Brain Gain, Waste & Drain.
Non-EU Migrant Doctors in Ireland*
1
Humphries ,
2
Tyrrell ,
1
McAleese ,
2
Bidwell ,
Niamh
Ella
Sara
Posy
2
2
1
Steve Thomas , Charles Normand and Ruairí Brugha
1. Division of Population Health Sciences, RCSI, Ireland.
2. Centre for Health Policy and Management , Trinity College Dublin, Ireland
Doctor Migration & Irish Health System
Ireland has developed a reliance on migrant health workers to staff its health
system [1-5]. In 2008, it was reported that Ireland had the second highest
reliance on migrant doctors and the highest reliance on migrant nurses in the
Organisation for Economic Cooperation and Development (OECD) [6]. Other
OECD countries with a heavy reliance on migrant health workers include New
Zealand, the UK, the USA and Australia [6].
A Cycle of Brain Gain, Waste and Drain
Respondents described a cycle of brain gain, waste and drain for non-EU migrant
doctors in Ireland:
Two factors facilitated this migration of migrant health workers into Ireland:
1. The insufficient availability of locally trained health workers and
2. New immigration policies designed to facilitate the inward migration of health
workers.
Medical Workforce Challenges
Training Challenge
Traditionally, Ireland has trained too few doctors to meet demand and has relied
upon non-EU migrant doctors to meet the shortfall.
In 2007, Graduate Entry Programmes (GEP) were established in Ireland [7] to
increase the number of Irish/EU medical graduates from the baseline of 305 per
annum. By 2010/2011, there were 750 Irish/EU entrants to medical school (both
undergraduate and postgraduate) (HEA unpublished statistics). This scale up of
medical training means that the number of locally trained Irish/EU doctors will
soon meet the levels required to achieve national self sufficiency. This should
reduce Ireland’s reliance on non-EU migrant doctors to staff its medical
workforce.
Retention Challenge
However, increased numbers of locally trained Irish/EU doctors has not eased
the recruitment challenges facing the health system. This indicates an
underlying problem of retention and correlates with Buchan and Aiken’s
assertion that a shortage may not indicate a shortage of suitably skilled and
qualified people, but rather the unwillingness of those skilled individuals to work
under the available conditions [8].
‘Service Post’ Challenge
There are more NCHDs in Ireland than there are Consultant posts, meaning that
many NCHD posts do not offer a pathway to consultancy. Doctors occupying
unpopular ‘service posts’ have limited opportunities for career progression. In
2011, ‘service posts’ accounted for 1278 of the 4751 NCHD posts in the public
health system [9]. The latest available data (from 2007) indicate that non-Irish
doctors are more likely than Irish doctors to occupy these posts [10].
Brain Gain
Respondents felt that the demand for non-EU migrant doctors in Ireland was
driven by the need to fill vacant, ‘service posts’ within the Irish health system.
‘. . . We are getting them here just to cover the gap that we have from the
system . . . We are just bringing them to . . . give them the hard work’
(Doctor 18)
Brain Waste
Vacancies within the Irish health system tend to be at NCHD level, particularly
‘service posts’ unconnected to formal postgraduate training schemes. These posts,
which account for one in four NCHD posts [12] contain a disproportionate number of
non-EU migrant doctors [10] and offer limited opportunities for career progression.
‘Yes I had a great expectations, I thought . . . they will train me. Rather than
training me I have been losing my skills you know, so it was a really, really
upsetting’ (Doctor 3).
Brain Drain
Twenty-six of 37 respondent non-EU migrant doctors expressed intent to emigrate,
mostly because of stalled career progression and limited access to postgraduate
training. Respondents felt that they needed to move from Ireland in order to obtain
the training necessary to progress their careers.
‘I don’t think I have any career prospects, that is why we are planning to
move. . . I can work of course indefinitely, but just the conditions doesn’t
suit me anymore’ (Doctor 33).
Conclusions
Method & Contribution
Ethical approval for the study was obtained from TCD in 2011. In-depth
interviews were conducted with 37 non-EU migrant doctors in 2011/2. Doctors
from a range of non-EU countries were interviewed, largely reflecting the profile
of non-EU migrant doctors registered to practice in Ireland [11].
This research sought to deepen our understanding of non-EU migrant doctors
and their expectations and experiences of the Irish health system in order to
aid health workforce planning. Some of the issues faced by respondent non-EU
doctors are system-wide issues while others are specific to the non-EU migrant
doctor workforce.
* Poster Based on Article: Humphries, N. et al (2013) A Cycle of Brain Gain, Waste
and Drain – A Qualitative Study of Non-EU Migrant Doctors in Ireland. BMC Human
Resources for Health. 11:63.
A steady flow of non-EU migrant doctors into the Irish health system has ensured
that NCHD vacancies (particularly service posts) continue to be filled, while the
underlying reasons for those vacancies have not been addressed. The focus
needs to move away from facilitating inward migration towards policy which
improves the working conditions, training opportunities and career progression of
all NCHDs and which encourages their retention in the Irish health system.
Acknowledgments
The authors would like to thank the non-EU migrant doctors who participated in this research. They would also like to thank all of the
people and organisations who assisted the research team in contacting qualitative respondents. Thanks to the Higher Education
Authority and Medical Council of Ireland for providing statistics. Thanks to the HRB for funding the Doctor Migration Project (RCSI
&TCD) HRA_HSR/2010/18.
References
1. Humphries N, Brugha R, McGee H: Overseas nurse recruitment: Ireland as an illustration of the dynamic nature of nurse migration. Health Policy 2008, 87.
2. Humphries N, Brugha R, McGee H: 'I won't be staying here for long'. A qualitative study on the retention of migrant nurses in Ireland. BMC HRH 2009, 7:68.
3. Humphries N, Brugha R, McGee H: Sending money home: a mixed methods study of remittances sent by migrant nurses in Ireland. BMC HRH 2009, 7:66.
4. Humphries N, Brugha R, McGee H: Nurse migration and health workforce planning: Ireland as illustrative of international challenges. Health Policy 2012, 107.
5. Bidwell P, et al: The national and international implications of a decade of doctor migration in the Irish context. Health Policy 2013, 110:29–38.
6. OECD: International Migration of Health Workers. Improving International Cooperation to Address the Global Health Workforce Crisis. Paris: OECD; 2010.
7. Finucane P, et al: Graduate medical education in Ireland: a profile of the first cohort of students. Irish Journal Medical Science 2008, 177:19–22.
8. Buchan J, Aiken L: Solving nursing shortages: a common priority. Journal Clinical Nursing 2008, 17:3262–3268.
9. HSE MET: Annual Assessment of NCHD Posts July 2011 to June 2012. Dublin: Medical and Training Unit, Health Services Executive; 2011.
10. Royal College of Physicians: National Audit of SHO and Registrar Posts. Report of the Audit Steering Group. Dublin: Royal College of Physicians; 2007
11. Medical Council: Medical Workforce Intelligence Report. A Report on the Annual Registration Retention Survey 2012. Dublin: Medical Council; 2013.
12. HSE MET: Implementation of the Reform of the Intern Year. Second Interim Report. Dublin: HSE MET; 2012.
Doctor Migration Project (RCSI & TCD) is funded by the HRB HRA_HSR/2010/18