Ireland's reliance on international medical graduates is among the highest of the OECD countries: 34 per cent of doctors working in Ireland were trained overseas.
Many of these foreign doctors are prohibited from accessing training posts vital to their career advancement under a change in the Medical Practitioners Act 2007, which took effect in 2011.
Only doctors from Australia, New Zealand, Malaysia, Sudan, South Africa (with an internship after 2006) and Pakistan (with an internship after 2008) can enter training jobs or specialisations.
The remainder of non-EU doctors cannot apply for training jobs, which eventually lead to specialisation and consultancy, regardless of their qualifications or experience.
According to the Medical Council’s 2014 workforce report, international graduates comprise 74 per cent of doctors working as non-consultant hospital physicians in non-training posts.
Ceiling effect
Dr Muhammad Shakeel Majeed is an endocrinology registrar at the Mater hospital in Dublin. He came to Ireland after being recruited in Pakistan in 2011 and accepted a training post at St James's Hospital, Dublin. After eight months on the job, he was told he was ineligible for training because of the legislative change.
"I asked the Medical Council if there was any exam they wished me to do to get a training slot," Majeed said. "They said unfortunately, I could never be eligible for a training post, so it was closed to not only me, but hundreds of other doctors working here in Ireland."
Majeed decided to leave the post and take his current position, another non-training job. Meanwhile, he passed exams in the UK, where he could access the further training he wants. He hopes to stay in Ireland but will move to the UK if there is no other way to become a consultant.
“I graduated in 2007 and did a year of internship and two years of training in Pakistan. I was in a training post in my country. My colleagues working there are now consultants. And I left my training there . . . and here I am refused the training because my internship was before 2009. I have been working here in Ireland for three or four years,” he said. “Do you not consider that experience? And if I am not an experienced doctor, if I am not safe to the patient, why are you letting me work here in Ireland?”
Dr Wajiha Zia, a registrar in psychiatry at University Hospital Waterford, has had a similar experience. She came to Ireland "to work abroad and get better training" after she was recruited in her native Pakistan. She arrived in 2011.
“It’s limbo because, on the one hand, I’m doing the right things to progress my career,” she said. “On the other hand, I have these legislative and Medical Council rules making a ceiling effect. It’s sometimes heart-breaking when you’re trying so much. Eventually, if nothing happens, then probably I’ll move to some other country.”
Losing doctors
Dr Shakya Bhattacharjee from India is general secretary of the Overseas Medics of Ireland, an organisation for non-Irish medical professionals. "We want to work here, but if the situation doesn't change, we'll be forced to leave," he said. "The UK is benefitting most from the Medical Practitioners Act. They are getting a lot of doctors, but Ireland needs doctors.
“The law was brought in to ensure patient safety, but in the long run it’s causing a doctor shortage and more trouble to patients,” Bhattacharjee added.
Statistics show that Irish-trained doctors are leaving as well. According to the Medical Council’s workforce report, there was a 23 per cent increase in Irish medical school graduates aged 25-29 leaving Ireland in 2013. One in 10 young doctors “exited” the practice of medicine that year.
Eric Young, assistant director of industrial relations at the Irish Medical Organisation, which represents doctors in Ireland, said that if the issue is not addressed, the potential loss to the Irish health system is great. "It's treating doctors unequally," he said. "It's nonsense to allow doctors to work in a health system, treat patients and provide services and yet say they can't avail of training posts. There should be a level of equivalence there."
The standard of service those doctors are providing “is actually very good”, he said, and there is “no reason why they shouldn’t have access to training in the same way as other doctors”.
According to a spokeswoman for the Medical Council, there are different registration requirements depending on where a doctor is qualified. Doctors seeking registration in the Trainee Specialist Division who have qualified outside Europe must meet a number of criteria, which are set out in the Medical Practitioners Act 2007.
The legislation requires that, for doctors from outside of Europe, to pursue postgraduate training in the Trainee Specialist Division, doctors must (1) either pass or be exempt from a pre-registration examination, or (2) hold a “Certificate of Experience” or equivalent. The certificate verifies that an applicant has completed an internship which is equivalent to one completed in Ireland.
The Medical Practitioners Act 2007 itself states that it is “for the purpose of better protecting and informing the public in its dealings with medical practitioners and, for that purpose, to introduce measures, in addition to measures providing for the registration and control of medical practitioners, to better ensure the education, training and competence of medical practitioners . . .”
A spokesman for the Department of Health said: "The Medical Practitioners Act 2007 provides that nationals of a third country can only be registered in the Trainee Specialist Division of the Medical Council's Register if they have passed the Council's PRES examination or are exempt from the PRES, because they hold a higher qualification, have an approved training post and have been granted in a third country a document which, in the opinion of the Council, is at least the equivalent of a certificate of experience.
"This means that only nationals of non EEA countries whose certificate of experience is recognised by the Medical Council as equivalent to the Irish certificate of experience can register in the Trainee Specialist Division. Currently, Australia, New Zealand, Pakistan, South Africa, Sudan and Malaysia's certificate of experience are considered to be equivalent to the Irish certificate of experience.
"Discussions are now ongoing with the Department of Health and the Medical Council on the issue on specialist training access for non EEA countries including an examination of the intern programme conducted in India, received from the Medical Council of India."
