As an intern working at a hospital in Galway, Dr Louise Curtis from Mallow, Co Cork, recalls shifts being so busy and under-resourced she would almost dread coming to work.
“You feel like you’re not meeting demands, kind of drowning a little bit the whole time because you’re too stretched to give people the care they need.”
The hours were long; Curtis said she would easily clock up more than 70 hours in a week.
“You’d be doing so many things that weren’t even your job. I remember coming in slightly earlier than I was supposed to to wheel patients up to their scans because there weren’t enough porters,” she said.
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“It’s so anxiety-inducing and as a doctor you feel like you’re just going around apologising to people all the time for having to wait or not having services to refer someone to.”
Curtis graduated with a medical degree in 2016 and after her intern year in 2017 moved to Perth in Western Australia along with about 53 others from her class, she said.
According to statistics released by the Australian Department of Home Affairs, a total of 402 skilled visas were granted to Irish doctors from July 1st, 2021 to March 31st, 2022, the vast majority for Western Australia. In addition, 391 temporary skilled work visas were also granted to Irish doctors from July 2020 to June 2021.
Official figures show a total of 531 Irish doctors were resident in Australia during the period December 31st, 2021 to March 31st, 2022.
With the experience of working in the Australian health system, Curtis almost looks back on her time employed in the Irish system in disbelief. Interns straight out of medical school, working on call or on night shifts were often left to fend for themselves while covering the entire hospital, she said.
“You are the most junior person on the team. When you’re on call or on nights, it’s just the interns who are looking after everyone, with very little support. You can call the medical registrar but they’re usually quite busy.
“What you’d be expected to do on those shifts, without any kind of support, was quite dangerous.”
Curtis said she once accidentally booked herself on to a 72-hour shift and was expected to work the entire shift, which “can’t have been safe,” she added.
“I was lucky that I was able to have other interns cover a few hours while I had a bit of a nap.”
Like many junior doctors, Curtis arrived in Australia with the intention of staying a year, or maybe two, until she experienced the work-life balance doctors enjoy there. Now based in Melbourne, and working as a psychiatry registrar, she has no plans to move home.
Compared to her 70-plus hour week as an intern, she now works a 40-hour week, which includes about four to six hours training. She also gets a half day once a week and would only typically work one weekend day every three to four weeks.
According to the current enterprise agreement in the state of Victoria, junior doctors are allowed work a maximum of 16 hours per rostered shift; night shifts are limited to seven consecutive days; and doctors must have a 10-hour break between work one day and the next.
With better staffing and working conditions, Curtis said consultants and registrars in Australia are less stressed than at home and can offer time more freely. “There’s no antagonism. The culture’s quite nice.”
Since she’s been in Australia, some of her friends, who are also doctors, have returned home, mainly for family reasons, she said. Some who had been training in a medical speciality told her the demands on them have been so high since returning they’ve had to quit their training.
Although Curtis sees the work-life balance in Australia as far superior to that in Ireland, it was still difficult to make the decision to stay.
“You’re choosing between the culture you grew up with and your family and the friends that you have at home versus having a really good work-life balance here and better training opportunities and better mental health support.”
Dr Ryan O’Dowling, from Cork city, is a junior doctor who moved to Melbourne in 2019 after two years working in Irish hospitals as an intern and then as a locum. Both of his brothers live in Australia, and he always felt a pull towards the lifestyle. Although it made sense for him to move, he hadn’t necessarily planned on staying. Three years on, having worked in Australian hospitals, he is now applying for a general practitioner training scheme in rural Victoria and has no plans to move back to Ireland.
O’Dowling says the culture around vilifying junior doctors who are educated in Ireland and move abroad needs to change. Instead of blaming junior doctors for leaving Ireland, he says the conversation should be around supporting doctors to stay.
As an intern in Ireland, he said the hours listed on his roster were 8am-5pm. In reality, he’d work from 7am to 9pm or 10pm, he says, easily clocking up more than 70 hours a week. He was often expected to do rounds on up to 30 patients, he said.
“Back home, you’re lauded as the martyr and the person who goes above and beyond for going five hours past your shift to get all the patients seen because it’s seen as such an honourable thing to do,” he said.
“It becomes standard and everyone does it and if you don’t do it, you don’t meet the standard.”
In Australia, O’Dowling said junior doctors are “not left out to dry”. When he started working at the emergency department of a Melbourne hospital, he would stay an hour or two past the end of his shift to show he was keen and had a strong work ethic. But his seniors quickly put a stop to it.
“They’d look at you and be like ‘what are you doing? Get out of here, it doesn’t benefit anyone’. That behaviour stops quite quickly and it’s much more sustainable.”
In Ireland, simple everyday things like making a patient referral to registrars and consultants would be the “biggest chore in the world to do. You’re very likely to have a referral thrown back in your face and told to go back and do more, ‘you’re not doing enough’”.
Far from blaming his seniors, O’Dowling could see that they too were being burnt by the system. “It comes through years of going through that system, where you’re overworked, underpaid, underappreciated and under-resourced.
“You get a bit jaded, you know. And because you’re overworked, you’re reluctant to take on more work, so you push back on the other person, who’s already overworked and under-resourced. People need to be resistant to work so that they’re not overloaded.”
In comparison, O’Dowling said his first referral call in Australia was “eye-opening”.
“The person on the other end was genuinely interested in what I had to say and offered advice,” he said. “It didn’t instil fear in my heart or dread about the next 30-40 years working in the system.”
There needs to be a whole culture shift around work-life balance and martyrdom in the Irish health system, he said. “Your perseverance and stamina in that way, it’s finite.”
“People go through the system and become the way they are because of the system. It needs to be a culture shock from the top down.
“If you can’t change the top of the system, you need to heavily, heavily advocate for the junior staff to protect them from becoming jaded and overworked and burnt out.”
Dr Niamh Humphries, senior lecturer at the RCSI graduate school of healthcare management, has written numerous papers on doctor emigration to Australia and elsewhere. She says it’s worrying that doctors like O’Dowling and Curtis don’t plan to return to Ireland.
“We have a very high rate of doctor emigration. Policymakers tend not to worry about it because the assumption is that emigrant doctors will all return to work in the Irish health system. If doctors opt to remain abroad in significant numbers, Ireland will find it hard to staff its health system.”
Ireland must improve working conditions to retain doctors and encourage emigrant doctors to return, she says. “It should not be a health system that doctors dread working in or returning to. If Ireland wants a strong medical workforce in the future, it needs to address this. It will not happen by itself.”
In a statement to The Irish Times, the Health Service Executive (HSE) said it had initiated research, tracking the number of doctors employed in the public service both leaving and returning to Ireland over time. It found 82 per cent of those who commenced intern training in 2015 subsequently commenced a Basic Specialist Training or General Practice (GP) training programme between 2016 and 2021.
Review of intern year data 2015-2020 indicated a trend of interns leaving the system immediately following intern year; however a “substantial number have returned to the HSE within two-three years,” the HSE said.
In 2021, of the 2016 cohort of doctors who completed specialist training (excluding the GP training programme) 68 per cent were employed in Ireland and 32 per cent were abroad or their location was unknown, the HSE said, adding that it was “very common for doctors who have completed postgraduate training to undertake a fellowship or experience abroad before taking up a consultant post.”
The HSE said it was “committed to continuing to address the ongoing challenges faced by the health service in the area of doctor retention and will continue to work towards attracting Irish trained doctors back into the health service.”
