A new series for Irish Times Abroad focuses on the opportunities for Irish healthcare workers who are interested in moving overseas. Where can they find a job? How do salaries and working conditions compare? Here, Fiona Reddan takes a look at the options, while Irish healthcare professionals already working overseas, from dentists in the UK to psychiatric nurses in Tasmania, will be sharing their experiences daily for the next fortnight online. Next week, we'll examine the options for those looking to move back to Ireland. See irishtimes.com/abroad for more.
Emigration may be declining, but it hasn’t gone away. Irish medical professionals are still seeking out new opportunities and new experiences all over the world – sometimes for better pay and working conditions, sometimes for career development.
For Irish medical professionals, health workers and carers still thinking about leaving, where are the opportunities and what can they expect when they get there?
Why are healthcare professionals still leaving?
For some, it is about conditions in the healthcare sector at home. For others, it's about seeking new experiences and living in different places. General secretary of the Irish Nurses and Midwives Organisation (INMO) Liam Doran says demand to work overseas is strong.
“If you were to take a straw poll of last year’s graduates, 50 per cent will be gone by January,” he says. “It’s pay, workload and career opportunities.”
An estimated 7,500 Irish-trained nurses have gone to the UK in the past five years, with many others going farther afield to Australia and Canada. Since 2008, the Nursing and Midwifery Board of Ireland has received more than 20,000 applications for Certificates of Current Professional Status (CCPS). These are necessary for Irish-registered nurses and midwives who want to work abroad as they can be used to verify their qualifications.
Not every nurse or midwife who applies for a certificate goes abroad – and it’s also possible to submit more than one CCPS request at any one time - but these figures are a good indication of trends. A drop in numbers indicate that emigration in the sector has begun to taper off.
Indeed figures have been levelling since 2013, with just 1,018 registrations made so far in 2016 (up to October 25th), compared with 1,179 last year and 1,403 in 2014.
But where are they going? So far this year, the UK (385 registrations) and Australia (420) appear to be the most popular destinations, in line with previous years. Next up is the United States (98), the United Arab Emirates (96), Canada (40) and New Zealand (17).
The Gulf States appear to be growing in popularity with Irish healthcare professionals, while more established destinations such as Canada, are declining. In 2011, for example, 7.3 per cent went to Canada and just 0.3 per cent to the UAE. So far this year, however, registrations for the UAE have soared to almost 10 per cent of registrations, while those to Canada have fallen to about 4 per cent.
Where are the opportunities?
Irish-qualified medics are in demand all over the world but the amount of experience they have may determine where they can travel to. In the UK, for example, newly-qualified nurses can be assured of finding work but other countries, such as Australia, hire their own graduates first and look for experienced medics from overseas. “If you’re an Irish-trained nurse with more than three years of experience under your belt, you’re absolutely sought after,” says Doran.
Australia
In Australia, there is still strong demand for medics, given a shortage of nurses and midwives. Official figures show that the majority of the nursing/midwifery workforce in Australia is 47 years or older and set to retire in the next decade, while enrolments are declining.
Margaret Cox is a director of Ice Group, which recruits nurses to work in New South Wales. She says demand is coming from the expansion of existing hospitals and the creation of extra beds.
With Australian graduate nurses typically guaranteed jobs, she says most of the opportunities for Irish-trained nurses will be in specialities, such as emergency department, intensive care, cardiac care and mental health.
“There are always opportunities for nurses interested in community-type doctor or a flying doctrinaires scenario,” says Cox, adding that there are also jobs for midwives, but that they have to have a certain number of hours after qualification to be accepted for employment as full-time midwives.
If you are a general practitioner and willing to work outside the main urban areas in the outback, you will find plenty of opportunities. The isolation may not be for everyone however.
But remember the grass is not always greener. Consider this recent press release from the Australian Nursing and Midwifery Federation in September 2016, declaring that “nurses and midwives are overworked, undervalued and in danger of burning out, with 32 per cent considering leaving the profession”.
In a survey of nurses and midwives wellbeing, it had found that “chronic exposure to elevated workload and exhaustion, along with poor appreciation for their dedication to the job was hampering work engagement levels”.
New Zealand
Opportunities look good for Irish medical professionals in New Zealand. Doctors, midwives, surgeons and 36 other healthcare occupations, including anaesthetists, clinical psychologists and GPs are on the officialSkills Shortages list, which should make it easier to get a visa if your skills are in these areas. Indeed the New Zealand government estimates that it will need 380 extra specialists every year to meet the OECD average by 2021 – and it will need up to 25,000 more nurses by 2030.
“There are many unique medical experiences on offer in both Australia and New Zealand that can involve both spectacular scenic locations – like the Great Barrier Reef – or working in remote areas with indigenous communities,” says Melbourne-based Rob Embury of International Medical Recruitment.
“There is an overall need in all areas in Australia and New Zealand for medical doctors – at registrar and consultant/specialist level – and nurses, although there are some specialities and locations that are far more competitive with others,” he adds, noting that the more flexible doctors are on location, the more opportunities tend to be available regardless of speciality.
“As a general rule, the more major cities – Melbourne, Sydney, Auckland – are the most competitive in all specialities. General practice, psychiatry and emergency, acute and rural/regional medicine services are very much in high demand in both countries,” he says.
You can check which skills are most in demand on the lists of long-term or the immediate skills shortages here: skillshortages.immigration.govt.nz/
Gulf States
Irish medical professionals have long sought out tax-free incomes in the Gulf States, in countries such as Saudi Arabia and Bahrain. Today, the US-owned Cleveland Clinic in Abu Dhabi has opportunities for Irish doctors and nurses.
The clinic says it is the first replication of a US multispeciality hospital outside of North America, and as part of the Cleveland Clinic network. It has a diverse workforce and out of its more than 3,500 caregivers, some 169, or 5 per cent of the total, hold an Irish passport, according to a spokesman.
The clinic is recruiting most heavily for intensive care and critical care nurses, he says. “We select healthcare professionals based on their education, demonstrated clinical competency and experience. We also value commitment to world-class standards of care, dedication to a patients’ first philosophy and respect for, and understanding of, local culture and values,” he says.
There is also regular demand for Irish consultants in private hospitals across the Gulf States, recruiters say.
Canada
Declan Clune of visa specialist VisaFirst, says Irish medics head primarily to larger hospitals in one of two provinces: Ontario and British Columbia.
There are opportunities in all areas, with Clune pointing to nutrition in particular, as well as social work, diagnostics and clerical and medical support workers.
UK
It’s the first port of call for many Irish medics in search of better terms and conditions, more varied experience, or just a new home. And there are plenty of opportunities. “The UK will have a shortage of nurses for the foreseeable future; it doesn’t educate enough to meet its needs,” says Doran.
Group managing director of TTM Healthcare Barry Pactor agrees. In nursing "all specialisms are in demand due to the staffing shortages currently being experienced," he says. More specifically, TTM sees a "serious demand" for emergency room nurses, critical care nurses and experienced nurse managers.
“For doctors, the current demand calls for specialists in emergency medicine, radiology, old-age psychiatry, and paediatrics,” he says.
What can you expect? Salaries, benefits, working hours
For many people, a career abroad promises better opportunities and better salaries. But before you take salaries on offer at face value, don’t discount the impact taxes can have on your take-home pay.
Yes, personal income taxes typically are higher in Ireland than in popular overseas destinations such as Canada, New Zealand and Australia. Consider the example, provided by PricewaterhouseCoopers, of a single person earning €50,000 in Ireland: they will lose 28 per cent of their take-home income on taxes, compared to just 18 per cent in Australia. A married couple in Ireland with one earner making €100,000 will lose 36 per cent in taxes, compared with 28 per cent in New Zealand and 27 per cent in Australia.
Going to a tax-free destination such as the United Arab Emirates (UAE) or Saudi Arabia will have a bumper effect on your finances, as you won’t have any deductions on your monthly pay slip – although you can also expect a higher cost of living.
Elsewhere taxes can have a surprising impact on how much money you actually end up with. Income tax rates are generally lower in the UK than in Ireland and medical salaries often higher, but a married couple with one earner on €50,000 might still end up better off in Ireland thanks to tax rates. Indeed this couple would lose 27 per cent of their income in the UK, but just 21 per cent in Ireland.
According to Lisa McCourt of PwC, this is because of additional personal tax bands and credits in Ireland for married couples.
UK
Salaries remain attractive for Irish medics in the UK. Some NHS hospitals offer incentive packages of up to €10,000, which covers items such as travel, legal fees, estate agent fees and other expenses linked to moving and house sales.
For example, Pactor says an entry-level nurse in the UK would have a salary of about £21,909 to £28,462 (€24,568 to €31,912), and the same level in Ireland would be about €23,361 to €30,537.
For doctors, however, Irish salaries may be higher. According to Pactor, a junior doctor in the UK would have a starting salary of about £23,000 to £32,000 (€25,930 to €36,032), but in Ireland, a junior doctor’s salary would be about €38,839 to €46,334.
Until now, of course, Irish nurses and doctors have worked freely across the UK, but the situation has become more uncertain in light of the UK's decision to exit the European Union last June. Brexit, and exactly what it might mean, has yet to unfold, but in future years it could mean some form of restrictions on Irish people working in the UK.
“Although it is very early days and little real detail is known about the final machinations of Brexit, what we do know is that there is a global shortage of healthcare professionals,” says Pactor. “TTM firmly believes that the UK will continue to welcome Irish medical staff for many, many years to come.”
Australia
Salaries typically compare well down under. In New South Wales, for example, a nurse with one year of experience can expect to earn A$1,142 (€790) a week, compared with €528 in Ireland.
The work/life balance can also be more attractive, with typically more opportunities for career development and greater autonomy in Australia.
“The role of nurses is recognised in a different way. There is more weight given to it in New South Wales than perhaps there is in Ireland,” says Margaret Cox, director of the Ice Group, which recruits nurses for jobs down under.
She adds that demand for jobs there from Irish nurses has been steady in recent years, typically coming from three areas: younger nurses under 30 going to work on a working holiday visa – they spend three to six months in any one job and then move on to a new location; nurses who are a little older and more experienced going for couple of years, but who will probably return to Ireland; and those looking for a lifestyle change, who will move themselves and their family and get permanent residency.
A major benefit of working in Australia is so-called “salary packaging”, which is offered to all public hospital employees in Australia. It’s a tax-minimisation system which allows you to receive up to 30 per cent of your salary tax free, through spending on mortgage or rent, petrol and household utility bills.
According to Aster Medical (astermedical.com.au), a recruitment agency, GPs in Australia typically earn more than lawyers and accountants, with salary expectations in the region of €140,000 to €210,000 a year. These figures depend on the terms of the contract and may increase according to such factors as location, type of work, and extra hours. Like Ireland, most GPs work as independent contractors, but there is also an option of working as an employee for a fixed salary.
New Zealand
New Zealand has both a public and private healthcare system, but the public is much larger, accounting for 83 per cent of total healthcare spend.
Salaries can be attractive in New Zealand, particularly if you are willing to live in a remote area. In Tokoroa, on the north island, a GP position was being offered at a salary of NZ$400,000 (€263,650) plus 12 weeks’ holidays and a four-day week.
Canada
According to Clune of VisaFirst, a lot of nurses can expect to earn between C$30,000 to C$50,000 (€20,000 to €33,500). He says that almost 20 per cent of people applying for a Canadian visa with the provider will get salaries of between C$70,000 and C$90,000.
Most Irish medics typically head for British Columbia and Ontario, but if you are willing to travel farther afield, you might earn more. In Nunavut, for example, the northernmost and least-populated territory of Canada, nurses can expect a base salary of C$81,000 to C$120,900 (€55,876 to €83,318), while nurses may also be entitled to a northern allowance of up to €23,813 and a special annual allowance of €13,438.
Where you go in Canada can also affect how many days’ holidays you can expect. In Alberta, for example, the minimum vacation allowance is 15 days, rising to 30, while in Ontario, you will get 20 days holidays straight away.
Gulf States
It’s just two words but it might be all you need to know to make your decision: tax free. Yes, everything you earn in many parts of the Gulf States, including Dubai and Bahrain is tax free, which means that you get to keep everything you earn. The cost of living is higher there, but you can expect other benefits, such as up to 40 days’ paid holidays. So you will have plenty of opportunity to escape the heat of the desert for a while.
In addition, it’s common to receive free accommodation or a housing allowance, with health and dental insurance also covered, as well a travel allowance to help you to come home for a visit, and an educational allowance to help towards the cost of children’s school fees, as many international schools in the region charge.
The US-owned Cleveland Clinic in Abu Dhabi, for example, promises its health professionals accommodation and transportation allowances, an annual flight ticket, health insurance and generous annual leave packages. It also offers opportunities for continuing education.
What you need to know before you go
Typically Ireland is listed as a top tier country for qualifications, which means it should be a matter of sorting out your paperwork rather than requiring additional qualifications to work abroad. “Irish qualifications and experience are very highly regarded in Australia and New Zealand,” says Embury. Qualifications are recognised as being comparable, but there is an assessment process to go through too.
One Irish-based recruiter advises that one year of experience is typically discounted when you work abroad. So, if you have three years of experience in Ireland, it will be considered as two if you head to Australia or the UK, for example.
You will have to get your medical qualifications registered in your host country, in addition to going through the relevant immigration process.
In Australia, for example, to work as a healthcare professional, you must get a visa in the normal way, through the Australian Department of Immigration and Border Protection, but you must also register with the relevant board: Nursing and Midwifery Board of Australia or the Medical Board of Australia. Potential applicants should bear in mind that this can take up to six months.
Remember your application for a visa and your application to be registered are separate processes. “Irish-trained nurses are completely recognised (in Australia),” says Cox. “The Irish system is very comparable to the Australian system.” She says it can take up to six months to get your paperwork in order however.
The Royal Australian College of General Practitioners (RACGP) recognises Irish-trained GPs as being fully comparable to the Australian-trained equivalent, provided you are a graduate of the Irish College of General Practitioners (ICGP) and hold membership of the Irish College of General Practitioners (MICGP).
Irish health and care professionals seeking employment in the UK must register with the relevant board for their specialism such as Nursing and Midwifery Council for nurses, General Medical Councilfor doctors, Health and Care Professions Councilfor allied healthcare and HSS professionals.
“The process is relatively straightforward, but it can be time-consuming with a lot of paperwork involved,” says Pactor.
In Canada, the process can be more complicated should you decide to move around as each province has its own rules and regulations for nurses and doctors, according to Clune.
This means that nurses and doctors have to register in one province but then must do it again if they decide to move to another province. Medics under the age of 35 can work in Canada for up to two years under their working-holiday International Experience Canada Programme, and then have the opportunity to seek other visas if they wish to stay longer.
