Medical Practitioners Bill, 1951—Second Stage.

Dr. Ryan

I move that this Bill be now read a Second Time. The purpose of this Bill is to give effect to an agreement which was reached with the British Government in December, 1949. I should explain to Deputies that the Goodenough Committee, which was set up in Great Britain in 1942 to inquire into the organisation of medical education, had recommended in 1944 that all medical students in Great Britain should, after passing their final examination, be required to serve as a junior house officer for a period of 12 months in one or more approved hospitals before being fully registered as a medical practitioner. This recommendation was accepted by the General Medical Council in Great Britain and subsequently by the British Government. The recommendation was communicated by the General Medical Council to the teaching bodies in this country and in general they favoured the adoption in this country of the requirement of pre-registration hospital experience similar to that required in Great Britain. The matter was also considered by a committee which was set up by the Minister for Health in November, 1947, to report and make recommendations, among other matters, on any changes required in the curricula and organisation of medical education. In the report to the Minister for Health this committee recommended that pre-registration house appointments should be required of all graduates of medicine in this country.

When, therefore, towards the end of 1949, the British Government suggested that a joint discussion of the matter be held in Dublin, in order to preserve the existing arrangement whereby graduates of the British medical schools may be registered in our Medical Register, and our medical graduates may be registered in theirs, the Irish Government were cognisant of the general feeling in our own medical profession in favour of the requirement of a period of resident service in hospital before final registration. Knowing also that this principle of pre-registration training, commonly called internship, has been accepted in several other States, the Irish Government had no hesitation in accepting the proposals in principle and in agreeing to have the discussion with the British. The conference took place in Dublin in December, 1949, and an agreement was reached on the details of the application of the scheme in the two countries.

It was agreed that the existing position whereby Irish graduates have the right of registration in the British Register and British doctors have the right to registration in the Irish Register would continue and the complications in the reciprocal arrangements arising out of the proposals for provisional registration were smoothed out to the mutual satisfaction of the British and of ourselves. The agreement made envisaged the introduction, both in the British Parliament and in the Oireachtas, of legislation to implement it.

The British Government have, on their side, enacted the Medical Act, 1950, which accords with the terms of the agreement, and this Bill is designed to implement the agreement in this country.

I do not propose to deal in detail with the provisions of the Bill since the explanatory memorandum which has been circulated to Deputies has pointed out the main changes which this Bill will make. The important change is, of course, the proposal that, after a date to be appointed by the Minister no person shall be admitted to full registration as a medical practitioner unless he has had the prescribed experience as an intern in a hospital. The Medical Registration Council will be responsible for prescribing the minimum period of intern service and for approving the hospitals in which this service may be undertaken. While, of course, I do not wish to anticipate the decision which the Medical Registration Council will take regarding the time which an intern will spend in a junior house post, I may say that a period of one year is at present under consideration both here and in Great Britain. The internship will be used by the student to acquire practical experience both in medicine and in surgery; and there is provision for a period of training spent in midwifery to be counted towards the minimum period spent either in medicine or in surgery. When the intern has completed such service he may then go to the university which has granted his qualifying degree and when they have issued him with a certificate that he has had the required experience in an approved hospital he will, on presentation of this certificate to the Medical Registration Council, be entitled to be fully registered as a medical practitioner.

To enable newly qualified graduates to undertake the period of intern service at a hospital they must be given power to practise medicine in so far as it is necessary for their work in the hospital. It is therefore provided that after qualification they shall be provisionally registered in the Medical Register, until such time as they have completed their period of training and become entitled to be registered. All these requirements will, of course, affect only those who graduate after the "appointed day." Those already on the register then will remain fully registered, with all their rights preserved.

Under the Bill it is proposed to take power to appoint visitors to visit places where instruction is given to medical students. The Medical Registration Council has had the power to attend examinations in order to satisfy itself that the standard of knowledge required at qualifying examinations is such as to ensure that the persons qualified will have a satisfactory knowledge of medicine, surgery and midwifery. It is considered, however, that it would be more satisfactory if the council were also in a position to satisfy itself that there are no defects in the courses of training which medical students undergo in the universities and hospitals. The appointment of visitors to medical schools will be a function of the Medical Registration Council.

We are also taking this opportunity of making clear that persons who are registered in the British Register as foreign or commonwealth practitioners, that is, by virtue of reciprocal arrangements between Great Britain or a Commonwealth or foreign country, will not, because of that fact, be entitled to registration here. Commonwealth or foreign practitioners will only be entitled to registration in the Irish Register if there is a reciprocal agreement between this country and theirs and if they have had experience which our Medical Registration Council is satisfied is equivalent to that required of Irish graduates.

The standard of training provided by the Irish medical schools and of the doctors qualifying from these schools has always been high, and can be favourably compared with that in any other country. Medical knowledge is, however, being constantly extended and it is important that our medical graduates should be trained in accordance with modern concepts. This Bill should help to ensure that, on beginning his practice, the doctor will be in a better position to provide the high standards of treatment which are now required, and it is on this basis that I recommend it to you for a Second Reading.

General Mulcahy

I am afraid the Minister has left a very large part of the ground that this Bill affects uncovered in his statement. No doubt students who go through a year's hospital course immediately after qualifying as doctors will be very much better able to face their duties and responsibilities, but there are a number of matters in regard to which I should like the Minister to throw a little light.

Assuming that this Bill is passed—I take it that there is no great objection to it—and the Act is brought into operation by an appointed date, can the Minister say by what year he expects that it will come into operation?

Dr. Ryan

That has not been agreed yet. I think the suggested date is the 1st January, 1953.

General Mulcahy

The closeness of that date has a very important bearing on the facilities available in this country for giving this course in hospitals to students who have spent three or four years at the medical schools, and who will not qualify in the ordinary way for professional registration until 1953. These students now find themselves with another year of studentship clapped on to their course, so that a six years' university course has been extended to seven years. I ask the Minister to let us know the position from the point of view of the facilities available here for the giving of this extra hospital year course. At present, the students go to the medical schools and attend the hospitals as resident students. I take it that to a very large extent, if not entirely, that will disappear. But the number of vacancies that were available for resident students in that way will not at all be adequate to meet the provision that is now being made that students will have to spend a resident year in hospital after being professionally qualified.

As far as I can gather, there are something like ten hospitals in Dublin City that are reckoned within the teaching group. They would not in any way be able to provide the facilities that are required under this Bill.

Can the Minister give us any idea of how many additional places it will be necessary to provide for and how these places will be provided for either in the voluntary hospitals or the hospitals run by local authorities? If adequate provision is going to be made, a very great extension of the taking in of resident professionally-recognised medical officers will have to be arranged. Is it the intention that the local authorities will arrange that their hospitals will be open to receive such students? We must bear in mind that this measure prevents a person who up to the present would have been able to go out and earn some kind of a living from his profession from doing so for a further year. The maintenance of such students in whatever hospitals they are resident will have to be provided for and some payment will have to be made to enable them to cover their general personal expenses over the year. I understand that the maintenance would perhaps be reckoned, at a very conservative figure, at £100 a year and that about £150 a year would be required as a payment by way of a small bonus to the student who is doing his work.

If the local authority hospitals are going to be opened up for the purpose of giving this instruction, will the local authority pay for the cost of maintenance and any such fee as £150 a year to the doctor who will serve there? On the other hand, what provision will be made on the voluntary hospitals' side for the payment of the cost? Generally, however, there is a big problem there. Where is the hospital accommodation to give the professionally-qualified doctors an opportunity of carrying on through 12 months and where is the cost of that extra work going to come from? There is the further problem that students who have already entered on a medical career are likely to be caught by this requirement of an extra year. Will there be any recognition of the difficulties in which some of these students will find themselves?

I understand that, at the present moment, about 70 per cent. of those who qualify as doctors in this country find their ultimate professional life spent abroad; but that is no reason why students who are required to do a hospital course after completing their university education here should not be catered for on the hospital side here, once we are introducing a measure of this particular kind. These are matters which the Minister should give us some opportunity of appreciating.

Dr. Maguire

Let me say at the outset that when I started medicine, had I visualised spending seven years in the university doing it, I would never have started, for the simple reason that it would probably have resulted in putting my parents in the poorhouse. I cannot understand the arrangement come to with the British Medical Association. I fail to see the necessity for it. My knowledge of the present system of medicine in England certainly does not convey to me the necessity of compelling a doctor, having spent six years in hard study, to do an extra year in a hospital in order to become a general practitioner. I admit that that remark does not apply to specialist lines.

When I did medicine, the course was five years. Some time ago, it was raised to six—why, I do not know. When I look back and think of the valuable time and money I wasted in wading through subjects such as botany, zoology, physics and other unnecessary matter, I honestly think that I would have been qualified just as well and efficiently had I done just four years in subjects pertinent to the profession or more closely associated with it. It is difficult to imagine what bearing the anatomy of a frog or the propagation of a frog has on medical practice. In addition to these subjects, some additional ones have been tagged on, in order to try to justify the six-years' course.

My opinion is that altogether too high a standard is demanded of our medical students in the universities, and particularly in one subject, anatomy, which is recognised as the Becher's Brook of the course. In the matter of medical education generally the amending of the standard required should be seriously considered by the authorities.

When one thinks of the meteoric advances made in recent years in the simplification of diagnosis and treatment, it is hard to understand why any student has to spend six years in order to qualify. Now another year is being tagged on. At whose expense? At the expense of the unfortunate parents. The Minister did not divulge the fact that the British Government or the British Medical Association—I do not know which of them is responsible—it is probably both combined—have made provision for the doctor doing his interneeship in a hospital to receive a sum of £350 a year. The Minister did not mention any figure at all in connection with remuneration, to which Deputy Mulcahy referred. Deputy Mulcahy was not very generous when he mentioned £150, though I do not blame him, as that is the accepted salary in hospitals for house surgeons.

General Mulcahy

I was only mentioning figures that come back to me as an echo from the walls.

Dr. Maguire

However, if the Minister has a figure in mind I certainly hope it will be nothing less than £350. Money has changed considerably since I was a house surgeon or house physician. If it is a thing that there is no provision made for the payment of those doctors, then this Bill should not apply to this country. Again, as Deputy Mulcahy said, where are the hospitals in which they are to spend their time? I presume the Minister will enlighten us on that point.

The Minister mentioned the qualifying date as 1953. I presume this does not apply to present students, or even to a student who has done his first year, or even his pre-registration examination. I believe they have a pre-registration examination now and a pre-registration term in a hospital before starting on the course at the university. I never heard such nonsense in my life. In connection with the qualifying date 1953, the Minister must remember that not every student qualifies in six years. In fact, the number who survive, who get through in six years, is very few. Some take ten years to qualify—there is a number of chronics, and I think they should be considered as well as everybody else— and by the time they qualify there is another year to be tagged on before they can earn a halfpenny. The whole thing seems to me to be very unfair. Frankly, I will be glad if this Bill has the effect of deterring a large number of students—yes, and parents, too— who erroneously regard the medical profession as an El Dorado. The Minister must remember that parents, even in the past, to say nothing about the expenses associated nowadays with putting children through the university, are put to the pin of their collar to try to squeeze and economise in order to get their children qualified as doctors.

In my opinion, after six years of intensive study in university and hospitals, and in view of the advances which have simplified medicine to a great extent, there is absolutely no necessity for anybody who gets through the final examination to have to spend another year in a hospital before taking up general practice. That remark applies either here or in any other country. I say that with full knowledge of the standards and experience demanded in other countries and also in the full knowledge that Irish people are more critical and expect a higher standard from their family doctors than people expect in most other countries.

Dáil Éireann debate - Wednesday, 5 Dec 1951

Medical Practitioners Bill, 1951—Second Stage.

Dáil Éireann debate -
Wednesday, 5 Dec 1951