Limited resourcing, Consultant recruitment challenges in regional hospitals and Covid care has led to long waits for appointments essential to the early detection of IBD and cancer
- Approximately 40,000 people in Ireland already live with IBD, but delays to treatment are worsening their long-term outcomes and quality of life
- Dr Brian Egan, Consultant Gastroenterologist at Mayo University Hospital, also notes a rise in acute liver disease and Irritable Bowel Syndrome over the course of the pandemic
- Almost 17,000 patients are currently on a waiting list to see a Gastroenterologist – an increase of 7,000 (71%) since 2015; but around 1 in 5 permanent Consultant posts remain unfilled as young medical talent continues to leave the Irish health service
- Dr Brian Egan: “Trying to attract doctors to our regional hospitals with more onerous on-call duties, less resources, and limited access to specialty care is really difficult.”
A Consultant Gastroenterologist and Acute Medical Physician at Mayo University Hospital has warned that regional hospitals in Ireland are finding it increasingly difficult to attract the necessary number of Consultants and younger doctors.
It comes as growing waiting lists for gastroenterological procedures are having a serious impact on outcomes and quality of life for patients with Inflammatory Bowel Disease (IBD) and other conditions.
Speaking today (31 January 2022)on behalf of the Irish Hospital Consultants Association (IHCA), Dr Brian Egan said that there are around 40,000 people in Ireland who are already living with IBD.
Dr Egan said that even before the pandemic, Mayo University Hospital had a waiting list of “about a thousand patients” in his specialty. But his hospital’s situation is not unique: in Ireland overall, there are almost 17,000 people waiting to see a Consultant Gastroenterologist for diagnosis or treatment – an increase of 71% since December 2015, or an additional 7,000 patients.1
“The pandemic has had a major impact on gastroenterology throughout the country. Many of us who work in the care of patients with stomach and bowel problems and liver disease were re-allocated in the first wave of the pandemic to treat patients with Covid,” said Dr Egan.
“It also resulted in an absolute stop of scheduled work, which is essential for early detection and prevention of stomach cancer, bowel cancer, and oesophageal cancer.”
Dr Egan said that his team at Mayo University Hospital was seeing “much later presentations of cancer”, often people who have waited months following a referral. He noted that as a small hospital, there are limited specialist resources which means that it is almost impossible to keep up with the sheer volume of patients waiting for diagnosis and care in the region.
Consultant numbers and beds
Dr Egan was speaking as part of the IHCA’s ‘Care Can’t Wait’ campaign, which seeks to highlight the serious deficits faced by healthcare staff and services in delivering timely patient care in Ireland, their root causes, and their effects on patients’ lives and quality of life.
Ireland hasthe lowest number of medical specialists per 1,000 population in Europe at 1.48, 42% below the EU average of 2.54. The IHCA says the severe shortage of Consultants is the main contributor to the unacceptable delays in providing care to patients.
One in five permanent Consultant posts in Ireland across all specialties are currently vacant or not filled as needed. In gastroenterology, 10 of the 82 approved Consultant posts were vacant (as at 8 February 2021) – or 12% of the total.2 With a further 9% of all Consultant posts in Medicine (which includes gastroenterology) filled on a temporary or agency basis, around 20% of Consultant gastroenterology posts are understood to be not filled as needed.3 A shortage in one area, such as gastroenterology, can have a knock-on effect on another, such as oncology, and vice versa, as some patients have multiple diseases or ‘comorbidities’.
To cope with Ireland’s growing population, and the rising incidence of gastroenterological disease, the HSE will need to hire 67 additional Consultant Gastroenterologists by 2028 – an increase of nearly 80% on current staffing levels in this area.4 However, successful recruitment and retention of top medical talent is an ongoing and serious issue.
Impact on regional hospitals
A report published in December 2021 by the Medical Council5 revealed the severity of the Consultant recruitment and retention crisis. According to the report, 44% of specialist trainees intend to go abroad to practise medicine, meaning that at a time when more Consultants and doctors are badly needed, the health system in Ireland is losing them. The impact is most pronounced in Ireland’s regional hospitals.
“We’re finding it increasingly difficult to attract Consultants and younger doctors to work in our hospitals,” said Dr Egan.
He said that Irish doctors are highly regarded as experts abroad. Our specialists are emigrating to countries which don’t discriminates against consultants. The pay inequity imposed on Consultants appointed after 2012 has caused a recruitment and retention crisis, massive increases in waiting lists and delayed care for patients. Countries such as Australia also offer incomparable conditions through better work-life balance, and well-resourced services which allow for more effective and timely provision of care to patients.
“Trying to attract these doctors back to our regional hospitals in Ireland with more onerous on-call duties, less resources, and reduced access to specialist care is really difficult,” he said.
Bed capacity also remains an issue across the country, but particularly in regional hospitals like Mayo University Hospital.
“In terms of bed capacity, we [Mayo University Hospital] have one of the lowest acute bed per population ratios in Ireland. We need about 60 beds to bring us up to the national average and an additional 200 beds to bring us up to the EU average,” said Dr Egan.
Professor Alan Irvine, President of the IHCA, added: “Without urgent Government action, our ability to provide essential care to patients with serious illnesses will decrease significantly. While Irish doctors are among the best in the world, with so many posts unfilled across so many specialties, there is a limit to what we can achieve and that shouldn’t be the case in a developed nation like Ireland.
“The solution is simple. We must appoint additional Consultants and address the long-standing issues of pay inequity and poor working conditions quickly. The longer the Government fails to act, the longer waiting lists become and the worse our ability to provide rapid and effective diagnosis and treatment to patients.
“Many other Western countries, including Australia and Canada, provide timely, world-leading care to patients and an efficient, empathetic, and fair place to work for doctors, and other frontline healthcare staff. We must learn from their example.”
