Abstract
BackgroundThe failure of high-income countries, such as Ireland, to achieve a self-sufficient medical workforce has global implications, particularly for low-income, source countries. In the past decade, Ireland has doubled the number of doctors it trains annually, but because of its failure to retain doctors, it remains heavily reliant on internationally trained doctors to staff its health system. To halve its dependence on internationally trained doctors by 2030, in line with World Health Organisation (WHO) recommendations, Ireland must become more adept at retaining doctors.MethodThis paper presents findings from in-depth interviews conducted with 50 early career doctors between May and July 2015. The paper explores the generational component of Ireland’s failure to retain doctors and makes recommendations for retention policy and practice.ResultsInterviews revealed that a new generation of doctors differ from previous generations in several distinct ways. Their early experiences of training and practice have been in an over-stretched, under-staffed health system and this shapes their decision to remain in Ireland, or to leave. Perhaps as a result of the distinct challenges they have faced in an austerity-constrained health system and their awareness of the working conditions available globally, they challenge the traditional view of medicine as a vocation that should be prioritised before family and other commitments. A new generation of doctors have career options that are also strongly shaped by globalisation and by the opportunities presented by emigration.DiscussionUnderstanding the medical workforce from a generational perspective requires that the health system address the issues of concern to a new generation of doctors, in terms of working conditions and training structures and also in terms of their desire for a more acceptable balance between work and life. This will be an important step towards future-proofing the medical workforce and is essential to achieving medical workforce self-sufficiency.
Highlights
The failure of high-income countries, such as Ireland, to achieve a self-sufficient medical workforce has global implications, for low-income, source countries
Their early experiences of training and practice have been in an over-stretched, under-staffed health system and this shapes their decision to remain in Ireland, or to leave
There was remarkable consistency between those who intended to remain in Ireland and those who planned to leave, with almost all considering international experience to be beneficial to the medical career
Summary
The failure of high-income countries, such as Ireland, to achieve a self-sufficient medical workforce has global implications, for low-income, source countries. The failure of highincome countries to achieve a sustainable medical workforce inevitably leads to a reliance on internationally trained doctors, often from low-income countries already experiencing doctor shortages [2, 3]. As verification data is a measure of emigration intent rather than emigration [15, 16], the authors sought an alternative measure of doctor emigration via destination country immigration/registration data This analysis revealed that between 2008 and 2014, 3798 doctors migrated from Ireland to five key destination countries Australia, UK, Canada, New Zealand and the USA. This represents a significant outflow of doctors [14]
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