The hidden toll of our medical training schemes

The reality is that the current structure poses an unacceptable risk – not only to doctors, but also to our patients

Ireland’s medical training schemes are often praised as a cornerstone of professional development for doctors, ensuring that trainees gain a wide breadth of experience across specialties and locations. But behind the scenes, this system places a punishing burden on the very people it seeks to develop – particularly those with families, partners also in training, or those coming from abroad without local support networks.

For many, the schemes are far from family friendly. Instead, they demand personal sacrifices that threaten mental health, family life, and even patient safety.

One of the most disruptive aspects of training schemes are their insistence on frequent relocation. Every six months, doctors are expected to move to a new hospital – often in a different county. On paper, this seems like a way to broaden experience. In practice, it creates chaos. For doctors with children, securing consistent schooling and childcare becomes an almost impossible challenge. Families are uprooted repeatedly. Partners are sometimes forced to live apart for months at a time, and children are left without a stable home or educational environment, compounding stress on the entire household.

This instability seeps into every part of trainees’ lives. Many find themselves maintaining a mortgage or long-term lease in one city while simultaneously renting short-term accommodation elsewhere to meet the demands of training rotations. This dual burden can drain already modest salaries, forcing some into debt just to comply with the programme. The emotional strain of living apart from family, often in unfamiliar areas, only compounds the financial hardship. Some doctors report feeling isolated, lonely, and increasingly disconnected from loved ones.

Then there is the relentless workload. Trainees are expected to work long hours, often including exhausting 24-hour on-call shifts. But the challenges don’t end when the shift does – because of the dispersed placements, many doctors must drive long distances before or after these marathon shifts. This is not just exhausting – it is dangerous.

I can speak to this from personal experience. About a year and a half ago, after one such shift, while driving home, I experienced a terrifying moment: A microsleep episode behind the wheel. I woke up just in time to swerve back onto the road, narrowly avoiding a serious accident. A car behind me blared its horn. Luckily, no one was in front of me – but it could easily have ended differently.

This experience is not unique. Many trainees quietly accept these conditions as “part of the job”. But the reality is that the current structure poses an unacceptable risk – not only to doctors’ own safety and mental health, but also to the quality of care they can provide. Exhausted, overworked doctors are more likely to make mistakes and burnout is rampant. Long-term, this puts patients at risk and undermines trust in the healthcare system.

It is time to acknowledge the hidden toll of our training schemes and to call for urgent reform. The current model was designed at a time when the demographics and expectations of the medical workforce were very different. Today’s doctors are more diverse, more likely to have caring responsibilities, and more aware of the need for work-life balance – not just for their own wellbeing, but because good mental health and rest are essential to providing safe, effective care.

In recent years, some training bodies have been making efforts to introduce more regionalised training. By allowing trainees to stay within a defined region for the duration of their training, the HSE and training bodies could reduce the financial and emotional burden of frequent moves. Doctors could maintain stable homes, partners could plan careers without being constantly uprooted, and children could remain in the same schools. In turn, doctors would be better rested, more focused, and less likely to suffer burnout – and patients would benefit from safer, higher-quality care.

A more stable, regionally based placement model is not only feasible, but long overdue. If we continue to ignore these issues, we risk driving talented young doctors away from the profession, or out of the country entirely, at a time when our health system cannot afford such losses. Reforming the training scheme structure is not just an act of fairness – it is an investment in our doctors, our patients, and the future of our healthcare system.