Dr. Anthony Breslin:

I will deal with Senator Colm Burke's questions. I was asked about overseas graduates entering specialist training. There is a difference between EU and non-EU graduates. EU graduates have an automatic right to enter basic specialist training and then higher specialist training as long as they do their entry exams and so on along the way and are appropriately assessed. For non-EU graduates, it is a more complex programme. They must have a certificate of equivalent experience to the Irish internship. We have that in place for a number of countries including Pakistan, for those people who started their internships after January 2009, Sudan, New Zealand, Australia, South Africa after 1 July 2006, and Malaysia, the UK and Malta. That was set up under the Act and the council has to consider the equivalent certificate of experience and that would exempt the applicant from doing the examination.

In order to deal with the significant number of people trying to register in Ireland, we established an adjudication group with representatives from Ireland and overseas to determine the requirements to ensure we had a high standard of doctors finishing their internships before we would register them here. After reviewing evidence based on the quality of medical schools, quality of internships, the time taken and type of work done, the adjudication group recommended that internships undertaken in the countries I mentioned met the council's standards. In addition, a person seeking to take up a training post in Ireland must have performed a higher examination. He or she must demonstrate a level of education and training above the internship.

The current situation is disadvantageous to a number of doctors working in Ireland in that they have sufficient qualifications to work here but, due to legislation, they do not qualify to get onto training schemes. One can have two doctors working on the same clinical team, one of whom is on a formal training scheme run by the Royal College of Physicians of Ireland or the Royal College of Surgeons in Ireland while the other is not eligible for that scheme. We have had representations from a number of junior doctors and countries like Nigeria and India to try to deal with this. The proposed amendments to the Act, which have been agreed between the council and the Department of Health, would get rid of that variation and allow those who are working here and providing good service to the country access to the training scheme. It would also help the public by encouraging those people who are doing a job here to stay in the long term. A lot of them come here to try to get on a training scheme. When they cannot, they leave to go to Australia, Canada and so on. As such, we are losing a valuable resource there. I hope that clarifies matters.

Senator Colm Burke referred to people pre-2008 who did not grandfather across and who are now seeking to get onto the specialist register. We have a standard process to assess these individuals. That process is available on our website. When someone makes an application, he or she is told what documents and evidence are required. That comes to the council and the documentation and evidence are provided to the relevant postgraduate training body for surgeons, psychiatrists or physicians, which reviews the documentation and reverts to the council with a recommendation for the registration committee, which I chair. As such, I know the process. While the process is predicated on a person being in training today, we make allowances for the fact that someone might have trained a number of years ago. We take into consideration the fact that conditions and requirements were different in 2002 than today. In some situations, a college assessing an application might consider that by today's standards, an applicant does not meet the requirements for specialist registration. In committee meetings, however, we consider the evidence the doctor has sent to us and consider what was in place when he or she was in training. On a significant number of occasions, we have agreed to recommend that those people go on the specialist register. Such a recommendation goes to the full council meeting for approval. In a small number of situations, there might be a reason the doctor cannot be registered on the specialist register. In such situations, a doctor has a right of appeal and can go before an assessment group and that assessment will go to the whole council, which can make a recommendation. There is a clear process and we are cognisant of the issues for someone who trained a number of years ago. We make allowances for that.

People coming to the country post-2008 go through the same assessment process. We also make allowances for what training they have done and when they have done it. Again, the assessment goes out to the relevant postgraduate training bodies and comes back to my committee where we will make a final decision. Again, while we make allowances for people who have trained in different locations and at different times, we try to ensure they meet the relevant standard to practice in today’s environment in Ireland. All of that information is available on the council's website. Some people can be put off by the requirements regarding relevant evidence and documentation. For instance, if someone worked in the UK or Australia 15 years ago, it may be difficult to get proof that he or she worked in a certain hospital or carried out certain procedures. However, we make allowances for that. If there is any way for us to assist a doctor to achieve specialist registration where we think it is appropriate, we have no issue doing it. If the Senator feels we should communicate that to doctors and make it more visible on our website, we have no issue doing that.

Senator Colm Burke's final question was on the percentage of doctors who train in Ireland and leave. I cannot provide a figure off the top of my head but we know it is an issue. Some doctors do their basic training and then leave before they do their higher training. Some doctors leave after their internships while others complete their higher training but leave due to issues around consultant recruitment and get consultant posts overseas. We are trying to assess those numbers at present but I cannot give the Senator a figure off the top of my head.