Dr. Tom Ryan:

I thank the Chairman and committee members for the opportunity to address them on the importance of specialist registration for hospital consultant appointments.

The 2008 contract defines a consultant as a registered medical practitioner who by reason of his or her training, skill and expertise in a designated specialty, is consulted by other registered medical practitioners.

It is worthwhile to review what is involved in training a consultant and why the integrity of this process is of such importance. The majority of medical students enter medical school after their leaving certificate examination and then complete a five-year course in medical college. This is followed by a year-long internship before progressing to sub-specialty training. In most sub-specialties doctors will complete two or three years of basic training to provide a foundation of specialist knowledge and to develop both as individuals and doctors.

Then they complete five or six years of higher specialist training which is punctuated by specialist examinations, usually finishing with an exit examination and a professional qualification conferred by a recognised postgraduate college. Only at this point will a doctor become eligible for specialist registration, which is regarded as a basic qualification for doctors who wish to apply for a position as a consultant. I say basic because the vast majority of doctors who become eligible for inclusion in the specialist register will subsequently travel abroad, usually in order to gain clinical or research experience in a prestigious recognised international institution. This has been the pattern for many years, and is likely to continue, because consultants in Ireland wish to provide patient care to a recognised contemporary standard and wish to gain the experience in an early stage in their career that will act as a foundation for their subsequent profession.

This model of training has several advantages for the healthcare system and for patients. In the past there was a consistent supply of well-trained and experienced consultants in the Irish health system. This was good for patients as they received the benefit of the consultants’ prolonged and sometimes arduous training. It was good for the health system as there was a continuous supply of talented consultants entering the health system, and these newer consultants brought with them fresh thinking, vision and new approaches to what, on occasion, seemed intractable problems.

The health system also benefited as a whole because many of these motivated individuals became leaders within their professions and sub-specialties. As a collateral benefit, the quality of patient care in the health system consistently improved.

The sustaining of these improved standards of care on a consistent basis now requires continuous recruitment of consultants who are trained to the highest international standards. If we deviate from this paradigm of training and recruitment, we are at risk of compromising the standard of patient care in our healthcare service and there will be inevitable and unacceptable consequences for patients. Therefore, at all stages of training we must foster a culture of academic achievement and clinical excellence in order that we can provide the best possible care for our patients. In our efforts to achieve clinical excellence we must insist that doctors who act as consultants in our healthcare system are appropriately trained in that they are deemed eligible for specialist registration. After all, this is the most basic of professional standards for doctors who wish to practise as consultants in Ireland. We cannot deviate from international best practice whereby doctors are required to comply with recognised specialty-specific training criteria in order that the quality and consistency of patient care is protected.

Unfortunately, it has become apparent that these most basic standards are not being observed when filling an increasing number of consultant posts and there is a concern that this development is not in the best interests of patient care. There are similar concerns about the appointment of non-consultant hospital doctors who have trained in countries outside the EU and the EEA who are no longer required to pass Irish Medical Council examinations, a requirement which applied until recently. It was standard practice that doctors from some countries, following their intern year, completed the Medical Council's pre-registration examination system, PRES, clinical exam before they were deemed eligible to take up posts in the acute hospital services in Ireland. We are of the view that the public deserves to receive a consistent standard of care across all public hospital and mental health services based on a uniform standard of training. The failure to verify, by way of examinations, the basic and sub-specialty training and competencies is at odds with contemporary international practice in other European jurisdictions and English-speaking countries. There is a serious concern that, in the absence of Medical Council exams for non-consultant hospital doctors, NCHDs, inconsistent standards of medical training and competence will undermine the care patients receive. Overall, the concerns relating to the appointment to specialist consultant posts of doctors who are not eligible to be on the Irish Medical Council specialist register have the potential to compromise seriously the standards of care we provide to our patients in our healthcare system. That is our major concern.