Rebalancing the medical workforce

The latest specialty reports from HSE National Doctors Training and Planning (NDTP) have underscored the need for significant increases in consultant and trainee numbers. This growth is required to meet population healthcare needs, as well as to implement measures such as more sustainable rostering.

In this edition’s main feature, written by David Lynch, key medical leaders state that a lack of clarity on future funding is hindering workforce planning and retention efforts.

As well as the sizeable increases required in consultants, from our current low base, a striking theme of recent NDTP reports is the continued extent of reliance on doctors who are not in consultant or training posts, ie, ‘non-training scheme doctors’, or ‘NTSDs’, another acronym that has entered the HSE’s
vast lexicon.

The Irish system’s dependence on NTSDs – who are predominantly international graduates – is far out of kilter with comparable nations. Many of these doctors are ambitious to develop their careers, but face obstacles accessing specialist training despite some improvements. 

The very high level of dependency on NTSDs and low proportion of consultants, is a recognised patient safety risk. This situation is more pronounced in certain specialties and settings – for example, in some model 2 and model 3 hospitals.

According to NDTP’s Medical Workforce Analysis Report 2023-2024, the number of NTSDs stood at 3,970, which was a 21 per cent growth on the previous year. There were 4,324 trainees, a 4 per cent increase; and 4,254 consultants, a 12 per cent rise.

The Medical Council’s 2023 workforce intelligence report stated that 33 per cent of doctors were registered in the general division. In the areas of practice within ‘medicine’, this figure was almost 45 per cent.

Rising service demands, the requirements of the European Working Time Directive, and difficulties in attracting doctors to some clinical sites and specialities, have been identified as among the reasons for the growth in NTSD numbers and in doctors with general registration.

NDTP has been working with a number of training bodies and clinical sites across medicine/surgery to identify NTSD posts that can be converted to training posts.

As noted in NDTP’s recent report, Surgery Medical Workforce in Ireland 2024-2038, the RCSI is also planning to provide another pathway to higher specialist training for doctors who are currently NTSDs, subject to criteria and an assessment process, which will likely be introduced in July 2026. This was in response to a Ministerial request to introduce a pathway for ‘recognition of prior learning’.

Such developments represent a valuable opportunity for NTSDs and form part of the puzzle of rebalancing the workforce. More broadly, the outputs of the NCHD taskforce and model 3 hospitals project are important vehicles for reform.

Ultimately, medical workforce issues will require greater attention and support from the incoming government to move matters forward.