The Irish Association for Emergency Medicine is very seriously concerned that a number of Emergency Departments (EDs) around the country have been left very short of key medical staff as a result of the implementation of a HSE Directive intended to cap the pay of locum doctors. This directive took effect on 1st September 2017 and has resulted in significant pay cuts for the affected doctors who have chosen not to attend for their shifts today as a result. It has also made the filling of short-term vacancies less timely and more likely to be unsuccessful.
The Association’s concerns are based solely on the safety implications of rosters that are missing doctors which puts at risk the safety of patients attending EDs – such a cornerstone service of the acute hospital system. The Association is acutely aware that in some hospitals the majority of medical staff are employed through Locum Agencies and in these hospitals the ED will cease to function in the absence of doctors.
Clearly, questions need to be asked as to why it is that such a high proportion of the medical workforce are employed as locums and, in particular, why so many local graduates choose to work as locums rather than take posts on standard contracts. As long as regular contract posts are so unattractive there will be continue to be a shortfall in medical rosters in many of the country’s 29 EDs (and in other critical hospital specialities) which will inevitably only be filled with locum doctors. Allowing a situation to develop where regular medical employment (particularly in training posts) is so unrewarding and unsatisfactory that so many choose this alternative is yet one more failing of those with political and managerial responsibility for the Health Service.
In the short term, suitable compromises need to be found to ensure that ED and other key departmental medical rosters are fully filled and, in parallel, steps taken to ensure that an environment is created where doctors preferentially choose to work on regular contracts leaving only unforeseen or other short-term vacancies filled by locum doctors.