It is hard to believe that the Irish health system still hasn’t got a handle on why so many Irish trained doctors emigrate.

There is a presumption that they leave Ireland to escape a hugely stressed health system and in search of good working conditions and a better work-life balance in other countries. Doctor migration can be hugely beneficial for the individual, and can potentially benefit countries like Ireland. But the sheer scale of doctor emigration in recent years is problematic, and shows no sign of abating.

In the past year, more than 300 Irish doctors have obtained working visas for Australia. Doctor emigration on this scale is unsustainable and demands an urgent policy response. This response must be informed by a clear and up-to-date understanding of why doctors emigrate, and of the change necessary to encourage these talented doctors to remain in (and/or return to) the Irish health system.

As part of a four-year research project for the Royal College of Physicians, I will be in Australia in July and August 2018 to explore this issue further. I am seeking to interview Irish doctors working across Australia whose experiences can help to inform recommendations to improve the Irish health system as a workplace for hospital doctors.

It’s been a difficult decade for the Irish health system. Reduced health budgets and staffing levels, along with contract changes, have contributed to the further deterioration of already difficult working conditions. These factors continue to drive doctor emigration.

My research has shown that the rate of doctor emigration increased between 2008 and 2014. In 2008, 446 doctors migrated from Ireland to the UK, US, Canada, New Zealand and Australia. In 2014, 627 doctors made the same journey.

Since 2008, Australia has emerged as a key destination for emigrant Irish-trained doctors and is the backdrop to many successful medical migration stories. Data from Australia reveals there were 1,063 Irish-trained doctors registered in Australia in 2015/6; that 290 Irish-trained doctors obtained Australian working visas in 2015, including both specialists and non-specialist Irish-trained doctors.

Retention

Despite a decade of doctor emigration from Ireland, the Irish health system still does not record the departure of doctors from Ireland. There is no information generated on how many Irish trained doctors have emigrated so far this year; whether they were recent graduates, GPs or consultants. The system doesn’t know what countries these doctors move to, or how many of those who have left Ireland since 2008 have subsequently returned.

Lacking basic information on doctor emigration makes it difficult (if not impossible) to improve doctor retention, or to respond in a timely manner to changes in migration flows. Yet, timely responses to changing patterns of doctor migration, particularly between the UK and Ireland, will be critical following Brexit. Basic data on doctor emigration, combined with research, can enable an informed debate on, and a timely response to, the changing dynamics of doctor migration.

To meet future demands for healthcare (as projected recently by the ESRI), the Irish health system of 2030 will need to have the right doctors with the right skills in the right place at the right time.

Ensuring that the Irish health system of tomorrow is adequately staffed requires a robust policy response to doctor emigration today. This policy response must address the underlying working conditions which continue to drive doctor emigration and hinder return migration.

That any Irish-trained doctor feels compelled to travel 17,000km to achieve good working conditions and time for a personal life is not good news for the Irish health system.

What is good news, however, is that these issues are fixable by the Irish health system. Emigrant doctors have plenty to teach Irish policy makers in this regard - about their experience of working in and leaving the Irish health system and the comparative experience of working as a doctor in Australia.

Eager to help

While emigrant doctors no longer work in Ireland, my research has shown they remain eager to improve the Irish health system. With colleagues and friends working within it and family members dependent on it for their healthcare, emigrant doctors continue to have an interest in improving and strengthening the Irish health system.

Irish trained emigrant doctors should be considered important stakeholders in the Irish health system. Some will wish to return to work in the Irish health system and it’s vital that policy makers ensure these return journeys are encouraged and facilitated. Others will opt to stay abroad, but remain a potentially powerful force for change in the Irish health system, particularly in relation to doctor retention, emigration and return.

I am looking forward to meeting Irish doctors in Australia over the coming months to talk to them about their experiences of migration, of working in the Australian health system and their thoughts on potentially returning to work in Ireland. I will use this information to inform the wider research project on retention and motivation in the Irish health system, and to inform policy discussions on these topics in the Irish context.

If you are an Irish trained hospital doctor in Australia and would like to take part in an interview, or find out more about the project, please get in touch via niamhhumphries@rcpi.ie or @humphries_niamh on Twitter.

Dr Niamh Humphries is a reader in health systems research at the Royal College of Physicians in Ireland and holds a HRB Emerging Investigator Award.