Time to change the changeover

In the previous issue of the Medical Independent, columnist Dr Michael Conroy wrote about the significant personal and professional disruption caused by the NCHD annual changeover (‘The Mayfly Effect’). According to Dr Conroy, who is a registrar in oncology: “The turbulence of our rotation system has few parallels in any other workplace and
make a stable adult life near impossible.” He describes the changeover as “more than an inconvenience”.

“Professionally, we leave behind systems, colleagues, and institutions that we are familiar with to take on new ones, with all the risk that this newness brings. Socially, we leave behind partners, children, family, and friends repeatedly,
and bring strain on relationships that can be taut at the best of times in medicine.

“Amid a housing crisis, we tear our hair out trying to find a short-term let when there are none. And as a workforce, we are among the weakest in the public service. We need roots and stability to organise ourselves and bring change. This is impossible when we are dragged asunder and land on unfamiliar turf every few months.”

The column received an overwhelming response online. The problems with the current system, which Dr Conroy describes so vividly, chimed with the experiences of many others (see Reader Comments). Anger and frustration were expressed about how difficult it is for doctors to put down roots and achieve any stability in their lives. The changeover has been part of NCHD life for many years. It has been around for so long it is easy perhaps to believe it will never change. That it is a rite of passage which doctors must simply endure because ‘that is the way things are done’. The same was once thought about working shifts of over 24 hours.

However, in 2013, the IMO’s ‘24-No-More’ campaign sought to highlight how NCHDs were still regularly forced to work shifts of more than 24 hours, in breach of their contracts and the European Working Time Directive (EWTD).
After meetings with the HSE failed to deliver a satisfactory agreement, 97 per cent of IMO members voted in favour of strike action. Under the subsequent deal between the IMO and the HSE to end the strike, it was agreed that hospitals would be financially penalised if they did not implement the Directive.

As we have regularly reported, EWTD breaches are still occurring and are an ongoing concern. But the 2013 campaign and strike showed how the status quo can be challenged. This does not necessarily mean industrial action. But pressure should be put on the Department of Health and the HSE to show the cost of the changeover system, and the negative consequences it has for both doctor and patient wellbeing.

In our last editorial, we asked whether health management would listen to the negative reaction to the draft Sláintecare consultant contract. This reaction and the comments in response to Dr Conroy’s column are signs of an extremely disillusioned profession. The context of the Covid-19 crisis has deepened this disillusionment. But these are long-standing issues that pre-date the pandemic and require urgent and sustainable solutions.