Dr. Louise Curtis of Mallow, Co Cork, as an intern working at Galway Hospital, recalls that the shifts were so busy and ill-equipped that she would almost be afraid to come to work.
“You feel like you’re not meeting the requirements, you’re getting a little drowning all the time because you’re too tense to give people the care they need.”
The hours were long; Curtis said she could easily handle more than 70 hours a week.
“You’d do so many things that weren’t even your job.” “I remember coming a little earlier than I had and bringing patients to the scan because there weren’t enough carriers,” she said.
“It causes anxiety and as a doctor you feel like you’re still apologizing to people for having to wait or for not having services to refer someone to.”
Curtis graduated with a medical degree in 2016 and after her year on an internship in 2017, she moved to Perth in Western Australia with about 53 others in her class, she said.
According to statistics published by the Australian Home Office, a total of 402 qualified visas were issued to Irish doctors from 1 July 2021 to 31 March 2022, the vast majority for Western Australia. In addition, 391 temporary qualified work visas were issued to Irish doctors from July 2020 to June 2021.
Official figures show that between 31 December 2021 and 31 March 2022, a total of 531 Irish doctors lived in Australia.
With experience in the Australian healthcare system, Curtis looks back in almost disbelief at the time she was employed in the Irish scheme. Trainees directly from medical school, working on calls or on night shifts, were often left to themselves while covering the entire hospital, she said.
“You’re the youngest person on the team.” When you are on call or at night, it is the trainees who take care of everyone with very little support. You can call a doctor, but they usually have a lot of work to do.
“What you were expected to do on those shifts, without any support, was quite dangerous.”
Curtis said she had mistakenly signed up for the 72-hour shift and was expected to work the entire shift, which “could not be safe,” she added.
“I was lucky I could have a few hours to cover other interns while I took a nap.”
Like many young doctors, Curtis came to Australia with the intention of staying a year or maybe two before experiencing work-life balance doctors there. She is currently based in Melbourne and works as a psychiatrist registrar and has no plans to move home.
Compared to her more than 70-hour internship, she now works 40 hours a week, which includes about four to six hours of training. He also gets half a day once a week and usually only works one weekend day every three to four weeks.
Under the current Victoria Business Agreement, GPs can work a maximum of 16 hours on a scheduled shift; night shifts are limited to seven consecutive days; and doctors must have a 10-hour break between work one day and the other.
Thanks to better staffing and working conditions, according to Curtis, advisers and registrars in Australia are less stressed than at home and can offer time more freely. “There is no antagonism.” The culture is quite nice. ”
Since she was in Australia, some of her friends, who are also doctors, have returned home, mainly for family reasons, she said. Some who trained in medical training told her that the demands on them had been so high since their return that they had to stop training.
Although Curtis sees a work-life balance in Australia much better than in Ireland, it was still difficult to make the decision to stay.
“You choose between the culture you grew up in and your family and friends at home, as opposed to a really good work-life balance and better training and mental health support.”
Dr Ryan O’Dowling of Cork is a junior doctor who moved to Melbourne in 2019 after two years working in Irish hospitals as an intern and then as a lokum. Both of his brothers live in Australia and he has always felt a move towards lifestyle. Although it made sense for him to move, he did not necessarily plan to stay. After three years working in Australian hospitals, he is now asking for general practitioner training in rural Victoria and has no plans to move back to Ireland.
O’Dowling says the culture of defaming young doctors who are studying in Ireland and moving abroad needs to change. Instead of accusing younger doctors of leaving Ireland, the interview should be about encouraging doctors to stay.
As an intern in Ireland, he said the hours on his list were 8: 00-17: 00. In fact, he would work from 7:00 to 21:00 or 22:00, he says, and would easily work more than 70 hours a week. He was often expected to patrol up to 30 patients, he said.
“Back home you are praised as a martyr and a man who goes beyond the fact that you went five hours after the shift to see all the patients because it is considered such an honest thing,” he said.
“It becomes the standard and everyone does it, and if you don’t, you don’t meet the standard.”
In Australia, O’Dowling said younger doctors were “not left dry.” When he began working in the emergency room at Melbourne Hospital, he stayed an hour or two after the end of the shift to show that he was excited and had a strong work ethic. But his seniors quickly stopped it.
“They would look at you and say, ‘What are you doing?’ This behavior will stop quite quickly and is much more sustainable. “
In Ireland, simple everyday things like referring a patient to registrars and consultants would be “the biggest job in the world. It is very likely that you will be given a recommendation and told that you will come back and do more, “you are not doing enough”.
Far from blaming his seniors, O’Dowling saw that they, too, had been burned by the system. “You are going through years in this system, when you are overworked, underpaid, underappreciated and under-equipped.
“You’re a little tired, you know.” And because you’re overworked, you’re reluctant to take on more work, so you’re pushing back on someone else who’s already overworked and lacking resources. People need to be resilient to work so that they are not overwhelmed. “
By comparison, O’Dowling said his first recommendation in Australia was “open the eyes”.
“The person on the other end was genuinely interested in what I wanted to say and offered me advice,” he said. “It didn’t arouse in my heart the fear or fear of another 30-40 years of working in the system.”
There must be an overall cultural shift in the Irish health system around work-life balance and martyrdom, he said. “Your perseverance and perseverance in this way are finite.”
“People go through the system and become what they are, thanks to the system. It must be a top-down culture shock.
“If you can’t change the top of the system, you have to work hard and harder for younger employees to protect them from exhaustion, overwork and burnout.”
Dr. Niamh Humphries, an associate professor at the RCSI Postgraduate School of Healthcare Management, has written a number of articles on the emigration of doctors to Australia and elsewhere. He says it is worrying that doctors like O’Dowling and Curtis are not planning to return to Ireland.
“We have a very high emigration rate for doctors. Policymakers are not worried about this, as it is assumed that all emigrant doctors will return to work in the Irish healthcare system. If doctors decide to stay in significant numbers abroad, it will be difficult for Ireland to secure its healthcare system.
Ireland needs to improve working conditions to retain doctors and encourage emigrant doctors to return, he says. “It should not be a health system in which doctors are afraid to work or return to it. If Ireland wants a strong medical workforce in the future, it must address it. That will not happen by itself. “
In a statement to The Irish Times Health Service Executive (HSE), he said he had launched a study looking at the number of doctors in the civil service who leave and return to Ireland over time. It was found that 82 percent of those who started an internship in 2015 subsequently started a basic vocational training or practical training (GP) program between 2016 and 2021.
The revision of the 2015-2020 data indicated a trend of trainees leaving the system immediately after the year of the traineeship; however, “a significant number have returned to the HSE within two to three years,” the HSE said.
In 2021, of the 2016 cohort of doctors who received specialist training (in addition to the GP training program), 68 per cent were employed in Ireland and 32 per cent were abroad or their location was unknown, the HSE said, adding that it was “very normal ”. for doctors who have completed postgraduate training so that they can complete an internship or experience abroad before taking up the post of consultant. “
The HSE stated that it “is committed to continuing to address the persistent problems the health service faces in retaining doctors and will continue to work to attract Irish trained doctors back to healthcare.