A study of the career paths of Irish medical school graduates who have gone abroad to train and work has found 40 per cent of those abroad at the moment do not intend to return to work in the Republic.
The study, carried out by University College Dublin and commissioned by a committee set up by the Department of Health, states that "the loss of young graduates and experienced clinicians from the public health system is a matter of serious concern".
The study, a draft of which has been seen by The Irish Times, has been presented to Minister for Health Mary Harney. It found graduates were travelling abroad for training because they considered Irish postgraduate training "substandard to training abroad".
Its findings are contained in a report drawn up by a group that was asked by the Department of Health to look at postgraduate medical education and training issues arising from the publication of the Hanly report.
It said the fact that postgraduate training in the Republic was seen as substandard could be leading to "an enormous brain drain".
The study the group commissioned tracked the career choices of doctors who graduated here in 1994 and 1999.
"The results of the career tracking survey suggest that 40 per cent of the graduates abroad at the moment do not intend to return to Ireland. . . this deprives our health service of highly trained, competent doctors," the report said.
However, it added that it was reassured by another finding from the survey which indicated some 700 doctors based outside Ireland may "at least consider a return to medicine in Ireland" and thus constitute a potentially valuable resource in addressing in part the consultant workforce expansion proposed in the Hanly report.
The survey, it said, found that the single most important factor likely to influence Irish-trained doctors abroad to return to medicine in Ireland was the availability of consultant posts.
"Realistically, no significant progress is likely in relation to improving our rates of graduation retention until the policy of increasing consultant numbers begins to be implemented," it said.
It added that the increasing emphasis on work-life balance and the rising trend in female medical graduates (females represented 53.5 per cent of enrolments in 2001/02 and 56 per cent in 2003/04) was clear evidence of the need for more family-friendly policies and flexible training schemes for graduates.
The study found the lack of flexibile/part-time training was considered to be a major problem by 23.8 per cent of the 1994 class and by 34.3 per cent of the 1999 class.
It also said about half the 4,000 junior doctors in the Irish healthcare system at present are not in recognised training posts. This needed to be addressed.
"Patient care must be delivered by doctors who are trained to the highest standard," it said.
It also noted a recent rapid growth in the proportion of non-EU graduates in Irish medical schools, up from 6 per cent of graduates in 1994 to 20 per cent in 1999. It now stands at over 50 per cent.
The report said specific measures might be considered to retain non-EU graduates. This could include a review of their work permit requirements.
A further finding, which the report's authors said was of concern, was that over one-third of non-Irish doctors surveyed indicated they experienced definite discrimination on grounds of their nationality.