Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Poor working conditions, training and career opportunities still driving doctors from Ireland

22 May 2018

A new report from RCSI concludes that some of the measures introduced in early 2015 to retain Ireland’s non-consultant hospital doctor (NCHD) trainees are now having a positive effect. However, important root causes of why many of our young doctors emigrate are still not being addressed.

The report includes preliminary findings on training and working conditions from a 2018 survey of over 1,500 NCHDs.

Conducted by RCSI’s Health Workforce Research Group, the research reveals that over 30% of trainee doctors report improvements in supervision of their training and better mentoring supports. However, one in five trainees say that supervision and mentoring are worse and there has been little improvement in designated training time. Moreover, over half report that the financial costs for them in undertaking training courses, much of which are mandatory, are increasing.

The new research confirms earlier findings, showing that poor working conditions persist, with trainees continuing to be required to complete 'non-core tasks' that divert them from patient-care and training, which is a poor use of this precious and expensive resource. Furthermore, over 50% of trainee doctors report that staffing levels and work-related stress had become worse or much worse. Worryingly, this latest study confirms earlier research that poor training and working conditions continue to be associated with an intention to go abroad and not return. The ‘level of stress in my workplace’ is worse or much worse, according to 65% of those who plan to leave Ireland for good, compared with 43% of those who plan to make their long-term careers in Ireland.

According to Professor Ruairi Brugha, Head of the Department of Epidemiology and Public Health Medicine at RCSI, who has led the Research Group for the last six years, “the research has some good news about doctor emigration. Only 14% of trainees said that they planned to go abroad and not return; 42% said they planned to go abroad and then return to practice medicine in Ireland, 41% planned to remain here; and 3% planned to leave medicine”.

“This new finding that 83% of Irish trainees wish to ultimately make their careers in Ireland is positive. However, once doctors leave to work abroad, they often establish roots and the window of opportunity for getting them back closes over time. In two of our earlier studies, Irish doctors working abroad reported that training, working and career opportunities are usually better in the countries to which our doctors go; and that Irish trained doctors are highly sought after in these countries,” added Prof. Brugha.

Prof. Brugha said that implementation of the 2014 Strategic Review of Medical Training and Career Structure recommendations has produced some important wins. The six monthly progress reports, produced by the Department of Health, show that an effective NCHD Lead initiative is in place, including a full-time National Lead and a lead NCHD in each hospital, which give NCHDs a real voice. Other achievements include flexible and predictable training schemes, reduced paperwork when NCHDs rotate to a new hospital; and better career planning information.

However, these new findings show that progress in addressing some of the critical training and working conditions factors is at a standstill, or is getting worse. Underlying them is the lack of consultants to deliver training and to take a greater share of routine service work in hospitals, so as to allow NCHDs do the training they need to become specialists.

Prof. Brugha added that “other research has shown that stress and burnout are a reality for consultants as well as NCHDs, and some of the NCHDs in our research reported that the life of a consultant in Ireland was a disincentive to them considering making a permanent career here”.

”Over the years, our work has shown that many of our doctors are leaving because of the lack of acceptable working conditions and training opportunities; but also, as recent specialty workforce reviews produced by the HSE help to confirm, because the permanent posts for which we train them are not there. Addressing the root causes, including establishing more consultant posts to implement the policy of a consultant-delivered health service, will ultimately come down to political commitment,” added Prof. Brugha.

The report summarises six years of medical workforce research from RCSI, supplemented by routine data from the HSE’s National Doctor Training and Planning Unit and the Medical Council. Most of the findings in this report, covering 2013-18, were presented by RCSI researchers to a meeting of national medical workforce stakeholders in November 2017. Those who attended included senior representatives from the Department of Health, the HSE, national training bodies and NCHDs.

The discussion threw new light on Ireland’s medical workforce crisis. The meeting concluded that one important root cause of the poor training, working conditions and career opportunities experienced by NCHDs is the shortage of consultants in hospitals. Ireland compares poorly in terms of numbers of consultants per head of population with countries to which our doctors emigrate, namely the UK and Australia.

RCSI is ranked among the top 250 (top 2%) of universities worldwide in the Times Higher Education World University Rankings (2018) and its research is ranked first in Ireland for citations. It is an international not-for-profit health sciences institution, with its headquarters in Dublin, focused on education and research to drive improvements in human health worldwide. RCSI is a signatory of the Athena SWAN Charter