Addressing the needs of the ageing medical workforce 

From training to retirement, retention of our doctors must be a focus  

This summer I’m heading to my 30-year university reunion. We will meet and compare notes on who is still married, where our children are, who is retired, and who in our class are sadly no longer with us.

Our population, as well as our medical workforce, is ageing. The average age of GPs in Ireland is 60 years, with a similar age profile across a range of medical specialties. Medical Council 2023 workforce intelligence data shows that a substantial proportion of GPs in Ireland (32 per cent) are now close to retirement age at age 55 or older.

While the increased health and social care needs of people who are living longer are being discussed at every policy and service level, the fact that healthcare is being provided by an ageing medical workforce also needs to be addressed.

Even though increasing numbers of doctors are approaching retirement age, many doctors would like to continue working to some degree. As such, full-time demands combined with the need for a work-life balance mean we should be seeking ways to support these doctors to continue to be a key part of our health service.

I recall a consultant colleague aged in their 60s, who some years ago was on-call over a long weekend. On Tuesday morning they handed in their notice, having had little sleep for four days. This is a sad way to finish a career of lifelong service. Restructuring the duties of a healthcare professional to facilitate them to reduce their overall hours or change their out-of-hours commitment could be the difference between losing a valuable health professional with decades of experience and retaining that expertise for a further five to 10 years.

The ageing profile of the medical profession is also an issue throughout the EU, matching the same demographic change occurring in European populations. The World Health Organisation has estimated that the European health system has a deficit of 1.5 million healthcare professionals. This deficit is predicted to rise within five years, with 600,000 fewer doctors and 2.3 million fewer nurses, at a time when they are needed more than ever. Measures to address the Irish deficit have largely focused on increasing the number of university places to study medicine and nursing, as well as increasing postgraduate opportunities. These increases are welcomed and will assist in addressing our deficits in the longer term.

Outside of Europe, our system must also consider the lure of countries that recruit heavily from Ireland, principally Australia and Canada. Due to the long lead-in time for producing greater numbers of healthcare professionals and our ongoing export of these professionals, measures to improve retention are the wisest and most cost-effective course of action.

Retention measures should be grounded in the reasons why doctors stay or return to Ireland – based on my experience, retention in a region is based on family ties, and the quality-of-life offered there. Efforts to keep doctors and nurses can begin when they are students, with students being treated well when they are on clinical placements. If a student has a positive experience in a hospital, they are more likely to return there to train further and ultimately settle in the local area.

Of course, all healthcare professionals need a positive, supportive working environment. The detail of support lies in having safe staffing levels, rosters that are not unduly onerous, time off in which to truly switch off, leadership on toxic behaviours and career progression. People make quiet choices to leave when they are faced with a lack of support day in, day out. Over my career, I have worked in more than 15 different hospitals, and, as I rotated through various training jobs, I pictured myself long-term in most of them – in just a few I knew I would not choose to work there again.

Retaining staff is an investment in the service. Understanding the concerns of healthcare staff is key to maximising that investment. Most people who work in healthcare have families of their own. Work-life balance is the tension between time and energy spent at work and the time with family, friends, along with other interests. To retain staff, a focus on access to childcare, housing, and public transport makes sense as these are essential tools in making sure that staff of all ages get the most out of their time with their families. Working from home is rarely an option in healthcare.

There is much that can be done to help older doctors remain in the workforce, including reduced hours and administrative help. For doctors in training who emerge fresh-faced into medicine, investment in retention must be the priority. The demographic changes we face require a creative, hands-on approach, and can only be addressed by doctors, employers, policymakers, and other key stakeholders listening to each other and implementing solutions.

Dr Suzanne Crowe is a Consultant in Paediatric Intensive Care Medicine and President of the Medical Council