THE NUMBER OF Irish doctors granted visa applications to work in Australia has increased significantly this year, according to new official figures, as experts and medical professionals criticised poor working conditions in the Irish healthcare system.
The number of visa applications granted by Australia to Irish doctors rose to 391 last year, compared with 332 visa applications granted the previous year, and 272 visa applications granted in 2018.
That represents a 44% increase in three years.
Niamh Humphries, a senior lecturer at the RCSI Graduate School of Healthcare Management, told The Journal that around 725 doctors graduate each year, meaning that a “significant” number of newly-qualified doctors are choosing to go abroad (while not all doctors who emigrate are newly-qualified, the vast majority are).
According to research carried out by Humphries, the reasons for emigrating to Australia include a better work-life balance for healthcare workers, the ability to progress into senior roles more quickly, and the option to tailor healthcare jobs to a person’s interests.
“They can craft their jobs a little bit more than they can here,” Humphries said. “So they might take on a 20% leadership role on top of their clinical role, or take a 20% contract for research. They can craft a job that suits them in terms of working hours and their own skills and experience and interests.
“They can also have a really good work-life balance – they do their 40 hours a week, and they can have a life outside work, which isn’t always available to them in Ireland.”
Although Irish doctors may head to Australia with the intention of returning, Humphries says that strong retention policies make it more appealing for doctors to stay.
“I think for a long time, Australia was seen as somewhere that people would take a year out to go to, and it wasn’t really taken seriously as a destination because it was presumed that all of these doctors are early in their career and they’ll all come back.
But I think Australia is very good at working conditions, very good at offering doctors opportunities while they’re there. So they might go out on an 18-month fellowship, but the chances are they’ll be offered a consultancy in that 18 months.
“We can learn a lot from Australia,” she said. “When I interviewed the doctors in Australia, some of them do want to return. They’re really watching for signs of hope back here. They’re watching for anything changing.”
A non-consultant hospital doctor, who worked in New Zealand before moving back to Ireland after the pandemic began, spoke to The Journal about why she left.
She said the reason she left for New Zealand was “multi-factorial”, that she had always wanted to travel with her degree, she felt burnt out after her intern year and that there was a good work-life balance in the healthcare system in New Zealand.
For example, in New Zealand if you worked 10 days in a row, you got an extra two days off, in what was called a “ten four”, which she said made “a huge difference”. The doctor is working 12-14 days in a row now in Ireland.
The doctor also raised a number of issues with the Irish healthcare system, including “not-fit-for-purpose” old hospital buildings; a bulk of forms to be signed when a doctor moves to a new hospital in Ireland due to a lack of a centralised IT system; and not having support for further education through leave or having courses reimbursed.
She is now considering moving back abroad again.
“Training isn’t at the standard of other countries regarding education leave and course reimbursement. You also often get boxed into things that are not technically your job in Ireland, but you sort out because it’s best patient care.
“And a lot of that is just the understaffing of the whole healthcare system, it’s not just doctors. We really need to look at training up nurses to become more specialised, and I’m sure there’s a lot of crossover with nurses in terms of emigration as well.”
Dr John Cannon, who represents non-consultant hospital doctors at the Irish Medical Organisation (IMO), said that instead of working the expected 40-48 hours a week, Irish doctors are reporting to the IMO that they’re regularly working 60-80 hours a week.
Despite this “underpowering” of the Irish healthcare system, Cannon told The Journal that the reasons doctors were leaving Ireland ten years ago are still the same as they are now.
“That is the most worrying thing when we’re trying to improve working conditions for NCHDs, which is what we call junior doctors in Ireland.”
In the IMO’s annual health and wellbeing survey carried out among its members in 2021, 80% of NCHDs responded to say they felt they were burned out.
“90% of the respondents to the survey last year said that they had some sort of depression, anxiety, stress, emotional stress, or some other mental-health condition that was related to or made worse by work, or brought on by work.
When they’re burnt out, they feel that their reserves are gone, there’s a level of physical and mental fatigue there that they can no longer perform their duties properly. That’s what ‘burnout’ means.
“So if your loved one, your son, your daughter, your mother, your father walks into a hospital, there’s a good chance that nine out of ten junior doctors that are taking care of them will be struggling with their own mental health because of the stress of their job, and there’s an 80% chance that the doctor taking care of your loved one is already burnt out.”
In Humphries’ research on Irish doctor emigration published last year, she cites a culture of medical emigration, poor working conditions and the limited availability of posts in the Irish health system as ‘push factors’.
According to that same research, the Covid-19 pandemic didn’t change the underlying reasons people were leaving, but rather “intensified everything”.
Dr Cannon notes that money is not the primary reason young doctors are moving away from Ireland.
“It’s all of the other sundry elements, and what the HSE would describe as periphery elements, that are really central to making an attractive, rewarding and holistic career.”
Humphries added: “For too long there hasn’t really been a response to what I think looks very like a crisis in terms of the numbers leaving, compared to the numbers that we train.
If you’re going to let people go away for a fellowship, you need to attract them back. It can’t just be a one-way ticket.
“If you’re working really hard to say ‘okay, I see that you’ve done this really wonderful fellowship, we will have a post lined up for you in 18 months, or in two years’.”
According to the Irish Medical Council’s Medical Workforce Intelligence Report, in 2019 there were 1,135 voluntary withdrawals from the medical register in Ireland out of a total of 23,558 doctors registered.
That was a decrease of 21.8% on deregistrations since 2018, and the first decrease since 2014.
This report also lists the reasons doctors who emigrate left, which included “personal impact arising from excessive hours and lack of support”. These were raised as significant challenges to morale and patient safety.
It also showed that 29.8% of doctors reported working more than 48 hours a week in 2019, and 27.5% in 2020.
As of August 2020, 862 doctors had voluntarily withdrawn their registration from the Medical Council’s register.
The Department of Health said in a statement that the recruitment and retention of healthcare workers is a key priority for the Government and the Minister for Health, and said that the increase could be partly related to some Covid-related policies.
“The HSE National Doctor Training and Planning has recently commenced the tracking of doctors who complete medical internship in Ireland. Early and provisional data shows that a high percentage of medical interns who graduate leave Ireland for at least one year.
“However, the data also shows that 82% of interns who commenced one year intern training in July 2015 subsequently commenced a Basic Specialist Training (BST) or General Practice (GP) training programme in Ireland in subsequent years (2016-2021). A small number of the 2015 cohort also remain in the Irish health system either in HSE service grade posts or employed within the private health sector.
“In 2020, in response to the Covid-19 pandemic, the Minister for Health requested the HSE to increase medical intern posts to provide a post for all Irish Medical School graduates (CAO and non-CAO) who wished to accept a post. This resulted in the total number of intern posts increasing to 995, an increase of 261 places which represents a 36% increase from 2019. This increase was for one year only, as a direct result of the Covid-19 pandemic. This temporary increase translated into a permanent increase in the number of medical interns entering internship in July 2021 to 854.
“It should be noted that when the researcher is referring to Irish-trained doctors or doctors trained in Ireland the research is referring to doctors who are Irish/EU passport holders who obtained their basic medical qualification in Ireland. Ireland trains a significant number of doctors from non-EU countries.”
Ireland has the highest number of medical graduates per population of all OECD and EU countries (24.4 per 100,000 of the population), the statement pointed out.
“The medical intern numbers exiting internship in July 2021 were higher than 725 (over 900) and for July 2022 it will be approx. 854. The increase in the number of Australian visa applications 2020-21 could be partly explained by the increased number of medical interns exiting medical internship in July 2021.”
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