Council anxious to expand remit to be an advocate for patients and doctors

The language of the Medical Practitioners Act feels very outdated, the President of the Medical Council told the College of Psychiatrists of Ireland Spring Conference 2024.

Dr Suzanne Crowe said the law was very controversial at the time of its introduction and was “very reactionary” in terms of a number of crises and scandals.

The 2007 Act, which laid the foundations for a 25-member Council with a lay majority, “already feels outdated” in terms of its language, according to Dr Crowe.

She described it as “quite a clunky piece of legislation”.

“One of the phrases that is used in the Medical Practitioners Act of our remit, why we’re set up, is to protect the public in their interactions with doctors… immediately there is language there where we are pitting the public against doctors and doctors against the public.”

She explained that the Council had appointed a liaison manager recently who will work with doctors who have a complaint lodged against them “to help them navigate the complaints process, which is very difficult and certainly feels very punitive. There is a lot we can do to support doctors in that regard”.

Dr Crowe said she and her colleagues on the Council were very anxious to expand on the Council’s remit to be an advocate for patients and doctors, in what is a very challenging healthcare environment.

“Currently we have three vacancies on the Council and again I think that that reflects some difficulty with doctors and other clinicians coming in and working in public roles because there is a tension and workload associated with that,” she said.

“I think that is quite different to 10 or 15 years ago where it would have been considered perhaps something more desirable to come on to the Council. Now it is seen as less so.”

Speaking about equality, diversity, and inclusion in medicine, she said it was a topic informed by her own experiences as a woman and that it was important that the Council reflected the desire to meet its obligations in the area.

“Also, I think because we know that our healthcare environment from a patient perspective and from a clinician perspective is really changing,” Dr Crowe said. “It is dramatically different in the last 20 or 30 years.”

She said there had been a huge increase in doctors on the register and, as of April, the number was approximately 30,000. However, not all of these doctors were clinically active and quite a few of these do not intend to work in Ireland, the meeting heard.

“It was being used as a mechanism to become registered and work in other EU countries, so we need to collect more information around this,” Dr Crowe said.

There were approximately 20,000 clinically active doctors in Ireland, she told the meeting.

Dr Crowe said the number of women in medicine had increased steadily over the years, with women now making up 52 per cent of doctors in the 20-to-35 age group.

“I think that has major implications for how we work and for our training schemes… given that a very large proportion, now the majority of doctors, will need or want to take some time off to have families.”

In some specialties such as general practice, paediatrics, and psychiatry, there were more women than men.

However, other specialties were lagging behind, the meeting heard.

“I strongly feel all jobs from this day on should be open to less-than-full-time working applicants. And we shouldn’t be asking people why they want to work less than full-time. It should be a choice that people can make. Certainly, in the NHS that would be the case, that all jobs are advertised as being open to less than full-time working.”

In terms of doctors from different cultural backgrounds working in Ireland, there had been huge changes over the last 10-to-15 years, she added. “Now approximately 45 per cent of psychiatrists here have graduated outside of Ireland.”

Dr Crowe said the Council had taken this information to the HSE to petition for enhanced induction programmes.

“There’s no doubt that when we look at our complaints data, we see that doctors who have graduated outside Ireland who come to work here, for the first five years, are very vulnerable to having a serious clinical incident and a significant complaint made against them,” Dr Crowe said.

“That reflects a very different environment that doctors are working in, culturally, from a language perspective, and perhaps from different clinical practices in terms of consent or information sharing. So I think we have huge work to do in terms of supporting what is a very significant portion of our workforce. So a lot more data sharing and data collection needs to be done across all of the bodies that interact with our profession.”

She said the Council and other bodies collected a lot of workforce information and were “sitting on it”.

“Not analysing it enough, not teasing out the messages from it, and not sharing it sufficiently. There is no reason in the world why we shouldn’t be publishing a lot more information.”

Looking at the Council’s most recent Medical Workforce Intelligence Report, she said it would come as no surprise that there is “still widespread non-compliance” with the European Working Time Directive.

I think that has major implications for how we work and for our training schemes… given that a very large proportion, now the majority of doctors, will need or want to take some time off to have families

“There is a big disparity between the stories that we are being told by doctors in training who tell us the hours that they’re working. So we have a lot of work to do.”

She also pointed out that Ireland relies heavily on international medical graduates.

“We allow them to sit their exams often unsupported if they’re on the general division and they’re not linked into a training scheme. We may not give them any form of certification as to their experience, despite the fact that they’ve worked with Irish patients for three, five, or eight years,” she said.

“And then they leave and take all that wonderful experience and go to another country. So, we need to look at the doctors in the general division, men and women from different cultures, and include them in a lot of our support and training structures.”

She said that detailed workforce planning was vital for the health service, and the Council believed that work-life balance should be a priority. She said following Covid-19, it was clear that employees across all industries wanted to work differently.

“I want to work less. I want to see my family more,” Dr Crowe said.

She said it was also important to acknowledge and accommodate people who wished to return to working full-time. “We need to bring those people back in and foster them into a second wave of participation within academia and senior positions so that we can really capitalise on what is very rich life experience.”

Dr Crowe also highlighted that with a population that was living longer, many people were “bookended by caring responsibilities” for children and older parents.

“So how do you change and adapt your working life to match up so that you don’t necessarily have to step away completely from your post? You could perhaps reduce your hours and responsibilities on the understanding that this is the wave. And yet you will come back and perhaps contribute very actively to your department in five years’ time or in 10 years’ time for another time period.”

Dr Crowe said she was very passionate about on-site childcare.

She pointed out that in the major infrastructural projects that have been funded in the State, there are no on-site childcare facilities provided.

“So that is disappointing.”

During the question-and-answer session, Dr Crowe said the Council’s statutory powers were very limited in terms of making workplaces better.

“If you look at the Medical Practitioners’ Act, it is a great source of discontent to me that the powers are aimed at the practitioner, and we know that in the complex environment that we work in, it is very, very, very rare that any issue is uniquely related to one doctor.

“And yet the regulation of our profession is very much set up that the Medical Council can pursue, from a regulatory point of view, an individual doctor, but has very limited powers in terms of what we can do about perhaps a very under-resourced system that you’re working in. Or a very toxic environment where you feel very unsupported.”

She said that the Council does have powers in terms of accreditation for training.

“We do carry out inspection and accreditation of training sites. Traditionally we haven’t used our teeth in that, and there probably a variety of reasons for that. And it is felt to be a very radical action to go into a training site and say we have such concerns about the training environment for doctors, that we will be suspending accreditation. That has never been done.”

She concluded that it had been discussed at Council meetings more recently “as something that we feel increasingly pushed towards as a regulator… because of being aware of some services that are just underwater in terms of resources”.