Mealy K, Keane F, Kelly P, Kelliher G
National Clinical Programme in Surgery, Royal College of Surgeons in Ireland, 2 Proud's Lane, Dublin 2, Ireland.
Surgical Affairs Operations and Planning, Surgical Affairs, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland.
Ir J Med Sci. 2017 Feb;186(1):225-233. doi: 10.1007/s11845-016-1545-0. Epub 2017 Jan 4.
General Surgery consultant recruitment poses considerable challenges in Model 3 Hospitals in Ireland.
The aim of this paper is to examine General Surgery activity and consultant staffing in order to inform future manpower and service planning.
General surgical activity in Model 3 Hospitals was examined using the validated 2014 Hospital Inpatient Enquiry (HIPE) dataset. Current consultant staffing was ascertained from hospital personnel departments and all trainees on the National Surgical Training Programme were asked to complete a questionnaire on their career intentions.
Model 3 Hospitals accounted for 50% of all General Surgery discharges. In the elective setting, 51.5% of all procedures were endoscopic investigations and in the acute setting only 22% of patients underwent an operation. Most surgical procedures were of low acuity and included excision of minor lesions, appendicectomy, cholecystectomy and hernia repair. Of 76 General Surgeons who work in Model 3 Hospitals 25% were locums and 54% had not undergone formal training in Ireland. A further 22% of these surgeons will retire in the next five years. General Surgical trainees surveyed indicated an unwillingness to take up posts in Model 3 Hospitals, while 83% indicated that a post in a Model 4 Hospital is 'most desirable'. Lack of attractiveness related to issues regarding rotas, lack of ongoing skill enhancement, poor experience in the management of complex surgical conditions, limited research and academic opportunity, isolation from colleagues and poor trainee support.
These data indicated that an impending General Surgery consultant manpower crisis can only be averted in Model 3 Hospitals by either major change in the emphasis of surgical training or a significant reorganisation of surgical services.
在爱尔兰的3级医院中，普通外科顾问医生的招聘面临着相当大的挑战。
本文旨在研究普通外科的业务活动和顾问人员配置情况，为未来的人力和服务规划提供依据。
使用经过验证的2014年医院住院患者查询（HIPE）数据集，对3级医院的普通外科业务活动进行了研究。从医院人事部门确定了当前的顾问人员配置情况，并要求参加国家外科培训计划的所有实习生填写一份关于他们职业意向的问卷。
3级医院占所有普通外科出院人数的50%。在择期手术中，所有手术的51.5%是内镜检查，而在急症手术中，只有22%的患者接受了手术。大多数外科手术的急症程度较低，包括小病变切除、阑尾切除术、胆囊切除术和疝气修补术。在3级医院工作的76名普通外科医生中，25%是临时代理医生，54%没有在爱尔兰接受过正规培训。另外22%的这些外科医生将在未来五年内退休。接受调查的普通外科实习生表示不愿意在3级医院任职，而83%的人表示4级医院的职位“最理想”。缺乏吸引力与排班问题、缺乏持续的技能提升、复杂外科疾病管理经验不足、研究和学术机会有限、与同事隔离以及实习生支持不足等问题有关。
这些数据表明，3级医院只有通过大幅改变外科培训重点或对外科服务进行重大重组，才能避免即将到来的普通外科顾问人员危机。
