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Health system uses ‘medicine-as-vocation’ narrative to justify neglect of doctors’ work needs – research


Study comes as new report makes 44 recommendations to improve NCHD working conditions

A narrative of ‘medicine-as-vocation’ is regularly used to justify the neglect of hospital doctors’ core work needs, a new study has found.

The research, which gathered the opinions of 28 hospital-based clinicians across the country, also found that non-consultant hospital doctors receive minimal line management and are afraid to speak out against overstretched patient cases and long working hours for fear of it impeding their career progression.

The study, published in latest issue of the journal SSM – Qualitative Research in Health, found that the vocational-level of commitment shown by doctors – including sometimes volunteering to go into work to check on patients on their day off – would be used to justify organisational neglect in and a failure of the health system to provide doctors with their core work needs.

Doctors also expressed frustration that their level of commitment was not being matched by hospital management or HSE officials. One respondent said “I like being busy, I like being part of the team, sorting out patients, helping teams … but we are not resourced or funded. It is ad hoc and based on goodwill, our good nature, always wanting to do the right thing for the [patients].”

The study was led by Dr Niamh Humphries as part of the Hospital Doctor Retention and Motivation Project based at RCSI. She told IMT: “The system relies on the vocational commitment of doctors going above and beyond their job spec and beyond their hours to keep things running in a system that is understaffed and is under strain, and I think that is becoming normalised.”

More findings from the study can be read in the February issue of Irish Medical Times.

It comes as a new report published this week contains 44 recommendations to improve the working standards for NCHDs in Irish hospitals.

The Report of the National Taskforce of the NCHD Workforce recommends the reduction in working hours in line with workplace legislation, the implementation of policies to support a work/life balance, flexible training and the availability of healthy food options during night shifts.

Minister for Health Stephen Donnelly said that it is critical the recommendations are carried out as a matter of priority, and has committed to return Government within four months with an update on the report’s application including a costed implementation plan.

In response, the Irish Medical Organisation (IMO) gave a guarded welcome to the recommendations, but warned that sufficient funding is now needed to follow through on the proposals.

The IMO also said that areas such as childcare, a medical workforce plan and the digitisation of the health service are not adequately addressed in the report.

“We have been experiencing ever-increasing numbers of NCHDs emigrating to systems where they are valued, supported and offered a work/life balance,” said IMO NCHD Committee chair Dr Rachel McNamara.

“The recommendations in this report go some way to addressing the issues faced by NCHDs today but for any of us to have real confidence we need to see major investment and implementation to make those recommendations a reality.”

The Medical Council reacted positively to the report overall. Its president Dr Suzanne Crowe described its recommendations as ‘practical, supportive and will make a meaningful difference to the quality of life of our NCHDs’.

She added: “NCHDs are the backbone of the medical workforce in our hospitals. These recommendations, accepted by the Minister today, will enhance training pathways and opportunities with greater flexibility to reflect real-life demands and work-life balance.”



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