Abstract
BackgroundMedicine is a high-status, high-skill occupation which has traditionally provided access to good quality jobs and relatively high salaries. In Ireland, historic underfunding combined with austerity-related cutbacks has negatively impacted job quality to the extent that hospital medical jobs have begun to resemble extreme jobs. Extreme jobs combine components of a good quality job—high pay, high job control, challenging demands, with those of a low-quality job—long working hours, heavy workloads. Deteriorating job quality and the normalisation of extreme working is driving doctor emigration from Ireland and deterring return.MethodsSemi-structured qualitative interviews were conducted with 40 Irish emigrant doctors in Australia who had emigrated from Ireland since 2008. Interviews were held in July–August 2018.ResultsRespondents reflected on their experiences of working in the Irish health system, describing hospital workplaces that were understaffed, overstretched and within which extreme working had become normalised, particularly in relation to long working hours, fast working pace, doing more with less and fighting a climate of negativity. Drawing on Hirschman’s work on exit, voice and loyalty (1970), the authors consider doctor emigration as exit and present respondent experiences of voice prior to emigration. Only 14/40 respondent emigrant doctors intend to return to work in Ireland.DiscussionThe deterioration in medical job quality and the normalisation of extreme working is a key driver of doctor emigration from Ireland, and deterring return. Irish trained hospital doctors emigrate to access good quality jobs in Australia and are increasingly likely to remain abroad once they have secured them. To improve doctor retention, health systems and employers must mitigate a gainst the emergence of extreme work in healthcare. Employee voice (about working conditions, about patient safety, etc.) should be encouraged and used to inform health system improvement and to mitigate exit.
Highlights
Medicine is a high-status, high-skill occupation which has traditionally provided access to good quality jobs and relatively high salaries
Drawing on 40 interviews with emigrant Irish doctors who moved to Australia since 2008, this paper considers how deteriorating job quality and the normalisation of extreme working drive emigration—conceptualised as exit
Only 14/40 respondents intended to return to work in the Irish health system, which indicates a break with the traditional return migration pathways of an earlier generation of doctors and which echoes the findings of a 2014 survey which found that only one in four emigrant doctors surveyed intend to return to work in Ireland [51]
Summary
Medicine is a high-status, high-skill occupation which has traditionally provided access to good quality jobs and relatively high salaries. The 2008 global economic recession and resultant austerity measures—including widespread pay cuts, recruitment embargoes, staff reductions and increased workloads [7]—led to high rates of emigration and intent to migrate among doctors in higher income countries across the European Union (EU), including Ireland [8,9,10], Hungary [11], Romania [12] and Portugal [13]. Medicine is a high-status, high-skill occupation which has traditionally provided access to good quality jobs and relatively high salaries, continuing to provide such benefits in the context of an economic recession and period of austerity is a challenge. Health systems and health employers must adapt to today’s expectations of what constitutes a good quality medical job [14], and do so within funding constraints, either austerity-related and/or, as in Ireland, those resulting from ‘historic long-term underfunding’ [15]
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