A typical conversation among medical students in Ireland involves at least one person asking, "So where are you going after you graduate?" Without any hesitation, the group starts weighing the pros and cons of working in Australia, New Zealand and the UK.
As an international student from Canada studying medicine in Ireland, I began to wonder if any of my peers intended to stay in Ireland after graduation. As I entered my third year of medical school and into clinical placement, all those I talked to, from patients to consultants, had one clear message: you need to go abroad. One lecturer asked people in the lecture hall to raise their hands if they planned to stay in Ireland permanently after they graduated. One person raised their arm, a student from Co Clare. That is when I knew that I wanted to ask more questions about this.
After several months of planning, myself and a team of researchers from across Ireland launched a national survey asking medical students in Ireland about their migration intentions. Our results can only be described as shocking. Out of 1,519 Irish medical students, 88 per cent had already decided or were thinking about migrating after they finished their intern training.
As I have progressed into my final year of medical school and get a feel for the working environment, I don’t know if I could blame them.
Junior doctors describe an environment where they are overworked and under-appreciated. So it is of no surprise that 83 per cent of medical students identified working conditions as one of the reasons they were considering migration.
It’s obvious that something needs to be done about this.
Let’s conservatively estimate that it costs €100,000 to train a medical student from first year until they graduate. So the loss of those medical students who stated they were definitely going to migrate (34 per cent), represents a potential loss of over €51 million of taxpayer money. This is a very crude estimate. However, the message is still clear. Urgent interventions are needed for the sustainability of the Irish healthcare workforce.
But what can we do about it? The results of our study suggests a number of solutions. First, as 85 per cent of students indicated that career opportunities and progression were influential factors, it is obvious that the medical postgraduate training system has to change.
As it stands now, training in Ireland after you graduate from medical school is broken into small chunks. You do a year as an intern, then two years as a senior house officer; if you are lucky you may get on straight onto a specialised training scheme and spend half a decade as a specialist registrar.
In this system, there are natural breaks where training is interrupted and trainees are forced to consider if they want to stay in Ireland for the next part of their training. Canada and the US, meanwhile, favour longer stretches of training immediately after graduation, typically a minimum of four years.
Second, it is disheartening that the HSE has been recruiting doctors from abroad over the past decade to help battle this workforce shortage while there are medical students graduating from medical schools here who will not be offered jobs. Some people might argue it is not feasible to keep these international students, due to the money needed to create training positions. However, a simple return of service contract, as is common in other countries, would see that the money spent to train these young doctors would be offset by years of service upon completion.
The Irish healthcare system finds itself in a dangerous position. If we do nothing, the potential migration of 88 per cent of Irish medical students will only exacerbate the current workforce shortage.
Pishoy Gouda, is a Final year medical student, NUIG and the lead researcher on "Ireland's medical brain drain: migration intention of Irish medical students" (supervisor, Dr Diarmuid O'Donovan, NUI Galway). He is also past chairperson of the Association of Medical Students in Ireland