1. Issues in Surgical Training 2011 Royal College of Surgeons in Ireland

2. Surgical staffing 2011 Total = 1200 Consultants 400 Training register NCHDs 400+ General register NCHDs 400 Figure 1

3. Dynamics Consultants Training register NCHDs General register NCHDs 400 1. Average age at appointment – 38 Vacancies – retirement, illness, resignation ~ 20 / year 3 Training 12 years + Graduates 30-40/year Match depends on vacancies at the time 20 30-40 80 30+ 2. BST intake 80/year withdrawals over years 1-4 other specialities ? ? 4 very few doctors in non-training posts progress into Consultants posts (EU equivalence process, IMC) 5. some non-EU doctors do progress into BST posts numbers Figure 2

4. Medical Migration National Geographic 2010 Figure 3

5. Staffing issues 2011 Total = 1200 Consultants 400 Training register NCHDs 400+ General register NCHDs 400 60-80 vacancies Figure 4

6. World medical workforce Inhabitants per doctor Ireland 360 (includes all registered doctors) Ireland1,700 Pakistan1,400 http://goo.gl/7kavT http://goo.gl/YVRm5 Figure 5

7. RCSI Worldwide Figure 6

8. Surgical staffing 2011 Consultants Training register NCHDs Figure 7

9. Surgical staffing 2011 Consultants Training register NCHDs Specialists nurses Physician assistants Reconfiguration Figure 8

10. Strategy, plan, execution Crisis in staffing has been addressed with a short term solution More radical approach needed to prevent recurrence/progression Rapid work by a high level group to report in a short time frame is required Opportunity and need to restructure medical workforce –grow consultant numbers (consultant-provided care): –Increase training places (to accommodate growing numbers of Irish/EU graduates, provide those consultants and create more stable workforce structure Rapid development and extension of the role of nurse specialists Consider (quickly) creation of new roles such as physician assistants Reconfiguration of specialist services to provide critical mass and to ensure that patients have access to services of high quality will be crucial to this process. Redeploy, reskill and/or retrain where necessary Figure 9