Stop the haemorrhaging of talent from the Irish medical system

The treatment of young Irish doctors by the HSE is causing a gathering crisis in the Irish health system. There is an alarming exodus of young doctors from Ireland which should concern us all. HSE figures indicate that 50% of non consultant hospital doctors are leaving the country. At the same time an OECD study shows a dramatic increase in the number of non-Irish doctors working in Ireland .

In 2010, according to the OECD report, 33.4% of all registered doctors in Ireland were non-Irish medical graduates. The same study shows that the number of non – EU doctors registered in Ireland increased from 972 in 2,000 to 4,700 in 2010. This is equivalent to a quarter of all registered doctors in Ireland .

This is a dramatic change in the composition of the Irish medical profession in a very short period of time. There are issues surrounding the levels of training, language skills and cultural factors in the employment of such a large number of non-EU trained doctors in the Irish hospital system. There is also the bigger issue of Ireland taking doctors from countries which desperately need them, while we have in place a system which effectively forces hundred of young Irish doctors to emigrate.   

Ireland ’s pattern of international recruitment of medical personnel is in clear breach of the WHO code of practice in this area.

Students entering Irish medical schools are among the brightest and most hard working of their generation. They undertake a very rigorous training programme for 6 years in undergraduate school, or 4 years if they take the post graduate stream.

As a group they are highly motivated and show high levels of dedication and application. They should be treated as a critical resource by the Irish health system. Instead they are treated in a cavalier and careless fashion in their early years after graduation. The inevitable result is a determination by many young doctors to seek better career prospects and a better quality life abroad.   

Each young doctor who leaves Ireland is of course a personal loss to their family and the wider society. There is also the loss of very valuable human capital. It costs the state in the order of   €150,000 for each medical student going through undergraduate medical school. In addition family and personal costs involved in rearing and educating a person to become a doctor in their mid 20s must be of the order   €250,000. The total human capital invested in each young medical graduate is of the order of €400,000. For every 100 young doctors who emigrate there is a loss of human capital investment of €40 million.  

During the last 10 years a clear pattern has emerged. Young Irish doctors are emigrating in increasing numbers. During the same period the HSE has massively increased its recruitment of non Irish doctors. This pattern may well pose a threat to the quality of care being provided in our health system.  

The WHO is very clear on what needs to be done. Its Code of Practice on the International Recruitment of Health Personnel emphasises that countries should implement effective health workforce planning, education, training and retention strategies to sustain a health workforce   that is appropriate for the specific conditions of each country and to reduce the need to recruit migrant health personnel. Ireland ’s medical schools produce world class young doctors.

Where the HSE fails abysmally is in work force planning, post graduate training and retention strategies. Young Irish doctors graduate with high ideals and strong ambitions. Studies indicate that within a very short period of time of entering the hospital system many of them become disillusioned and de motivated and determined to emigrate.  

There are real and serious concerns surrounding support and mentoring structures for young doctors.   Young doctors need and deserve high levels of support in the early years of their careers.

There are issues regarding postgraduate training programmes and careers structures in the HSE. Many young hospital doctors have substantial grievances regarding the implementation of the EU working time directives and non-payment of hours worked. Excessive on-call obligations, excessive overtime, which are a feature of hospital doctors working lives, are unfair to doctors as well as being unhealthy and dangerous.   A tired and over worked doctor is much more likely to make mistakes. In particular the hospital contract system for young doctors is a cause of justified resentment.     Offering highly qualified professionals six month contracts, with no certainty as to where they might be working is demeaning. Young doctors deserve better.

They need to be able to plan their lives in a more human way. At the end of their intern year young hospital doctors should be offered a three year contract. In addition to fair pay and decent conditions of work that contract should include training elements, rotation between hospitals and ideally should also include a semester in an overseas hospital.   Young doctors rightly put great value on training and building their levels of expertise. An overseas placement early in their career in well run hospitals in other countries would be of enormous benefit to their professional development and would also enrich the Irish medical system through knowledge transfer.  

The HSE and the Department of Health need to wake up and respond in a thoughtful and considered way to needs of young Irish doctors. Every year the state continues to invest heavily in the training of medical students.   Yet more than 50% of young doctors emigrate shortly after completing their intern year.   The medical profession is a global profession. People will leave unless they are treated fairly. Irish doctors are highly valued all over the world.    The careless attitude of the Irish health system to our young doctors is counter productive. We need to value them a great deal more.   Allowing Irish doctors to emigrate in increasing numbers and an ever growing reliance of foreign trained medical professionals in our hospital system is not conducive to good long term health outcomes.   

We must stop the haemorrhaging of talent from the Irish medical system.   The HSE urgently needs a human resources policy clearly focused on the retention of young Irish doctors in Irish hospitals.   Our health system will the better for such a policy.