Why our hospitals have a shortage of junior doctors
After the controversial overnight closure of Lagan Valley Hospital's accident and emergency department, what are the reasons behind the glut of unfilled posts in casualty units?
At 8pm on Monday, security men at Lagan Valley Hospital shut and locked the doors of the A&E unit.
Bosses at the South Eastern Health & Social Care Trust have blamed the overnight closure on a shortage of junior doctors.
Despite extensive recruitment efforts, they have been unable to fill four out of six junior doctor posts required to keep the unit running 24 hours a day.
However, with A-level pupils fighting to win a coveted place studying medicine to fulfil their dream of becoming a doctor, how has this situation arisen?
According to Dr David Farren, chair of the British Medical Association's (NI) junior doctors committee, it is down to a combination of factors resulting in a junior doctor shortage which is affecting the health service right across the UK.
"There are a couple of reasons why this happened but it is important to stress this is not because junior doctors don't want to work in a particular hospital," he said.
"Junior doctors are told where they will work by the organisation which oversees the training of doctors in Northern Ireland."
Historically, junior doctors - who have graduated from university and are training to specialise in a particular area of medicine - worked over 100 hours a week.
But in August 2009 new European legislation came into force which restricted the number of hours people, including doctors, can work in a week.
People who work in jobs that come under the scope of the European Working Time Directive (EWTD), cannot work over 48 hours a week on average.
This means the health service needs more junior doctors to keep the service going.
At the same time, changes to immigration laws have made it harder for non-EU citizens to come to European countries to work.
Over the years, the health service has been propped up by junior doctors from countries such as India coming to the UK to gain valuable experience they might not get in their own country. However, now that preference is given to EU citizens, they tend to overlook the UK when applying for jobs and go to Australia or America instead.
This means we have to rely on junior doctors from the EU to fill vacancies. The problem is the training, pay and conditions in other European countries are on a par with Northern Ireland so there is little incentive for junior doctors to leave their own country and come here to work.
So, what about the hundreds of people graduating from the school of medicine at Queen's University in Belfast each year?
Essentially, the annual intake to the university has not been enough to address the increased need for junior doctors caused by the EWTD and immigration laws.
And so hospitals such as Lagan Valley find it increasingly challenging to fill all their vacancies.
However, Lagan Valley is by no means unique, with latest government figures showing there are 17 gaps right across emergency medicine in the province.
Junior doctors are training to be specialists in a particular area in medicine and, as such, they work in different departments - A&Es, GP surgeries and cardiac wards.
Essentially, not enough junior doctors are choosing to follow a career in emergency medicine.
A&Es are the real coalface of the health service where attacks on staff are increasing, doctors frequently make life or death decisions about patients and work unsociable hours, so it is not hard to see why it may not be the most attractive career option.
The number of places at the QUB school of medicine has increased, but with the degree taking five years it will be years before the effects of this are felt.
So it is likely Lagan Valley Hospital's A&E will not be the last to make changes to opening hours.