Should I Stay or Should I Go?

Top’o the morning to ya”- a phrase which is perhaps echoing more frequently in the Emergency Departments of many hospitals across Australia and New Zealand; said in that distinctive and charming brogue is which is unmistakably that of yet another Paddy Irishman fresh off the boat, stethoscope at the ready.

It can be hard not to miss these twenty and thirty something’s who arrive through the Triage door, at what seems a rate similar to emigrants to the United States during Irish Potato Famine in the 1800’s, and like those famine survivors, they are seeking a better life

So why Australia do you ask? It is not simply sun, sand and the Sydney Harbour Bridge. Australia is quite the package for budding junior doctors. To work in Australia affords many opportunities which are simply too good to say no to, especially for a young aspiring Emergency Physician.

As a junior, a large focus has to be on what you gain in experience in each place you work, what you take forward and learn from each posting throughout your medical career. What has impressed this newly immigrated Irishman is the focus on teaching by consultants. Not only with scheduled teaching sessions through the week, but also bed-side learning opportunities, be it explaining a clinical sign/symptom worth taking note of, or the monitoring of a nervous RMO putting in their first central line. Each day at work is an opportunity for learning in a safely monitored environment, with consultants who have the time to teach as they go. With their healthy mix of clinical and non-clinical shifts, they provide an excellent service to the people of Australia, monitoring their junior staff whilst ensuring the i’s are dotted and t’s are crossed in the office.

Let us then look at the typical working week, a week which has the ideal mix of work, rest and play. At a typical 40 hours work per week, the newly arrived Irish find it a stark difference to what they were previously accustomed. Doctors are given the opportunity to work hard during their shifts AND have the down time to recover and relax. It is indisputable that the well rested doctor is not only a happier doctor but also a safer doctor.

What perhaps makes this a more poignant factor for the Irish doctors is the hours many worked as interns or residents back in the Emerald Isle, where this element of practicing safely is tested to breaking point at times. On a standard day, the typical surgical intern starts at 7.30am and works through until 8.00pm, this of course before doing call at night. 24-hour shifts are the norm with the hope of perhaps a 3 hour break for a snooze, however many have been asked to go beyond the call of duty and work more. Indeed this Irish-trained Registrar, whilst as an intern, one night worked 30 hours non-stop (including treating an unstable upper GI bleed and an 87 year old lady who was saturating at 83%) with no sleep, whilst the surgical registrar was in theatre. It has to be no surprise to the reader that I did not get home scot-free after a reluctant snoozing spell on the drive home. Thankfully the only cost of this incident was a Renault Clio, a hiked insurance cost, a matter of pride and not waking up back in ICU being tended to by my boss. However to add insult to a slightly stiff neck for a week, the overtime payment due was simply laughed at by the a paper pusher in the Finance Department who was more interested in what buns Norma in Human Resources had baked than my problems.

I wish to say that my own experiences were unique, there are, however, worse ones. I will however not delve into those stories, but when this becomes the norm, why would Irish doctors stay? People are being driven away by the strain of the working life. The allure of leisure and labour co-existing harmoniously is a sweet one, and with the Australian College of Emergency Medicine Programme, it does appear that the Emergency Trainee has a very structured but also manageable opportunity to further their training.

Now I don’t wish to completely disregard the Irish Health System. Although it does face problems, there are rays of sunshine for Emergency Trainees. 2011 saw the introduction of the membership programme affiliated to the College of Emergency Medicine. A 3 year programme encompassing Emergency, Orthopaedic, Internal, Paediatric Medicine and Anaesthesiology. A well rounded programme encompassing core elements required for competent Emergency Physician. After completion of this programme, one then applies to the Specialist Registrar Scheme of 5 years training. Now that this is finally set in stone, junior doctors now have a pathway to become a fully trained Emergency Doctor without having to leave the country. This will hopefully increase the number of much needed Emergency Physicians. Now bear in mind that St. James’s Hospital in Dublin has only 5 full-time Emergency Consultants.

Emergency Physicians in Ireland are keen to teach, as much as the typical Australian consultant and to bring on the next generation of specialist trainees. However when busy departments are staffed by very few consultants, a huge proportion of time is spent in the office doing the mandatory paperwork and not on the shop-floor where most would prefer to be. The simple answer is to hire more consultants and thankfully the program is giving this opportunity to train new residents and registrars coming through. But is the Irish Healthcare system going to hire more consultants? Will funding for new positions become available? If positions do pop up, a new question fresh on lips at present is will people take them? Only recently have the new public consultant contracts been revealed with a dramatic slash in their annual wage. Why stay when more can be earned elsewhere? Not that money is the be all and end all, it does however factor when mortgages are to be paid and mouths to be fed and educated.

The future for the Irish Emergency trainee is very uncertain. Steps have been taken in the right direction, the question now is, will the Irish Healthcare System decision makers realize the importance of a well consultant staffed Emergency Department? With the drive to convert to an Australasian-like Emergency model, consultants are trying to reel back the junior doctors they are losing to foreign shores. With resident numbers tightening, Ireland is not only looking at a problem in regards to consultants, but a very real problem of limited junior doctors to staff busy departments. More and more find themselves getting on a flight bound for the southern hemisphere with the promise of money for the hours they work, safe working environment and the bonus of sunshine most of the year (this is certainly something that can not be guaranteed in Ireland). In the past Irish doctors came for a year or two before returning to Ireland to ride the back of the Celtic Tiger when financially Ireland was much more affluent. Now the reality is these travelers are now packing their bags for good.

The best preparation for tomorrow is to do today’s work superbly well

Sir William Osler

Emergency Medicine Physician, #FOAMed advocate and self confessed rugby tragic | @JohnnyIliff | LinkedIn

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