Doctor Emigration Research Articles

COVID-19 and doctor emigration: the case of Ireland

BackgroundSince the 2008 recession, Ireland has experienced large-scale doctor emigration. This paper seeks to ascertain whether (and how) the COVID-19 pandemic might disrupt or reinforce existing patterns of doctor emigration.MethodThis paper draws on qualitative interviews with 31 hospital doctors in Ireland, undertaken in June–July 2020. As the researchers were subject to a government mandated work-from-home order at that time, they utilised Twitter™ to contact potential respondents (snowball sampling); and conducted interviews via Zoom™ or telephone.FindingsTwo cohorts of doctors were identified; COVID Returners (N = 12) and COVID Would-be Emigrants (N = 19). COVID Returners are Irish-trained emigrant doctors who returned to Ireland in March 2020, just as global travel ground to a halt. They returned to be closer to home and in response to a pandemic-related recruitment call issued by the Irish government. COVID Would-be Emigrants are hospital doctors considering emigration. Some had experienced pandemic-related disruptions to their emigration plans as a result of travel restrictions and border closures. However, most of the drivers of emigration mentioned by respondents related to underlying problems in the Irish health system rather than to the pandemic, i.e. a culture of medical emigration, poor working conditions and the limited availability of posts in the Irish health system.Discussion/conclusionThis paper illustrates how the pandemic intensified and reinforced, rather than radically altered, the dynamics of doctor emigration from Ireland. Ireland must begin to prioritise doctor retention and return by developing a coherent policy response to the underlying drivers of doctor emigration.

How the organisation of medical work shapes the everyday work experiences underpinning doctor migration trends: The case of Irish-trained emigrant doctors in Australia

Medical migration is a global phenomenon. In Ireland, hospital doctor emigration has increased significantly in recent years, with Australia a destination of choice. With work and employment conditions cited as a driver of these trends, this article explores how health system differences in the organisation of medical work shape the everyday experiences of hospital doctors which underpin migration decisions. Drawing on 51 semi-structured interviews conducted in July-August 2018 with Irish-trained hospital doctors who had emigrated to work in Australia, the findings highlight doctors’ contrasting experiences of medical work in the Irish and Australian health systems. Key system differences in the organisation of medical work manifested at hospital level and related to medical hierarchy; staffing, support and supervision; and governance and task coordination. Findings indicate that retention of hospital doctors is as much about the quality of the work experience, as it is about the quantity and composition of the workforce. At a time of international competition for medical staff, effective policy for the retention of hospital doctors requires an understanding of the organisation of work within health systems. Crucially, this can create working contexts in which doctors flourish or from which they seek an escape.

Hospital doctors in Ireland and the struggle for work-life balance.

Ireland has a high rate of doctor emigration. Challenging working conditions and poor work–life balance, particularly in the hospital sector, are often cited as a driver. The aim of this study was to obtain insight into hospital doctors’ experiences of work and of work–life balance. In late 2019, a stratified random sample of hospital doctors participated in an anonymous online survey, distributed via the national Medical Register (overall response rate 20%; n = 1070). This article presents a qualitative analysis of free-text questions relating to working conditions (n = 469) and work–life balance (n = 314). Results show that respondent hospital doctors, at all levels of seniority, were struggling to achieve balance between work and life, with work–life imbalance and work overload being the key issues arising. Work–life imbalance has become normalized within Irish hospital medicine. Drawing on insights from respondent hospital doctors, this study reflects on the sustainability of this way of working for the individual doctors, the medical workforce and the Irish health system. If health workforce planning is about getting the right staff with the right skills in the right place at the right time to deliver care, work–life balance is about maintaining doctor wellbeing and encouraging their retention.

Hospital doctors and the struggle for work-life balance: the case of Ireland

Abstract Background Ireland has a high rate of doctor emigration. Difficult working conditions, particularly in the hospital sector, are often cited as a driver of doctor emigration. In October 2019, a random sample of Ireland's hospital doctors were invited to participate in an anonymous online survey about their working conditions. Methods The survey was distributed via the national Medical Register (with the assistance of the Medical Council of Ireland). Invitations were sent to 5356 hospital doctors, stratified by registration status (including interns, trainees, those not in training and consultants). An overall response rate of 20% was achieved (N = 1070). This paper focusses on responses to two free-text survey questions: (1) Do you have any other comments about your work-life balance? (N = 314). (2) Do you have any other comments on your working conditions as a hospital doctor? (N = 469). Results Respondent hospital doctors, at all levels of seniority, were struggling to achieve a balance between work and life. Of the free-text responses received, 8/10 were negative, with work-life balance/imbalance and work-overload being the issues arising most frequently. Respondents discussed how long and unpredictable working hours, combined with a high level of work intensity, meant that they often spent their personal time recovering from work. Conclusions Poor work-life balance has become normalised within Irish hospital medicine. The findings call to action to critically reflect on the sustainability of this way of working for the individual doctors, the wider workforce and the Irish health system.

Doctor Retention in Ireland - Where Are the Failings That Prolong the Problem? Comment on "Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle".

The issue of doctor retention has been a challenge in Ireland for many years. Poor working conditions including poor supervision, cost of training, bullying, worsening mentoring experiences and speciality specific issues are a substantial challenge faced by doctors in Ireland, thus leading to a higher degree of emigration. While some changes have been introduced to the system and have some positive effects, the root causes of doctor emigration have not been addressed. This commentary reviews the publication by Brugha et al published in the IJHPM in April 2020 on "Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle" and explains why the current system needs to change for the benefit of patient safety, doctor well-being and better patient care. Ireland’s Health Service Executive intends to take steps towards developing a new model of medical workforce to address the issue of recruitment and retention challenges within the healthcare system.

\u2018Everything was just getting worse and worse\u2019: deteriorating job quality as a driver of doctor emigration from Ireland

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.

The impacts of training pathways and experiences during intern year on doctor emigration from Ireland

BackgroundEmigration of domestically-trained health professionals is widespread, including in Ireland which has the highest rate of medical graduates in the OECD. Ireland’s failure to retain graduates necessitates high levels of international recruitment. This study aimed to identify factors associated with recently graduated doctors’ intention to migrate, focusing on their work experiences during the mandatory post-graduation year, their wellbeing, and their perceptions of postgraduate training in Ireland.MethodsA baseline survey was administered online to all final year students in Ireland’s six medical schools. A subsequent sweep surveyed those who consented to follow-up (n = 483) during the final month of first year of practice.ResultsOf the 232 respondents (48% response rate), 210 (94%) were Irish passport holders. Of these, only 36% intended to remain in Ireland after their internship, 57% intended to leave but return later, and 7% intended to leave permanently. A strong predictor of intention was study pathway: 60% of Graduate Entry Medicine (GEM) graduates and 25% of Direct Entry Medicine (DEM) graduates intended to remain in Ireland. Equal proportions intended to leave permanently (8% DEM, 6% GEM). Being a GEM graduate significantly reduced the likelihood of leaving to return (relative risk ratio (RRR) 0.20, 95% confidence interval (CI) (0.11–0.39), p < 0.001).When adjusted for study pathway, a negative experience as an intern increased the likelihood of leaving to return (RRR 1.16 CI (1.00–1.34), p = 0.043) and leaving permanently (1.54 (1.15–2.04), p = 0.003). Similarly, experience of callousness was associated with leaving to return (1.23 (1.03–1.46), p = 0.023) and leaving permanently (1.77 (1.24–2.53), p = 0.002), as was burnout with leaving permanently (1.57 (1.08–2.27), p = 0.017). Those planning to specialise in Medicine versus General Practice were more likely to leave and return (3.01 (1.09–8.34), p = 0.034). Those with negative perceptions of training in Ireland were more likely to leave and return (1.16 (1.01–1.34), p = 0.037); a positive perception reduced the likelihood of leaving permanently (0.50 (0.26–0.94), p = 0.032).ConclusionsIncreasing GEM training places might improve Ireland’s retention of domestically-trained doctors, reducing reliance on non-EU-trained doctors. However, improvements in the working experiences, perceptions of training, and protection of wellbeing are essential for retaining this highly sought-after and geographically mobile cohort.

Tracking the leavers: towards a better understanding of doctor migration from Ireland to Australia 2008\u20132018

BackgroundThe recession of 2008 triggered large-scale emigration from Ireland. Australia emerged as a popular destination for Irish emigrants and for Irish-trained doctors. This paper illustrates the impact that such an external shock can have on the medical workforce and demonstrates how cross-national data sharing can assist the source country to better understand doctor emigration trends.MethodThis study draws on Australian immigration, registration and census data to highlight doctor migration flows from Ireland to Australia, 2008–2018.FindingsGeneral population migration from Ireland to Australia increased following the 2008 recession, peaked between 2011 and 2013 before returning to pre-2008 levels by 2014, in line with the general economic recovery in Ireland. Doctor emigration from Ireland to Australia did not follow the same pattern, but rather increased in 2008 and increased year on year since 2014. In 2018, 326 Irish doctors obtained working visas for Australia. That doctor migration is out of sync with general economic conditions in Ireland and with wider migration patterns indicates that it is influenced by factors other than evolving economic conditions in Ireland, perhaps factors relating to the health system.DiscussionDoctor emigration from Ireland to Australia has not decreased in line with improved economic conditions in Ireland, indicating that other factors are driving and sustaining doctor emigration. This paper considers some of these factors. Largescale doctor emigration has significant implications for the Irish health system; representing a brain drain of talent, generating a need for replacement migration and a high dependence on internationally trained doctors. This paper illustrates how source countries, such as Ireland, can use destination country data to inform an evidence-based policy response to doctor emigration.

Yonder: Doctor emigration, vitiligo, canes, and self-harm pictures on Instagram.

Yonder: Doctor emigration, vitiligo, canes, and self-harm pictures on Instagram.

Factors influencing trainee doctor emigration in a high income country: a mixed methods study

BackgroundThe Global Code of Practice on the International Recruitment of Health Personnel focuses particularly on migration of doctors from low- and middle-income countries. Less is understood about migration from high-income countries. Recession has impacted several European countries in recent years, and in some cases emigration has reached unprecedented levels. This study measures and explores the predictors of trainee doctor emigration from Ireland.MethodsUsing a partially mixed sequential dominant (quantitative) study design, a nationally representative sample of 893 trainee doctors was invited to complete an online survey. Of the 523 who responded (58.6% response rate), 423 were still in Ireland and responded to questions on factors influencing intention to practice medicine abroad and are the subjects of this study. Explanatory factors for intention to practice medicine in Ireland in the foreseeable future, the primary outcome, included demographic variables and experiences of working within the Irish health system. Associations were examined using univariable and multivariable logistic regression to estimate odds ratios for factors influencing the primary outcome. Qualitative interviews were conducted with 50 trainee doctors and analysed thematically, exploring issues associated with intention to practice medicine abroad.ResultsThere were high levels of dissatisfaction among trainee doctors around working conditions, training and career progression opportunities in Ireland. However, most factors did not discriminate between intention to leave or stay. Factors that did predict intention to leave included dissatisfaction with one’s work-life balance (odds ratio (OR) 2.51; 95% confidence interval (CI) 1.53–4.10; P < 0.001); feeling that the quality of training in Ireland was poor (OR 1.82; 95% CI 1.09–3.05; P = 0.002) and leaving for family or personal reasons (OR 1.85; 95% CI 1.08–3.17; P = 0.027). Qualitative findings illustrated the stress of doing postgraduate training with inadequate supervision, lack of ring-fenced training time and pressures on personal and family life.ConclusionsLarge-scale dissatisfaction with working, training and career opportunities point to systemic factors that need to be addressed by health workforce planners if Ireland is to retain and benefit from a motivated medical workforce, given trainees’ perceptions that there are better opportunities abroad.

Can remittances compensate for manpower outflows: The case of Philippine physicians

This paper addresses questions about the desirability of skilled migration which generates remittance flows. Focusing on Filipino physicians, the paper explores under what conditions remittances from Filipino doctors practicing overseas might be sizeable enough to compensate the nation for the losses associated with doctor emigration. While data limitations and questions about the correct social welfare function preclude definitive empirical results, the analysis does indicate in the Philippine case that it may pay to train doctors for export.