A proposal to help graduate medicine students with college fees in exchange for a fixed term of service to the HSE could be an “infringement on people’s rights”, outgoing Irish Medical Council president Suzanne Crowe has said.
A growing number of newly qualified doctors have been emigrating to Australia and New Zealand and the proposal has been floated in the Department of Higher Education, with officials suggesting it could incentivise them to remain in the State.
In an interview with The Irish Times, Crowe said the idea of return of service has come up many times in the past, but she queried how it could be done equitably.
“How would you make the choice as to which professions to choose?” she asked. “I don’t know how you could do that in a very fair way because we also need speech and language therapists, psychologists, physios, nurses.
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“We need electricians and plumbers too and they’re all going abroad. I think that perceived unfairness, if we were only to do it for doctors, is one of the reasons why the unions would really resist it. I think that is an infringement on people’s rights.”
Last week marked Crowe’s last as president of the council, with her eight years on the board of the medical profession regulator coming to an end.
She said there were a “number of reasons” for her decision to get involved with the council, including wanting to be active in changing elements of the system that she and colleagues complained about, as well as trying to remove some of the fear doctors have about it.
The regulator receives and evaluates complaints made about doctors working in the Irish health service, making decisions on what consequences – if any – these individuals should face.
In recent years, she said, the public and other doctors are raising more conduct-related complaints than those about competency.
“We’re seen a big increase in serious complaints relating to things like sexual assault, sexual misconduct, criminal convictions for conduct, and that’s an international phenomenon,” she said.
“We’re increasingly looking at complaints related to harassment and stalking and inappropriate communication and that’s far more difficult to deal with. People are slower to change.”
Crowe said there “may well be a loosening of standards of conduct” but she also attributes the rise to people no longer accepting “being dismissed or not being listened to or somebody being rude”.
A paediatric doctor, Crowe said a big learning during her time as president was how State bodies operate in “silos”.
Speaking personally, she said there would be a benefit to having just one healthcare regulator rather than various professional bodies.
“It means patients can kind of fall through the cracks when we’re not working together,” she said. “One regulator would mop up any of the roles within healthcare that have developed over the last 10 or 15 years that are not regulated, like healthcare assistants, physician associates, perfusionists.
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“There’s a whole bunch of roles that aren’t regulated that actually can have a big impact on patient care and patient safety.”
It is not just regulation that looms over the medical profession, according to Crowe, who said doctors are “very aware of litigation and increasingly so”.
Minister for Health Jennifer Carroll MacNeill, in a recent parliamentary question, said the State Claims Agency had paid almost €320 million in relation to medical negligence claims last year, with a further cost of €105 million in the first four months of this year.
“To all medical care, there is the possibility of a complication,” Crowe said. “When somebody says to you ‘there’s a one in 1,000 chance of this happening’, I think many patients don’t appreciate there will be that one and that doesn’t mean something went wrong.”
She said she worried that “doctors are starting to not take on the challenging cases any more because the risks for them are so huge”.
This could stifle progress and innovation, she said, adding that if a growing number of medical staff are not willing to take on complex cases “we’d have to send them abroad and that’ll have massive implications”.
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Crowe qualified as a doctor more than 30 years ago, working in anaesthesiology for many years before returning to paediatrics as a consultant in intensive care medicine.
Having done part-time clinical work while president, she will return to Crumlin children’s hospital full-time in July – something she is looking forward to.
A lot has changed since she began her career, but she believes further changes are needed. These include a willingness by the health service to embrace more flexible working options and specialty training structures, as well as removing barriers to studying medicine.
However, one thing she said she noticed that has stayed consistent is the commitment of healthcare staff, even after the Covid-19 pandemic.
“I’ve been heartened that there’s still a huge amount of goodwill on the front line. People will still go the extra mile, stay the extra hour. Nurses will swap to be in with a specific patient. There’s a lot of goodness there.”
