Imagine if primary school teachers were emigrating in droves, turning their back on relatively secure, public sector employment because of intolerable working conditions in the Irish education system.
Imagine if those left behind had to cope with increased pupil numbers and if school corridors were filled with primary school pupils waiting for a classroom place to become free.
Imagine the outcry there would be, the concern for the pupils, for the teachers, for the country.
Substitute Irish education system for Irish health system and you begin to understand how difficult the health system is for those who work within it, you begin to see why so many doctors, nurses and midwives are opting for emigration.
The RCSI-funded Failure to Retain project, a collaboration between the Royal College of Surgeons in Ireland and Dublin City University, sought to examine the emigration of doctors, nurses and midwives from Ireland and give voice to their experiences (why did they leave, will they return?). Any national response to health professional emigration must be informed by such evidence.
Each year Ireland loses too many of the doctors and nurses that it trains. Australia has welcomed over 1,000 Irish-trained doctors and 2,000 Irish-trained nurses in the past five years. Doctors, nurses and midwives are also emigrating to Britain, Canada, the US and New Zealand.
The study drew on a self-selecting sample of 388 emigrant health professionals who completed an online survey in July 2014 from their new homes in Australia, Britain and the US.
The doctors, nurses and midwives who responded had emigrated for professional rather than personal reasons. They felt the working conditions in the Irish health system left them “with no option but to leave”.
Exhaustion
They experienced 36-hour shifts, 80-hour working weeks and spoke of understaffing and exhaustion while working in the Irish health system.
They explained that while they loved their professions, they also valued their health. They felt that they had no choice but to emigrate, they felt exiled.
Although we set out to identify what might encourage health professionals to stay in Ireland (retention) or return to Ireland, their responses spoke of a need to be valued and respected. They felt that the poor working conditions experienced in the health system were a mark of disrespect.
“I ended up in hospital twice because of the ridiculous amount of work we did due to long hours and understaffing,” wrote one doctor.
‘It’s about respect’
Another said: “It’s not about the money, it’s about respect and understanding that we love working in medicine, but we love our families and health more.”
These insights into the health system from emigrant doctors, nurses and midwives made us realise retention measures are just the first step in responding to health professional emigration.
We need to aspire to a health system that retains, respects and values its health professionals and provides them with a working environment in which they can work safely, care for patients and protect their own wellbeing.
In order to care for us, doctors, nurses and midwives must work in a system that cares for them.
Ireland’s health professionals are emigrating to achieve basic working conditions that most of us take for granted – regular working hours, regular breaks, paid overtime or time off in lieu, a career pathway and respect.
If they do not return, their emigration will represent a lost investment, a risk to health service delivery and a drain of talent and potential from the health system.
There is a short window of opportunity to encourage recently emigrated doctors, nurses and midwives home.
The longer they are away, the more likely they are to settle overseas.
Marriage, children, promotions, may all interfere with even the strongest intent to return.
Doctors, nurses and midwives are highly skilled individuals performing vital roles within the health system.
We encounter them when we are at our most vulnerable and expect them to do their best for us.
We should offer them a better choice than emigration. In the words of one of the doctors we surveyed: “It’s awful to feel exiled from your country because of the expectations and working conditions of your job.”
Dr Niamh Humphries is senior research fellow in the division of population health sciences, RCSI. She is co-author of 'Emigration is a matter of self-preservation. The working conditions . . . are killing us slowly': Qualitative Insights into Health Professional Emigration from Ireland