international doctors who report they are overworked, undervalued, discriminated against and denied access to residency training. Aside from the individual impact on physicians, the treatment of international medical graduates has serious implications for patient safety,” warned the Medical Council’s latest Workforce Intelligence Report.

Physician well-being continues to be a key issue identified in the 2021 report and we need to address this as we cannot afford the impact on patient care

Further risks arise from the fact that a quarter of doctors are forced to work more than 48 hours a week, in breach of EU law.

And there is an acute shortage of doctors in the Irish healthcare system, particularly at the level of qualified and experienced consultants, which can affect the quality of care and undermine patient safety.

Various reasons were also given for the departure of physicians.

“In 2021, physicians cited family and personal issues, lack of educational opportunities, inadequate resources, and working conditions as reasons for resigning,” the report reads.

The President of the Medical Council, Dr. Suzanne Crowe, said: “Physician well-being remains a key issue identified in the 2021 report and we need to address it as we cannot afford the impact on patient care.

“There are many problems ranging from non-compliance with the European Working Time Directive to a lack of career advancement, out-of-hospital consultant doctors doing the work of hospital consultants, reliance on international medical graduates and poor treatment of junior staff and non-hospital-national ones Doctors.

“The risks are obvious. We have vacant consultant positions. There is continued growth in the General Division of the Medical Association Registry and our medical staff continues to suffer from burnout, bullying and overtime.

They existed before the Covid-19 pandemic and have yet to be addressed by the broader healthcare system

“The responses of those who have withdrawn from the registry tell a story and unless we accept, acknowledge and act on the shortcomings of our workforce now, ultimately patients will suffer.”

She said these factors led to “wear and tear from the register”.

“They existed before the Covid-19 pandemic and have yet to be addressed by the entire healthcare system,” added Dr. Added Crowe.

“These and other related issues require urgent investigation as they result in compromising patient care and safety risks that have been identified.


Patient care is hampered by storage issues, the medical council said. Image from a photo agency

“There are many great projects underway or beginning on human resources issues at government, national, training, employer and local levels, but we need to ensure that a collaborative approach is taken that involves all stakeholders, including patients and educators, to ensure we address the issues highlighted in this report and other previously published reports and research.”

The report found:

  • A total of 21,680 physicians retained their place in the Medical Association Register in 2021, of which 18,424 or 85 percent were clinically active.
  • Of the active registered doctors in Ireland, 53 per cent were male and 47 per cent were female.
  • Over a third of all clinical doctors in Ireland are on the General Division of the Register.
  • The number of newly registered physicians in 2021 was 2,605, a 14 percent increase over the previous year.
  • Of these, 1,717 were international graduates and 888 Irish graduates.
  • 49.8% of NCHDs (Junior Doctors) held non-apprenticeship positions.
  • 62 percent of doctors said they work more than 40 hours a week.
  • Dublin has the largest number of working doctors with 7,426, which is 35 percent of the total.
  • There was a significant number of withdrawals and out of 982 registered voluntary withdrawals, 848 physicians (86.4 percent) completed the voluntary withdrawal form detailing the physicians’ reasons for voluntary withdrawal.
  • 68 percent left the general department, 25.4 percent left the specialist department and 3.5 percent left the internship department.
  • 25.5 percent of physicians gave family or personal reasons for leaving the registry, while 17 percent left the registry because of limited advancement opportunities, up from 14.8 percent in 2020.

According to the report, a number of work-related issues were cited as reasons for de-registration. These included resources, lack of appreciation, personal impact due to excessive work hours, and lack of support from management or clinical supervision.

These issues have been highlighted as significant challenges to physician morale and their ability to provide safe and quality patient care, thereby jeopardizing patient safety.

Something that needs serious consideration in the short-term to address recruitment, retention, distribution and supply challenges

Other factors in physicians’ decision to withdraw from the registry include the cost of professional indemnity insurance and registration, an inflexible registration model, and health concerns related to the Covid-19 pandemic.

“As part of our recommendations, the Medical Council is calling for a strategy for healthcare workers,” the report said.

“This needs serious consideration in the near term to address recruitment, retention, distribution and supply challenges. A medical workforce planning framework should strategically consider and identify measures to improve the working conditions of physicians. The goal is to arrive at a situation where there is an appropriate medical workforce that will result in quality patient care and safety.

“The Department of Health, HSE and other agencies are undertaking or embarking on some important transformational projects that will significantly improve access to care and treatment, and these important developments need to be considered when considering workforce planning issues.”

The report also states that while recent legislative changes allowing doctors without EEA qualifications to access training are very welcome, more needs to be done as those doctors without access to career development will also leave.

All of this affects patient safety

“NCHDs who are not in training report being overworked, undervalued, discriminated against and lacking access to proper training. The current training, oversight and working conditions of NCHDs have serious implications for patient and worker safety,” it said.

“In addition, the extremely high number of doctors in the General Section of the Medical Register is a major problem. This continued growth was largely unplanned. It also reflects our disproportionate reliance on international medical graduates who then have no career path or advancement opportunities. This in turn leads to a high level of voluntary departure and emigration.

“All of this affects patient safety and our primary responsibility as the regulatory body for the medical profession is to protect the public. But in order to play our role effectively and address the risks identified, we need to ensure our workforce operates within a system that supports them and helps them deliver care at the level people expect – this is a fundamental requirement. It requires sustained commitment.”

https://www.independent.ie/irish-news/health/overwork-unfilled-posts-and-poor-treatment-of-foreign-medics-putting-patients-at-risk-medical-council-warns-41952865.html Overwork, vacancies and poor treatment of foreign medics put patients at risk, Medical Council warns

Fry Electronics Team

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