A&E departments in smaller hospitals face a shortage of junior doctors as 158 posts remain unfilled, the head of the Health Service Executive (HSE) warned.
Cathal Magee said hospitals were facing a challenge in hiring non-consultant hospital doctors (NCHDs) despite a major overseas recruitment drive.
The health chief said the impact of the vacancies will not be known until next week but claimed emergency departments, particularly in smaller hospitals, faced shortages.
"Hospital management are working with clinical directors in a planned way to devise contingency arrangements which can be implemented if and as required, to ensure that any resulting impact on services is minimised and to ensure patient safety is maintained," Mr Magee said.
The HSE has been trying to fill gaps in the junior doctor positions through a recruitment campaign in India and Pakistanthis year.
Junior doctors or NCHDs usually rotate posts every six months as part of their training, with new rotations expected to take place on Monday.
There are 4,660 NCHD posts in the health system and, as of Monday, 80% of those will be part of structured training schemes run by postgraduate bodies and funded by the HSE.
Mr Magee told the Public Accounts Committee, the Dail's public spending watchdog, that the health service was facing challenging times in 2011, with around a billion euro in budget cuts.
More than 588,000 inpatients were treated last year - 9% more than expected - while almost 730,000 day-case treatments were carried out.
There were just over 1.1 million cases at the state's 33 A&E departments, with a third of these subsequently admitted to hospital.
In the first four months of this year, there was an increase of 5,614 presentation and 4,535 emergency admissions compared to the same period in 2010.
Mr Magee said emergency departments face considerable challenges. A&E costs account for 7% of total hospital costs.
"We accept that patients waiting on trolleys for long periods of time is not acceptable," Mr Magee said.
The Irish Nurses and Midwives Organisation said there were 322 people on trolleys at hospitals across the country today.
Beaumont had the largest number at 34, followed by Cavan General at 29
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