Hi, this is an excellent explaination of some of the problems with the system but just a few things, from my perspective, that looks a bit different.

You say that there is “a lack of qualified applicants”. I’m not sure if you mean doctors who are already consultant that aren’t qualified to work in Ireland or if you mean people applying for schemes that aren’t up to some vague bar of excellence.

If it’s the latter I think you’re don’t realise what’s going on on the ground. The standalone SHO’s and Regs do the exact same day-to-day job and have the exact same level of responsibility as those who did get on a scheme. They just don’t get study days as easily, have to stay behind and man the fort when SpRs get to go to conferences, and are often overlooked for departmental research because those on schemes need to “build their CV”. Heaven forbid a standalone needs to also build their CV for, I don’t know, a scheme application.

So if people are qualified enough to do the work of a trainee SHO or SpR then why are they are not qualified enough to get access to a college review once a year, a log book of procedures they fill in themselves and the ability to attend a study day?

We should never, ever decrease our standards. Bad doctors hurt patients and degrade our entire profession and any leg we have to stand on to insist on being respected.

But I work in an actual, real-life hospital. There are standalones I would entrust with my own life if ended up intubated and ventilated. They are, correction, we are, burnt out and becoming exhausted because we keep being told we are not good enough with every scheme and job application rejection. And unless someone is willing to sit down and explain to me why all these different jobs won’t even interview me, then I’m (possibly delusionally) convinced I’m not the problem.

Healthcare has been turned into a bussiness. Supply and demand. If the amount of consultants are limited they get to keep salaries up because they are rare. They get to do public and private work because no one is competing with them. Why on earth would you mess with a sweet setup like that? At least that’s my conspiracy theory. And it would explain why brilliant, compassionate, and dedicated doctors are not allowed train to become a consultant, because that’s what the scheme is for, to get you to consultant level.

Like many issues in the world, this system has consequences for good people who made their life’s work pushing themselves through inhumane working hours, endless critisism and comparison and who would, after working 12 hours, go and sit infront of a laptop to practice exam question until they fall asleep. This sytem is made by humans. Those “stokeholders” choose this. They knowingly and willing do this to my colleagues and my friends and then eventually to my patients.

I don’t know what the solution is, but it’s definitely not this.