THE CURRENT DEBATE on working conditions for young doctors is part of a bigger trend for young workers to work longer hours, in worse conditions, for less money. This shift has been based on policy decisions made by a government that continues to avoid taking on vested interests.
Unlike some other groups, young doctors have a choice about whether to accept this – and many are voting with their feet. A mass exodus would endanger the future of the health service.
Doctors on undergraduate courses study for six years. After completing medical school, they will work as interns for one year before pursuing a speciality training scheme. Should they choose to train to become a Medical Consultant it would require a minimum seven years further training, but in practice this is likely to be more.
Upon completing medical school, Non- consultant Hospital Doctors (NCHDs) can look forward to an average working week of 60-65 hours according to the Irish Medical Organisation. Shifts can last as long as 36 hours with no sleep. In contrast, in the UK and Australia, no shift exceeds 13 hours and the normal working week is 48 hours.
While the pressures on doctors are unique, the debate over NCHDs’ working conditions fits into a bigger picture where policies toward younger workers diverge significantly from the treatment of older peers. Government decisions have focused the worst effects of the crisis on workers who are 35 and under. In addition to being twice as likely to be unemployed, young workers are also twice as likely to have part-time contracts and four time more likely to have temporary contracts.
In the face of this crisis, the government’s approach has been threefold: firstly, to freeze hiring of new workers (in areas like the civil service), effectively closing the doors of the largest employer in the state to the group that has by far the highest levels of unemployment.
Secondly, to introduce internship schemes like JobBridge that are effective at reducing numbers on the live register but which in practice often amount to jobs that don’t even pay minimum wage. This approach is based on a fundamental misapprehension that high unemployment rates are related to the supply of labour and not the supply of jobs.
Finally, the government has cut pay for new entrants in order to avoid balancing the books across wider sectors. New teachers who began their career in February 2012 will earn 30 per cent less than peers who began their careers only two years before, while over their working lives, they will contribute significantly more of their income in pension payments than older colleagues.
In medicine, the third approach has predominated. In the past, many young doctors endured their illegal long working weeks and 36 hours shifts because they were looking toward better pay and conditions if they reached consultant level. Though still high, new consultants’ pay has been reduced by 30 per cent. Necessary changes to how private patients are handled have led to deep divisions between pre-crisis and post-crisis medics.
Instead of tackling the issue of consultant’s pay in general, the government again focused on deeper cuts for new entrants. For many, the answer to these conditions have simply been to leave. In 2011 47 per cent of first year doctors emigrated after completing their compulsory internship.
This strike is about a simple issue, and it’s not pay.
Despite all this, the NCHD strike this week is premised on one simple demand: the end to unsafe working hours. Compliance with the minimum standards of the European Working Time Directive (EWTD) are no less than what they appear: minimum standards for safety and wellbeing. Given some evidence suggests that 28 hours without sleep can effect motor skills to the same degree as an illegal blood alcohol level, these long shifts are not a matter of comfort or conditions – they are a matter of patient safety. We should all be concerned about the idea of a doctor who hasn’t slept for 36 hours making decisions about patient health or treatment.
The recent Haddington Road Agreement saw NCHDs’ overtime cut from time and a half down to time and a quarter. This has had the effect of further reducing the incentive for the HSE to reduce illegal working hours and the issues of patient safety that come with it. That an overwhelming 97 per cent of NCHDs voted in favour of strike action is a powerful indication that these working hours are unacceptable and unsustainable. Most telling of all is the fact that if this strike achieves its aims, it should result in a decrease, as opposed to an increase, in pay.
We won’t be able to compete on pay with every other jurisdiction, but Ireland has an advantage that other countries do not: it’s home. If conditions aren’t improved, that advantage won’t be enough to maintain a sufficient population to carry the health service into the future.
In the ’50s, emigration produced a “brawn drain”, with low skilled and less educated workers making up the majority of those leaving. Today, a new pattern is emerging. Recent data from the CSO suggests that high skilled, well educated workers now make up the largest proportion of emigrants. The reasons for this should be obvious; higher skilled workers have less risk from emigration and they can quickly find a job commensurate with their skills.
Emigrants are also overwhelmingly young. In 2011, an Irish person under 45 was about 10 times as likely to emigrate as someone over 45. If working hours aren’t addressed, further “brain drain” is inevitable, and the costs of this will persist into the long term.
Young medics are relatively privileged workers. Their employment levels and prospects are good, and their work is meaningful. Yet while work security and pay levels are relative between industries or between states, standards for working hours and for patient safety should be absolute. It is imperative to provide for a safe working week for the sake of both doctor and patient.
Whether it’s cutting pay for new teachers or piling unhealthy hours on NCHDs, heaping the burden of the crisis on young workers and new entrants to avoid tackling entrenched interests is becoming the signature policy of this government. These practices don’t serve patients in the short term and will cause irreparable damage to the health service in the long term.
Dan Hayden is a PhD Candidate at the UCD Centre for Regulation and Governance, and an Irish Research Council Government of Ireland Scholar. Follow him on Tiwtter at: @danjhayden
Dr Antoine Murray is a Medical Senior House Officer.
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