Professor Matthew Sadlier:

As a psychiatrist, the issue with burnout is interesting. Burnout is not just about work and time at work. It is also about concepts of control and being valued. The way our hospitals work and are organised, including the lack of a comprehensive IT system and the fact doctors spend a large part of their day doing non-doctor tasks because of the inefficiency of the paper-based chart system, is a factor. Doctors feel they cannot progress in their career because they are sidelined into avenues. As Dr. Gilligan said, they want to deliver a service. They want to make the right choices. The textbook says they should do such and such but, actually, they come up against a system in which that action is not facilitated. This is a very big pusher of the burnout issue.

To expand on Dr. McNamara's point, one of the other big changes over the past 15 years or so is the addition of graduate entry to medical training. That option was brought in by the Government some time in the mid-2000s. It means we now have a different cohort of people graduating as doctors from what we had before. When I graduated, we were all aged about age 24, largely single and with no children. To a certain extent, some of the rotation we had to do, which involved going to different parts of the country and seeing different towns, was quite enjoyable. Now, a certain percentage of the cohort coming out of training is made up of people who are more settled and have children. They are facing the issues with childcare and having settled families.

The point I would make is that flexibility is needed. One model does not fit all. The biggest problem with mental health provision, both in Ireland and internationally, is that we have people preaching one model to everybody. Not everybody benefits from counselling and psychotherapy. Some do and others do not. Some people benefit from other interventions. I loved the rotation aspect of the job when I was young and single. Some people do not love that aspect. Having flexibility, whereby we could suit the work environment to the people working in it, is the key. One size will never fit all. If we do not solve those sorts of problems, frustrations will arise. There is no point changing the system to suit the people who suffer if the people who are happy with the current system then start to suffer and there is a constant flip-flopping.

It is about having that flexibility around training and career structures to acknowledge there are different people graduating who all have different needs and ambitions. As a final point, the issue of childcare is 100% critical because doctors work unusual hours. For example, if we are on call, we come in at weekends and in the middle of the night. That is a big issue and is one that can be easily solved. Every hospital should have some degree of on-site childcare.