A first-time visitor to an Irish hospital will immediately appreciate how dependent our health service is on doctors who are trained overseas. But what is not apparent is that those very same doctors are leaving this country, mainly because they feel unfairly treated here.
Of arguably even more concern many are discouraging other internationally trained doctors from coming to Ireland. We have not reached the tipping point yet. But if the problem worsens we will eventually lose more international doctors than we are recruiting, a situation that is not sustainable.
Research into the cross-cultural adjustment of 369 internationally trained non-consultant hospital doctors working and living in Ireland found that many come here for the same reasons that so many Irish trained doctors going abroad – career progression, better working conditions and higher remuneration packages.
Ireland is finding it increasingly difficult to recruit internationally trained doctors to fill vacant positions
This is not a problem unique to Ireland as many developed countries in the OECD are in the midst of a doctor shortage. In recent years the “brain drain” of Irish-trained doctors has left our hospitals seriously understaffed in some areas and under increasing pressure to provide vital medical services to our growing population.
Ireland has run aggressive recruitment drives in several developing countries to attract doctors to work in our hospitals. In the short-term, this strategy may have eased our shortages somewhat, but in the long run has it only contributed to the growing problem?
Vacant positions
We now see growing numbers of internationally trained doctors deciding to give up jobs in Irish hospitals and seek employment elsewhere. Coupled with this, Ireland is finding it increasingly difficult to recruit internationally trained doctors to fill vacant positions.
So, not only are we losing our homegrown doctors to other countries, but we are now seeing the internationally trained doctors recruited to help our healthcare system shortages also leave.
While internationally trained doctors say they are initially satisfied with their jobs in Ireland – including the hope of advanced career opportunities and progression – this satisfaction decreases when they interact with Irish doctors already in the system.
Internationally trained doctors felt that their job circumstances were different to their Irish counterparts’ conditions, and that they were not being treated equally. They formed the perception that they were being recruited into Ireland to merely fill vacant positions, and were not considered for promotions, training opportunities or even equivalent wages compared to Irish doctors in the same job role. In other words, career advancement opportunities within the system were nonexistent in their eyes.
The reputation of our health system is not positive and true change can only come about if issues such as these are taken into account and managed
This research – carried out at the University of Limerick by myself and Prof Michael Morley – gives us insight into one significant reason why internationally trained doctors may be leaving the country, and why Ireland is finding it increasingly difficult to attract and recruit more of them.
It is widely understood that one of the main influencing factors of job turnover in companies is job satisfaction. Employees who are dissatisfied with their jobs are more likely to leave. It is also acknowledged that word of mouth about poor working conditions and lack of career progression can deter individuals from wanting to work in particular organisations. Our healthcare system is no different and is suffering as a result.
Leaving Ireland
Internationally trained doctors are not only leaving Ireland, but may be discouraging other internationally trained doctors wanting to seek employment opportunities outside their country from working in Ireland.
The results of the research seem to indicate that internationally trained non-consultant hospital doctors are experiencing some form of systematic discrimination, however, more focused research needs to be conducted into the area to draw this as a concrete conclusion.
Ireland is more reliant on internationally trained hospital doctors than any other OECD country. In 2015, 35.7 per cent of doctors on the Irish register had qualified outside of Ireland compared to 3.1 per cent in France and 25.9 per cent in the US.
Ireland’s reliance on internationally trained doctors has been increasing over the past decade. The number currently working in Ireland is 6,233, an increase of 1,297 from 2011-2012.
If true reform is to happen in the health service, issues like this need to be addressed and resolved with a level of urgency. The reputation of our health system is not positive and true change can only come about if issues such as these are taken into account and managed.
We live in the hope that Irish-trained doctors will decide to stay in Ireland instead of emigrating, or if they do leave, that they will return to Ireland at some point in their career. In the meantime, we need to ensure that our patients have a sufficient number of doctors to care for them.
Dr Eimear Nolan is an Assistant Professor in International Business at Trinity Business School, Trinity College Dublin.
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