The high number of doctors emigrating to work abroad is a significant contributor to the crisis in our health services. The extent to which the Irish health system relies on internationally trained doctors, on agency and locum staff, and struggles to recruit consultants, shows it is time to reassess medical emigration and to challenge the presumption that it benefits the Irish health system.
Ireland is training more doctors than ever before, yet each year significant numbers of doctors emigrate to the US, UK, Canada, New Zealand, and Australia. Almost 300 Irish doctors obtained Australian work visas last year alone. This is a big problem for our health services.
Traditionally, Irish doctors emigrated to obtain specialist skills and experience before returning to Ireland to take up consultant posts. These overseas stints are a rite-of-passage that are considered good for their medical careers, good for medicine and good for Ireland. But do they damage our health service?
The fact that Irish medical graduates can work anywhere in the world is because Ireland has a reputation for producing world-class doctors. But the loss of so many doctors from the Irish health system each year is not sustainable.
Austerity has dented Ireland’s ability to attract emigrant Irish-trained doctors into consultant posts. The combination of reduced staffing levels, deteriorating working conditions and lower consultant salaries have made Ireland a less attractive place for Irish-trained doctors to stay in and return to. If they do not return, the loss to the Irish health system is permanent.
To better understand the reasons why so many of our doctors are emigrating, the Doctor Emigration Project 2013-17 funded by the Health Research Board, interviewed 50 doctors, including emigrants, those who remained in Ireland and those making plans to leave to better understand what motivated them to leave, or to stay.
Almost all (42 of 50) spoke of the importance of emigration for career progression. One said: ‘It would be almost unheard of to train exclusively in Ireland and go into a consultant post’. Doctors are expected to emigrate but the risk is that some may never return. As one doctor explained: “Irish doctors . . . are encouraged to go abroad to train . . . but I don’t even think it ever really occurs to the people encouraging us that we might not come back. So that’s the danger’. And sadly, that is becoming the reality.
Ireland has tended to use quick-fixes to resolve medical workforce crises, rather than genuine reform. As one doctor explained: “In the ‘90s . . . we threw money at consultants so they would come to Ireland . . . but eventually the money runs out . . . What we didn’t do in the ‘90s was actually reform or change any of the working practices that were potentially going to drive people away”.
Although the World Health Organisation (WHO) recommends that high income countries halve their dependence on international doctors by 2030, Ireland continues to recruit doctors internationally. To what extent is this recruitment needed to maintain staffing levels in the face of large-scale emigration?
Ireland now needs a better response to its doctor emigration crisis.
This requires further data on the numbers of doctors leaving and returning to the Irish health system. It needs to know what specialty and what career stage these doctors are at. And it needs to use this data to inform its response to current and future workforce challenges, including Brexit.
In January 2018, new research being led by researchers at the Royal College of Physicians of Ireland, will delve further into the factors influencing doctor emigration and retention, considering why so many doctors exit the Irish health system and opt not to return.
Encouraging Irish-trained doctors to remain in the Irish health system is key to resolving Ireland’s medical workforce crisis. It is already evident that this will require genuine reform of the working conditions across the Irish health system. Reviewing the culture of medical emigration must also be a priority.
Dr Niamh Humphries is a Reader in Health Systems Research at the Royal College of Physicians in Ireland.