Trainees in Anaesthesia in Ireland have given the thumbs down to the Minister of Health’s proposal for a “specialist” or “sub consultant grade”. These findings are contained in an impressive survey carried out by the group of anesthetists in training. What might be more worrying for Dr Reilly, is the sheer number of trainees planning on emigrating over the next few years. A major reason why over 80% of trainees may not return to the country is their rejection of contracts that they feel may not be equivalent to consultant colleagues. 91% would not envisage themselves employed in roles other that consultant, having finished their training. In other words – a big fat NO to the “sub consultant”, “specialist”, “associate specialist” grade (or whatever the Department of Health are calling it this week). Surprisingly, the majority of trainees would be happy to provide in house (1st call) cover as consultants and are happy to work alone (80.6%), without an NCHD (something they perceive to be different from current working practices). Perceptions indeed – 70.5% perceive that working conditions in Ireland are less attractive than abroad…..
The Western Anaesthesia Society has a policy on “subconsultants”: simply – a permanent job post CCST = consultant. The term “consultant” is emotional, of course and probably anachronistic. Elsewhere “attending physician” or “hospital specialist” is used, and these terms – although referring to consultants – conjure up different images. In some ways, from a sociopolitical perspective, it may be better to use the term “hospital specialist” as the current moniker has been severely soured by the media in recent years. But, whatever way you look at it – post CCST clinical specialist, with full autonomy, expected to teach trainees and medical students, participate in audit and research: sounds a lot like a consultant to us!
Perhaps the minister might take heed of these findings and engage the group of professionals whose future careers he seems intent on defining.
Indeed as you say the Minister needs to engage with the current generation of peri-consultants. I do have some sympathy with the concept however, and believe that people should be given the choice of standard training leading to a tenured service-provision post or alternatively further specialized (fellowship, PhD etc) training and education leading to a consultant post. The problem is with the definition of consultants and what trainees (and previous generations) perceive as the current level of expectation of a consultant. Is a consultant a doctor who, in addition to clinical practice, takes leadership roles in education, senior management, research, advancement of their speciality and their hospital. Alternatively, is a consultant who just provides clinical service really a consultant – however competent and valuable to the health service and their hospital? The current problem is that the minister, among others, evidentially is of the view that that such service providers (high quality or otherwise) are too expensive and need to be given anther moniker.