Consultant status for occupational health physicians is long overdue

The lack of equality accorded the specialty should not be allowed to continue

In terms of recognition, Irish medicine has form when it comes to some specialties being offered the leftovers. For many years it was public health specialists being denied consultant status despite graduating from rigorous training programmes. It took the tsunami of Covid-19 and its immense threat to public health for specialists to be granted consultant status. Now, a different group have emerged as second-class doctors.

Occupational medicine is one of the smallest specialties number-wise. Yet it is fully recognised as a distinct faculty within the RCPI, with a properly structured postgraduate training scheme that is on par with other specialist areas of medicine. Once admitted to the higher specialist training scheme, trainees follow the same thorough curriculum as other medical specialties under the umbrella of the RCPI. Working in a patient-facing role, they compile extensive portfolios of cases managed and carry out numerous worksite visits to locations across the country. In terms of assessment, they are required to complete two sets of mandatory written and clinical examinations. Upon finishing training, graduates receive the same certificate of satisfactory completion of specialist training from the RCPI as every other medical specialty.

While fully qualified occupational health physicians (OHPs) have been seeking full consultant status for some time, the issue has been brought into sharp relief by the recruitment freeze currently being implemented by the HSE. The freeze applies to OHPs, but does not affect other medical consultants.

In an open letter to the Minister for Health, current OHP specialist registrars (SpRs) describe the situation as “arbitrary, discriminatory, and unfair”. They state that many current trainees would not have trained in occupational medicine had they known they would not have public service consultant status at the end of higher specialist training. Some three SpRs have left the OHP training scheme in recent years, which accounts for 23 per cent of the trainees. And all of last year’s graduates in occupational medicine emigrated abroad. “Our lack of consultant status is bleeding talent and excellence from our specialty,” they write.

The big losers, apart from the SpRs themselves, are HSE staff. HSE policy dictates that an occupational physician review is mandatory in certain clinical situations. Staff members who have been injured or assaulted at work or who are critically unwell need timely appointments. However, patient safety and quality of care issues are not being met, with many staff members waiting six weeks or more to be assessed by an occupational specialist. This compares to the UK, where many NHS occupational health departments have time-to-appointment (the time from when a referral is received to the appointment date) as a key performance indicator and typically appointments take approximately eight days to be arranged.

The deteriorating wait times in Ireland are worrying. At a time when burnout is such a big issue for healthcare professionals, not having ready OHP support is damning. Operationally, it means that when staff members cannot be seen in a timely manner after referral by their manager, they remain on extended sick leave and their department has to try to function understaffed. Errors, mistakes, and incidents are more likely to occur in these understaffed departments.

Current waiting times for OHP appointments go against the HSE’s Values in Action model and signifies a lack of respect towards staff. The longer a person is out sick from work, the less likely they are to return to work. So by denying HSE staff timely OHP appointments, we are also reducing the likelihood of them returning to meaningful employment. This can only compound staffing difficulties and will negatively affect recruitment.

The problems associated with the continuing hiring freeze as a result of the lack of equality for the specialty will be exacerbated if the curent situation continues, according to the SpRs’ letter .

The cost implications for the public health service of granting consultant status to OHPs are minimal. It’s time we brought our colleagues in from the cold.