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President Newsletter 06

Re: President’s Newsletter No. 6 – October 2012

Dear Colleague,

I wish to update you on a number of important current issues for Emergency Medicine and the Association. I propose to deal with these under a number of headings

Current situation

Earlier this year saw headline achievements for EM in Ireland in the form of the EMP launch and ICEM 2012. In addition, instigation and various recommendations of the landmark Tallaght HIQA report endorse the approach taken by the Consultants in EM in Tallaght and strongly support implementation of the EMP. New departments have opened or are in development; some new EMP posts have been approved and interviewed and clinical programme implementation and interaction is underway to varying degrees.

However, this Autumn has seen increasing anxiety and discontent for EM practitioners. What are the sources of this disenchantment?

  1. Candidates for posts, who are successful at interview, are not receiving contracts due to the HSE recruitment pause.
  2. Contract discussions between representative organisations and HSE are perceived as uniquely disadvantaging doctors in EM.
  3. The new entrant terms will impact heaviest on EM recruitment particularly when combined with the management side’s historical unique resistance to contracts which allow options for income generation.
  4. Indications from interactions with the SDU (and others) that the role of EM is still inadequately understood and undervalued and seemingly of lesser priority than the acute medicine and acute surgery programmes. Ironically the promises of both of these programmes are charitably described as rather unsoundly based.
  5. Frustration within the EMP because of a lack of commitment by those tasked with prioritisation within the health service; lack of resources for implementation and continued extraneous delays to the EDIS project.
  6. Knowledge that these perceptions are based on ignorance, flawed data and wrong assumptions.

What has been happening?

Our belief in the central position of EM in a properly functioning health system, which has recently been restated by the Minister for Health, is supported by international experience and must be ratified by the HSE/DoH. While reiterating this fact to HSE/DoH leadership and demanding unequivocal approval and support for this stance, we must robustly rebut all attempts to deny it. On the other hand we must demonstrate the flexibility and lateral thinking, which characterises much of our clinical work, in offering solutions to the problems facing the wider health system.

Meeting between Dr. Barry White; Prof. Ronan O’Sullivan and Dr. Una Geary

A proposal to increase the starting Consultant in EM salary by €20K contingent on the specialty agreeing to working until midnight and/or Consultants in EM working a 40-hour week was proposed by BW. ROS and UG were opposed to further concessions being made by EM but agreed to bring this for discussion to the Consultant and trainee group (as per this update). The general mood within EM was explained and it was emphasised that individual doctors would decide through IMO/IHCA whether or not to accept the broader deal.

Prof R O’Sullivan and Dr P Gilligan continue to work hard to represent our interests through the representative organisations. They require our encouragement and support as the challenge in representing a minority group in these organisations cannot be underestimated.


  • Meeting with Prof. John Higgins regarding hospital groups – Emergency Care Networks are not considered within his remit but UG will follow up in this regard. The names of regional and subregional leads for the EMP have been communicated to the RDOs pending establishment of the hospital groups. These leads will liaise with the RDOs on behalf of the EMP and will also be available to attend SDU ED visits.
  • Meeting with Ms. Eilis McGovern, HSE MET, regarding workforce planning. Ms. McGovern is aware of the difficulties regarding middle grade recruitment to EM and her remit covers Intern, non-training posts, training and workforce planning in all specialties. There will be ongoing engagement between ICEMT and HSE MET regarding NCHD and Consultant staffing.
  • The EMP working group have sought a formal meeting with Ms Lis Nixon of the SDU which will take on Wednesday 3rd October.
  • It has become apparent from communication at recent Acute Medicine site visits that their Programme approach now differs significantly from that outlined in the AMP Report 2011 and agreed with the EMP and IAEM. There have been inter-programme difficulties over the past 9 months including the de-railing of the EDIS project and further attempts to undermine the specialty of EM. Inappropriate and unprofessional behaviour encountered by members at these visits will also be the subject of a formal complaint.

IAEM will continue to advocate and persuade policy makers of the core importance of EM in the health care system and

  • Highlight aspects of HSE/DoH policy which impede the ability of EM to maintain its crucial core role in the healthcare system, including issues that impact on the recruitment of high calibre Consultants;
  • Aggressively push for the maintenance of a middle tier medical EM cohort for service and specialist training;
  • Seek to ensure provision of the resources required to move towards our joint aim of enhanced Consultant presence in Emergency Departments;
  • Seek clear parity of esteem with competing specialties;
  • Robustly resist and argue with those who seek to subvert our specialty with the use of spurious data and arguments;
  • Provide support for and solidarity with our members and our colleagues;
  • Provide and support innovative thinking around providing emergency care for our patients including working cooperatively with relevant others;
  • Use the media to rebut some of the wilder misinformation as many of you are doing so well.

In order to get feedback from the wider membership on these issues and to receive guidance on future action, a special meeting of IAEM members will be held at the ASM in Carton House, Maynooth, Co. Kildare in October. This will follow and be separate to the AGM – details to be announced.

Yours sincerely,

Mark Doyle signature

Mark Doyle FRCSI, FCEM

Consultant in Emergency Medicine, Waterford Regional Hospital

President, Irish Association for Emergency Medicine

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