© Gunther Eysenbach 1998
Unauthorised redistribution without consent of the editor
is not allowed. Vervielfältigung ohne Erlaubnis des Herausgebers nicht gestattet.
Visitor:
© Gunther Eysenbach 1998
Unauthorised redistribution without consent of the editor is not allowed. Vervielfältigung ohne Erlaubnis des Herausgebers nicht gestattet.
Visitor:
Eysenbach, G. (ed.):
Medicine and Medical Education in Europe - The Eurodoctor,
Stuttgart-New York: Thieme 1998,
ISBN 3-13-115221-4
Medicine and Medical Education in Europe
Sample chapter from the book
"Medicine and Medical Education in Europe"Note: The following represents an unedited "preprint" of the country-chapter on Ireland from the book "Medicine and Medical Education in Europe", which has been published by Thieme, edited by Gunther Eysenbach. As explained above, this unique book contains information about 20 European countries in 20 country-chapters, one of which is the following. Tables and figures are not available online.
Redistribution is stricly prohibited !
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Ireland
1. Factsheet
Official Name:
Ireland (Éire)
Land:
Area: 6.889.456 hectares (68.895,56 sq. km/26.600,713 sq. mi.)
Capital and Largest City: Dublin (1991 population of greater Dublin: 915.516)
People:
Population 1991: 3.525.719; Density: 51 persons per sq. km (132 per sq. mi.)
Population Estimate 1995: 3.582.200
Distribution (1991): 57% urban; 43% rural
Annual Growth (GNP 1994): 7%
Official Language: Irish and English
Major Religions: Roman Catholicism, Protestantism
Education:
Literacy: approximately 84% - 95%
Universities (1995): 7
Health:
Life Expectancy (1992): Women - 77,9; Men - 72,3
Infant Mortality (1993): 5,9
Hospitals (Acute and District hospitals): 105
Hospital Beds: 13.644
Physicians (1995): 6.635
% of Female Physicians: No figures available
Unemployment (Physicians): No figures available
Population/Physicians (1995): 531:1
Medical Schools: 5
Medical Students Annual Entry (1994): 316
Physicians/Medical Students: 2,13:1
Annual Medical Students entry/school: 63,2:1
Applicants/accepted medical students: 21:1 (based on information from 3 medical schools)
Economy:
GDP (1994): IR£34.741m (43.774mECU); IR£9.698,23(12.219,77ECU) per capita
Labour Distribution (1991): Agriculture - 14,5%; Industry - 27,27%; Services - 59%
Foreign Trade (1994): Imports - IR£17.227m (21.706mECU); Exports - IR£22.830 (28.766mECU)
Currency: 1 Irish Punt(IR£) = 100 pence (2/1996: IR£ = US$ 1,59; IR£ = 1,26 ECU)
Government:
Type: Democratic Republic
Legislature: Dáil Éireann
2. General Information: history, geography, climate, economy, politics etc.
History
Conflict and religion dominate the long and varied history of Ireland from the time of the invasion of the Celts around 500BC to the present day. Ireland, as an independent state, is a relatively new country. Ireland gained its independence from Britain in 1921 following a war of independence. Britain agreed to the establishment of an Irish Free State which consisted of 26 of the island's 32 counties. The other six counties which make up Northern Ireland, have remained under British control to date and unfortunately continue to be the subject of some conflict. In 1948 the Free State became a Republic and in 1972, Ireland joined the EEC. Since its independence 75 years ago Ireland has developed from being an agricultural economy to an ultra-modern economy, proudly taking its place in the modern world order.
Geography
Ireland has a central plain which is ringed around the coast by many different mountain ranges. The central plain, which is broken in places by low hills, has considerable areas of bog and many lakes and rivers. The north and west coasts of the country are rugged and wild as a result of the almost constant assault from the Atlantic Ocean. The south and east coasts, though less rugged, are still very influenced by the strong seas.
Climate
Ireland's climate is mainly determined by its position in the north temperate zone and the effect of the warm waters of the Gulf Stream. The climate is relatively uniform throughout. The prevailing west winds carry rain from the Atlantic, resulting in heavier rainfall in the western and southern parts of the country. Summers are relatively cool, with July and August being the warmest months (14-160C , 57-610F), whilst winters are relatively mild with January and February being the coldest months (4-70C, 39-450F). Snow falls occasionally in winter months but it is rarely prolonged and usually only lasts for a few days.
Economy
Ireland has a small open economy with a favourable balance of trade. The small size of the home market makes the country dependent on a high volume of exports. Agriculture and tourism are the main sectors in the Irish economy. In addition, the country has encouraged foreign companies in the computer and pharmaceutical industries to invest in Ireland. Ireland is the second largest exporter of software in the world and is also investing heavily in the telecommunications industry.
Government
The Irish Parliament (Oireachtas) consists of Dáil Eireann (lower house), Seanad Éireann (upper house) and the President. Members of Parliament (Teachtaí Dála) are elected through a system of proportional representation and the Government is elected from the Dáil. The Irish Prime Minister is known as the Taoiseach and the deputy is called the Tániste. The Irish President is the head of state but has very few absolute powers and normally acts on the advice and authority of the Government. Local Government structures, while in existence, are heavily controlled from the centre.
3. People: ethnic groups, language, demography, age structure, society
Ethnic Groups
There is only one native ethnic group in Ireland, The Travelling Community. They have a nomadic type of lifestyle. Modernisation has made their traditional crafts such as scrap metalwork redundant. Their life expectancy is significantly lower than the rest of the Irish population and there are many social problems associated with this group such as alcoholism, poor health, lack of education, unemployment and discrimination.
Language
Ireland has two official languages, Irish and English. English is the language of every day use. However, there are areas in the country (Gaeltacht areas) where Irish is the first language. Signposts are written in both languages and schoolchildren must learn Irish while at school. According to the census in 1991, 32,5% stated that they could speak Irish, although they rarely do so.
Demography
Following the famine in the middle of the 19th century, the Irish population decreased dramatically as a result of large scale emigration to America, Britain and Australia. Since 1951 the population has been slowly growing, apart from the late 1950s and early 1960s and the mid to late 1980s when, owing to the poor economic performance of the country and the lack of employment opportunities, once again the solution was to emigrate to find work. In the 150 years between 1841 and 1991 the population of the 26 counties dropped from 6.528.799 to 3.525.719.
Age Structure
The Irish population has both a large number of young people (44,7% < 25 years) and a large number of older people (11,4% > 65 years), leading to a high dependency ratio. In recent years the Irish birth rate of 22,7 per 1.000 / population (1971) has fallen to an estimated 13,9 per 1.000 in 1993, however, the rate is still the highest in the European Union.
Society
Irish society is still a conservative society by western standards. The Catholic Church has a strong but diminishing influence on Irish society. Whilst divorce was legalised in 1996, abortion remains illegal. The election of a female President, Mrs Mary Robinson, in the early 1990s is seen as evidence of change to a more pluralist and tolerant society. Family life is very important to the Irish people. The Irish are well known for their sense of humour and relaxed attitude and many visitors to the country appreciate the slightly slower pace of life here.
4.Education: General Information about higher education in Ireland
4.1.Historical Development of Higher Education in Ireland
The first university in Ireland, Trinity College, was established in 1592, but entry to the college was severely restricted. In 1845 universities were established in Cork, Galway and Belfast and were known as Queens Colleges. The Royal University in Dublin (now University College Dublin)was established in 1850 and since then the number of universities and colleges and their populations have grown dramatically and people of all walks of life and religious denominations are welcome. In latter years, technical colleges were developed to satisfy the growing demand for technical and practical training. Free secondary education was introduced for all in 1967 leading to a much greater number staying in education until the required age of 14 (now 15) as well as a growing number completing school at 17/18 years of age.
4.2.Structure of the higher education system in Ireland
Irish education is organised in three levels, primary, secondary and third level. Primary school education lasts 8 years (4 to 12 years of age) and is provided free of charge. Pupils transfer to secondary school education (also free of charge) at 12+. Most schools at this level provide an academic type of education, however, an increasing number combine academic and practical subjects in a wide curriculum. Pupils take two public examinations during this period. The Junior Certificate examination is taken at the end of three years and the Leaving Certificate examination is taken after a further two to three years. Primary school teachers are trained in the 5 teacher-training colleges which are largely state funded. Secondary school teachers are trained in university post graduate courses (Higher Diploma in Education) or in teacher training colleges for particular subjects.
There are seven universities in Ireland, 3 in Dublin, and one each in Cork, Galway, Limerick and Maynooth. There are 51,000 students enrolled in the universities. There are also 17 Technical Colleges with a total student population of 32,000, 6 of which are located in Dublin and the remainder strategically located around the country. There are 5 teacher-training colleges for primary school teachers, and there is one higher level college which deals exclusively with medical and nursing students. Most of the above are state financed, however, the level of autonomy of each institution is variable. The number of private colleges is growing as more students complete the secondary cycle and demand for third level places grows.
Female students form the majority in the universities (53%) with the trend reversed in the Technical Colleges (43%). In the teacher training colleges, 90% of students are female. Most first year students (66%) are aged 18 + and all colleges take in a very low number of mature students (aged 23 or over). The social background of students tends to vary depending on their course of study. For example, 37% of those who study medicine come from a professional background, 21% from an employer/managerial background and only 11% have parents who are manual workers. On the other hand, 26% of student teachers come from a farming background, 28% have parents who are manual workers and only 13% come from a professional background.
Over 50% of students do some kind of part-time work to support themselves during the year and many go abroad for summer holidays to work in hotels, shops and restaurants. All of the universities have student residences but the vast majority of third level students either live at home, with other families, in student hostels or in rented accommodation.
4.3.Access and selection
Access to higher education in Ireland is almost exclusively based on the results of the Leaving Certificate Examination or its equivalent elsewhere. Applications are processed on an anonymous basis through a Central Applications Office (CAO). Foreign students need to apply to each institution individually to find out whether they would be eligible to apply through the CAO. One of the medical schools runs its own entrance examination for both Irish and foreign students. Many students from the EU take part in the Erasmus exchange programme and a number of courses are funded by the European Social Fund. Starting in the 1996/97 academic year, no fees will be charged for the vast majority of students entering college. However, a small fee of approximately IR£150 will be levied on students to pay for such things as subsidising student clubs and societies and students must still pay for books, stationary, travel and living expenses. Higher Education Grants (HEGs) are available from local authorities and are subject to a means test. Some money is also available from the European Social Fund. Grants for foreign students are only available for those from developing countries through the European Commission or the nearest UN delegation.
5. Health: Public health, health care system, social security, health economics
A comprehensive strategy for the Irish health care system called "Shaping a Healthier Future” was published in June 1994. The three underlying principles of the strategy are Equity, Quality of Service and Accountability. The main theme of the strategy is the reorientation of the health services so that health gain becomes the focus of the service. Particular emphasis is being put on health promotion in all areas.
The Irish health care system has a public and private mix. Some 35% of the population are entitled to all medical services free of charge. Their entitlement is based on a means test. The rest are entitled to free public hospital services, but must pay for General Practitioner services. Approximately 35% of the population have private health insurance and, in addition, a social welfare sick pay scheme is in operation once certain criteria are met. General Practitioners act as 'gatekeepers' with regard to specialist access. There are several community drug schemes which limit the maximum amount that a patient need pay for prescription drugs.
Other than a Department of Health report dealing with manpower planning in the acute hospital sector (1993), little else of note has happened in this area. However, the various post-graduate institutions and colleges are very much aware of the need to keep the situation under review.
As at 1st January 1995 there were 1,064 hospital consultants in practice, 223 consultants solely in private practice, 247 public health doctors, 2,050 general practitioners, of whom 1,600 are involved in the public health scheme and 2,123 non-consultant hospital doctors. There are 63 publicly-funded acute hospitals and 42 district hospitals in Ireland. The standard of health care in Ireland compares favourably with most developed countries.
Salaries for doctors in Ireland are as follows: Hospital consultants, IR£50.586 - IR£62.438 (63.738 - 78.672ECU); Non-Consultant Hospital Doctors, IR£14.317 - IR£33.456 (18.039 - 42.155ECU); Public health doctors, IR£28.920 - IR£48.874 (36.439 - 61.581ECU). General practitioners receive capitation payments from the state for those entitled to free medical care, the rest of their income is made up of private fees.
The cost of the health services has risen by a factor of 4,8 since 1960. The current cost of the health services is in excess of IR£2 billion (2,52 billion ECU), or 6,6% of GDP. International comparisons are difficult as the health services in Ireland provide a substantial range of personal social services. The future direction for the health services is as described in the new strategy document referred to above.
The Medical Council is the statutory registering and monitoring body for doctors in Ireland. It produces the "Guidelines for Ethical Conduct and Behaviour and to Fitness to Practise” which every doctor must follow. This covers all issues such as patient confidentiality, advertising and consent. Physicians do not have an exclusive right to treat patients and there is no regulation of 'alternative' treatments.
6.Medical Education: Student selection, curriculum, structure of medical education
Medical Schools
There are five medical schools in Ireland. Four of these are faculties of publicly funded universities and one is a private institution. As of September 1996, students will only have to pay a nominal amount for fees in the universities (i.e. University College Dublin (UCD), University College Galway (UCG), University College Cork(UCC) and Trinity College Dublin (TCD)). The annual fees for the Royal College of Surgeons in Ireland (RCSI) are IR£4.045 (5.097ECU) for Irish students and IR£14.445 (18.201ECU) for overseas students.
An Irish medical degree takes six years to complete. In principle, the first three years are spent in a pre-clinical programme studying such subjects as Biology, Anatomy, Physics and Physiology. The next three years are clinical years spent mainly in the hospitals, studying areas such as Communications Skills, General Practice, Medicine and Surgery, Clinical Pharmacology, Paediatrics, Psychiatry and Obstetrics and Gynaecology.
The curriculum is broadly the same across the five medical schools though some of the schools are bringing more clinical subjects forward into the first few years of their courses. UCD is in the process of introducing quite radical changes in its curriculum, bringing such subjects as Anatomy, Functional Histology and Epidemiology into the first two years of the course. UCD and the RCSI are by far the largest medical schools with an annual intake of approximately 140. The other three schools are of similar size with an average annual intake of 68. Minimum entry requirements are also similar and the standard of students entering each year are average across the schools as a result of the central applications process and the high number of applicants for each place.
Undergraduate medical education is the responsibility of the Minister for Education advised by the Higher Education Authority (HEA). The curriculum is a matter for each medical school but the Medical Council has the duty from time to time to satisfy itself (a) as to the suitability of the medical education and training provided by any recognised medical school and (b) as to the standards of theoretical and practical knowledge required for primary qualifications. The atmosphere across the four university schools would be similar, while the private school of the RCSI would be quite unique. Of the students in the RCSI, 70% are foreign and therefore the school has a very international atmosphere. It is also a much more intimate school in the sense that it is not part of a large university with many different faculties.
#Please place Table 1 here#
Course of Study
Undergraduate education in each of the medical schools leads to the award of degrees of Bachelor of Medicine, Bachelor in Surgery and Bachelor in Obstetrics. These degrees are awarded together at the end of the six years of study. In general, the first year of the course provides teaching in the basic sciences, while in the second and third years students learn the structure and function of the human body. From the beginning of fourth year, students attend hospitals continuously as well as lectures and practicals in various subjects. During fifth and sixth year, the students are attached to the teaching hospitals and obtain experience in the major specialisations within medicine (clinical clerkships). Assessments include formal written examinations, clinical examinations, continuous assessment and practical assessment. Some of the universities have a semesterised system with exams being held in December/January and in the summer.
The medical schools have the following curriculum with some differences between the schools:
First year: Chemistry, Physics, Biology, Biomathematics or Mathematics.
Second year: Anatomy, Physiology, Biochemistry
Third year: Anatomy, Physiology
Fourth year: Pathology and Medical Microbiology, Pharmacology, Medical Ethics, Junior Medicine, Junior Surgery, Psychiatry, Medicine
Fifth year: Public Health Medicine, Medical Jurisprudence, Therapeutics, Opthalmology, Oto-rhino-laryngology, Medicine, Surgery, Obstetrics and Gynaecology, Psychiatry, Paediatrics
Sixth year: Public Health Medicine, Medical Jurisprudence, Opthalmology, Oto-rhino-laryngology.
The following is a timetable of a clinical (fifth year) medical student from University College Cork:
#Please insert table 2 here#
Application and Entry
Entry into the universities for Irish students is entirely based on the results of their Leaving Certificate Examination, taken at the end of the secondary cycle of education. Applications are processed centrally through the Central Applications Office (CAO) from February in the year of entry. A very high academic standard is required to gain entry and only those who do exceptionally well in the school leaving examinations have any hope of gaining a place. Foreign students should contact the admissions offices of the universities to find out whether they will qualify for entry. If they qualify, they will then also apply through the CAO. Certain specific requirements are laid down for students from the United Kingdom, the USA and for students who have taken the International Baccalaureate Diploma. The RCSI, as well as accepting results from the Leaving Certificate and other non-Irish examinations, also holds an Entrance Examination in General Education. Applicants apply directly to the College and selection for entry is based on examination results and an interview. Specific subject requirements for each of the medical schools is contained in the table above. Apart from the RCSI, there are no quotas for foreign students. Transfer of students between the medical schools is allowed for specific lengths of time and in specific circumstances but is extremely rare. Students wishing to transfer to an Irish medical school should contact the school directly for information.
Student Life
Students live either at home, in student accommodation which consists of apartments or rooms with access to central cooking and common room facilities, in private hostels, with other families ('digs') or in private apartments. Many first year students would live in digs or in private hostels, moving to their own accommodation in subsequent years. Some students would qualify for maintenance grants but in general, even a full grant would not nearly cover all their costs. Most students are supported by their families, obtain a bank loan and/or work during the year and in summer holidays to support themselves. There are no loans from the state available for students. The Union of Students in Ireland (USI) estimates that it costs IR£5.497 (6.926ECU) per annum for a single student living away from home and going to college in Dublin. They also estimate that it costs IR£3.193 (4.023ECU) for a student living at home and going to college in the same town/city.
It is quite common for medical students to go abroad or to work in an Irish hospital during at least one of their summer holidays. The most popular destinations, apart from Ireland, for students from all the colleges are the poorer countries in Africa and Asia, the United Kingdom and the USA, though due to insurance restrictions it is difficult for students to gain practical experience in some of these countries. Most foreign students in the RCSI go home and work for their holidays.
Major research projects are not obligatory during the course of study though some minor pieces of work may be undertaken for the purposes of continuous assessment. A doctoral degree will only be awarded on the basis of further study following the medical degree.
Pre-registration Year
Following graduation, graduates must register provisionally with the Medical Council and undertake what is known as an 'Internship'. This involves six months of surgery and six months medicine in a hospital setting. Graduates have to apply directly to individual hospitals for these positions. Interns usually work between 39-65 hours per week, some work longer hours. Interns are paid a flat rate of IR£ 14.317 (18.039 ECU). Overtime is paid for work in excess of 39 hours at a lower rate. Interns work under supervision for this year and there are no formal assessments or examinations at the end of this period.
Most doctors decide within one or two years of qualification what area they would like to specialise in. Entry into certain schemes is very competitive and students depend on a good reference from their internship and the results from their examinations to secure places.
7.Electives/clinical clerkships
Apart from UCC where an elective of approximately six weeks is mandatory before entry into final year, summer electives are undertaken on a voluntary basis. In general, the involvement of the medical schools in organising such electives is minimal apart from writing letters of recommendation for the students and, in some cases, providing them with contact names and addresses. Students go all over the world to work in and observe community schemes, hospitals and medical practices. Electives are taken in the summer holidays, generally after completing at least three years of study and can be undertaken in all areas of medicine. It is very common for students to undertake electives abroad though a large number would also stay at home and work in practices or hospitals. In general, foreign medical students apply directly to hospitals or consultants in order to gain access to an elective in this country.
8.Addresses
Medical Faculties:
1. Faculty of Medicine
University College Cork
College Road
Cork
2. Royal College of Surgeons in Ireland
123 St Stephen's Green
Dublin 2
3. Faculty of Medicine
University College Dublin
Earlsfort Terrace
Dublin 2
4. Faculty of Health Sciences
University of Dublin
Trinity College
Dublin 2
5. Faculty of Medicine
University College Galway
Galway
National Medical Students' Association:
1. Irish Medical Students' Association
c/o The Irish Medical Organisation
10 Fitzwilliam Place
Dublin 2
Ministry of Health:
1. Department of Health
Hawkins House
Hawkins Street
Dublin 2
Ministry of Education:
1. Department of Education
Marlborough Street
Dublin 1
Major Hospitals in Ireland:
1. Beaumont Hospital
Beaumont Road
Dublin 9
2. Our Lady's Hospital for Sick Children
Crumlin
Dublin 12
3. Royal Victoria Eye and Ear Hospital
Adelaide Road
Dublin 2
4. National Maternity Hospital
Holles Street
Dublin 2
5. Mater Misericordiae Hospital
Eccles Street
Dublin 7
6. St James's Hospital
James's Street
Dublin 8
7. St Vincent's Hospital
Elm Park
Dublin 4
8. University College Hospital
Newcastle Road
Galway
9. Cork University Hospital
Wilton
Cork
10. Mercy Hospital
Grenville Place
Cork
A full list of public hospitals and their addresses is available from the Department of Health. A list of private hospitals is available from the Voluntary Health Insurance Board. A list is also available from the Irish Medical Organisation.
Other Useful Addresses:
1. Irish Medical Organisation
10 Fitzwilliam Place
Dublin 2
2. Royal College of Physicians of Ireland
6 Kildare Street
Dublin 2
3. Irish College of General Practitioners
Corrigan House
Fenian Street
Dublin 2
4. Medical Council
Portobello Court
Lower Rathmines Road
Dublin 6
5. Central Applications Office
Tower House
Eglinton Street
Galway
6. Applications offices for the universities are at the same addresses as the medical faculties, apart from:
Applications Office
University College Dublin
Belfield
Dublin 4
7. Voluntary Health Insurance Board
VHI House
20 Lower Abbey Street
Dublin 1
8. Bord Failte
Irish Tourist Board
Baggot Street Bridge
Dublin 2
6.Postgraduate/Continuing Medical Education
Pre-Registration after Qualification (Internship)
Following graduation, graduates must register provisionally with the Medical Council and undertake what is known as an 'Internship'. This involves six months of surgery and six months medicine in a hospital setting. Graduates have to apply directly to individual hospitals for these positions. Interns usually work between 39-65 hours per week, some work longer hours. Interns are paid a flat rate of IR£ 14.317 (18.039 ECU). Overtime is paid for work in excess of 39 hours at a lower rate. Interns work under supervision for this year and there are no formal assessments or examinations at the end of this period.
Most doctors decide within one or two years of qualification what area they would like to specialise in. Entry into specific training schemes is very competitive. Candidates with high grades and good references from their internship year have an advantage.
Following the Internship, training is divided into two periods, referred to as General Professional Training and Higher Specialist Training. The aim of all programmes of training is to bring the trainee to the stage of 'accreditation', where the appropriate professional body certifies that the trainee has satisfactorily completed a full and approved course of training. There is no specialist register in Ireland.
There are Joint Committees representing Ireland, England and Wales, Scotland and Northern Ireland in all specialties except Obstetrics and Gynaecology, Pathology and Radiology. However, there is a degree of co-operation between the training bodies in each country in these three specialties. For General Professional Training the programme is specified by the appropriate Royal College or other training body, while the Higher Specialist Training programme is specified by the appropriate Irish training body and the Joint Committee.
Postgraduate Education
General Practitioner
Any doctor who is fully registered with the Medical Council can set up independently as a general practitioner in a private capacity. However, doctors who wish to work in the state supported general practice scheme, must, by law, complete an approved vocational training course in general practice. At present there are ten schemes for vocational training, offering a total of 53 places. Places are advertised in January each year with interviews taking place in March and successful candidates usually starting in July. The training is generally for a three year period, two of which are spent in hospital posts at Senior House Officer (SHO) level covering such areas as Accident and Emergency/General Surgery; General Medicine; Geriatric Medicine; Obstetrics and/or Gynaecology; Paediatrics; Psychiatry. The remaining year is spent in general practice, under supervision. During the three years trainees are expected to attend a weekly half day release course.
The standard qualification for general practice is Membership of the Irish College of General Practitioners (MICGP). The examination is usually taken in the final trainee year and consists of three written papers, two orals and a practical exam. For those not completing recognised vocational training, two years hospital experience and two years general practice experience are required before you can sit the membership examination. Part-time training is also recognised. It is advantageous for trainees to take diploma examinations in Child Health (DCH), Obstetrics (DObs) and Family Planning when they have worked in these areas in hospitals. General Practice is now recognised as a specialty by the Medical Council and the MICGP is a registerable qualification.
On completion of training, trainees can apply for positions within the state scheme as they arise. In reality most work as assistants in established general practices in order to gain further experience. Some doctors enter private practice by either starting a practice de novo, buying into an existing practice or joining an established private practice as an assistant.
Physician (Internal Medicine)
General Professional Training in Internal Medicine starts after the Intern year and lasts three years. Most six month SHO posts are recognised for training purposes. Trainees would be expected to pass the Membership Examination of the Royal College of Physicians during this period.
Higher Specialist Training in Internal Medicine and in other Medical Sub-specialties is organised by the Irish Committee on Higher Medical Training (ICHMT), which works closely with its UK counterpart. These Committees approve Senior Registrar posts and programmes which are suitable for specialist training. Certificates of accreditation are issued by the ICHMT on completion of four years in approved Senior Registrar posts. It is usual for trainees in internal medicine to spend some of their training outside Ireland.
General Surgery
The organisation of surgical training is divided into three phases: (a) Pre-fellowship; (b) Elective post-fellowship; (c) Higher Surgical Training. The Pre-fellowship Phase consists of a four year course which is assessed by the Final Fellowship examination. In the Elective period, the trainee seeks further surgical experience, usually at middle grade registrar level both at home and abroad and undertakes a period of further academic training in the form of research. There is no formal assessment at the end of this period, however, the research is usually presented for a postgraduate degree of either MD or MCh by thesis. The trainee is also expected to publish his/her work in medical journals. At the end of this period the trainee applies for Higher Surgical Training. This period of training lasts for four years. There is continuous assessment throughout this period with certification following consultant review.
Radiology
Applicants for a training post in Diagnostic Radiology must have completed at least one year after registration, preferably in clinical hospital practice. Posts are usually advertised in February and interviews take place in March/April. The training course commences on 1st October each year. General Professional Training consists of a three year course in a recognised post approved by the Faculty of Radiologists, Royal College of Surgeons in Ireland leading to the Fellowship to the Faculty of Radiologists (FFR). In the first year of the course hospital work is supplemented by tutorials and a comprehensive lecture programme. The primary examination is taken at the end of the first year in June. The second and third years include supervised full time practical experience in the department of radiology as well as lectures and tutorials. The final examination is taken at the end of the third year of training in December. Higher Professional Training involves a minimum of two years post-fellowship work on a full time basis in a recognised institution which includes further general training with the option of taking up one of the sub-specialties of radiology.
Career Opportunities
Manpower
The areas of General Surgery, Opthalmology, Cardiothoracic Surgery, Paediatric Surgery and Neurosurgery are over-supplied with trained doctors, with very limited opportunities in the foreseeable future. The specialties of Orthopaedic Surgery, Plastic Surgery and Urology whilst less competitive are still over-supplied. Otolaryngology is undersubscribed and the area of Accident and Emergency is expanding. While there are some opportunities for General Practitioners in private practice, gaining entry into the state scheme is very difficult.
Salaries
Hospital Consultants employed by the state can earn between IR£50.586 (63.738 ECU) and IR£62.438 (78.672). Most consultants can supplement their incomes significantly form private practice. General Practitioners working in the state scheme are paid a capitation fee, the average income from state fund would be IR£41,154. In addition they can supplement their incomes from private practice. Public Health doctors employed full time by the state earn between IR£28.920 (36.439 ECU) and IR£48.874 (61.581 ECU).
Table of Important Specialties : Table 3
Continuing Medical Education
Continuing Medical Education is a matter for each individual doctor and is not mandatory. However, all of the Postgraduate Colleges run courses in specific areas and encourage their members to participate in continuing education process.
7.Working Possibilities for Foreign Medical Graduates
Employment Rates
There is an oversupply of Irish doctors for posts in Ireland. For General Practitioners, competition is intense and many are forced into private practice. Almost all hospital specialties have many more registrars and senior registrars waiting for consultant appointments than will become available in the foreseeable future.
The Medical Council
The Medical Council is responsible for the registration of all medical practitioners, for standards of education and training at both undergraduate and postgraduate levels and for all matters relating to fitness to practice. The Medical Council has designated functions in relation to the operation and implementation of the EU Doctors' Directives, such as enquiries from other member states relating to the character or health and the verification of qualifications of Irish registered doctors moving to another member state. The Medical Council publishes "Guidelines to Ethical Conduct and Behaviour and to Fitness to Practise” which must be followed by all medical practitioners. It also publishes a General Register of all medical practitioners.
Statistics
In 1994 there were 879 doctors from outside the EU registered in Ireland, mainly working as house officers, registrars and senior registrars in the hospital service. This has risen from 242 in 1984 and now comprises 36% of the total number of NCHDs in Ireland. Non-EU nationals generally work in smaller hospitals all over the country rather than in the larger teaching hospitals. Most foreign doctors working in Ireland come from India, Pakistan and the Middle East.
Formalities for Foreign Medical Graduates
The documents required by the Medical Council to fully register a doctor who is a national of an EU member state and who holds a qualification from an EU university are as follows:
1. A Medical Council application form plus application fee
2. The original degree documentation (not a photocopy)
3. A Certificate of Good Standing
4. A document from their country's registering body stating that their qualifications are covered under Article 3 of Directive 75/362/EEC of the EU
5. Passport (not a photocopy)
EU nationals do not require either a work permit or a visa to work in Ireland.
Medical practitioners from outside the European Union may be temporarily registered with the Medical Council for a maximum period of five years. At the end of a minimum of four years they may apply to become fully registered so long as they have a postgraduate qualification and are recommended by their consultant. In order to become temporarily registered the following documentation is required:
1. A Medical Council Application Form plus application fee
2. An up to date Curriculum Vitae
3. Notarised degree documentation in support of the Curriculum Vitae
4. A Certificate of Good Standing
5. Two currently dated references
6. The letter of appointment if already offered a job in Ireland
A non-EU national must have a work permit (which is confirmed to the Department of Foreign Affairs by the Department of Enterprise and Employment) as well as a letter of appointment from an Irish hospital before a visa application will be granted. Applications should be made to the Irish Embassy or Consulate in the doctor's native country and each application is taken on its own merits.
Job Applications
Vacant positions are usually advertised in the medical and lay press to which foreign doctors may subscribe. A list of public hospital addresses may be obtained from the Department of Health and a list of private hospitals is provided by the Voluntary Health Insurance Board (VHI). In their letter of application doctors should detail their qualifications and the year and university in which they were obtained. They should also state whether they have already been (provisionally) registered by the Medical Council. The contracts of employment for NCHDs contain details of qualification requirements, conditions of service such as hours of duty, maternity leave, study leave, accommodation and qualifications which attract allowances.
Job Profiles
The standard working week is 39 hours. Overtime is paid at a low rate between 39 and 65 hours. NCHDs are not normally supposed to be rostered for more than 65 hours per week, however, many doctors work well in excess of this time.
Salaries
The basic salaries for hospital doctors as at 1st June 1995 are as follows:
#Please insert Table 4 here#
Alternative Jobs
Realistically, there are no significant openings for doctors in Ireland outside of the medical setting.
8.Addresses
1. Medical Council
Portobello Court
Lower Rathmines Road
Dublin 6
2. Irish Medical Organisation
10 Fitzwilliam Place
Dublin 2
3. Irish Hospital Consultants Association
Lowell House
Herbert Avenue
Dublin 4
4. Department of Health
Hawkins House
Hawkins Street
Dublin 2
5. Department of Education
Marlborough Street
Dublin 1
Major Hospitals in Ireland:
1. Beaumont Hospital
Beaumont Road
Dublin 9
2. Our Lady's Hospital for Sick Children
Crumlin
Dublin 12
3. Royal Victoria Eye and Ear Hospital
Adelaide Road
Dublin 2
4. National Maternity Hospital
Holles Street
Dublin 2
5. Mater Misericordiae Hospital
Eccles Street
Dublin 7
6. St James's Hospital
James's Street
Dublin 8
7. St Vincent's Hospital
Elm Park
Dublin 4
8. University College Hospital
Newcastle Road
Galway
9. Cork University Hospital
Wilton
Cork
10. Mercy Hospital
Grenville Place
Cork
A full list of public hospitals and their addresses is available from the Department of Health. A list of private hospitals is available from the Voluntary Health Insurance Board. A list of all hospitals is also available from the Irish Medical Organisation.
Other Useful Addresses:
1. Royal College of Surgeons in Ireland
123 St Stephen's Green
Dublin 2
2. Royal College of Physicians of Ireland
6 Kildare Street
Dublin 2
3. Irish College of General Practitioners
Corrigan House
Fenian Street
Dublin 2
4. Postgraduate Medical and Dental Board
Corrigan House
Fenian Street
Dublin 2
5. Voluntary Health Insurance Board
VHI House
20 Lower Abbey Street
Dublin 1
6. Bord Failte
Irish Tourist Board
Baggot Street Bridge
Dublin 2
7. The Irish Medical Times
15 Harcourt Street
Dublin 2
8. Irish Medical News
Taney Hall
Eglinton Terrace
Dublin 14
9. The Irish Times
11 D'Olier Street
Dublin 2
10. The Irish Independent
90 Middle Abbey Street
Dublin 1
References
1. Avison, Brigid (1994): Essential Ireland, 2nd edition, Basingstoke: AA Publishing
2 Department of Education (1995): Charting our Education Future - White Paper on Education, Dublin: The Stationary Office
3 Department of Health (1994): Shaping a Healthier Future - A strategy for effective healthcare in the 1990s, Dublin: The Stationary Office
4. Hensey, Brendan (1988): The Health Services of Ireland, 4th edition, Dublin: Institute of Public Administration
5 Information Management Unit, Department of Health (1995): Health Statistics 1993, Dublin: The Stationary Office
6 The Postgraduate Medical and Dental Board (1994): Career Guidance Programme for Interns and House Officers 1994/95, Dublin: The Postgraduate Medical and Dental Board
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