We must do more to retain our healthcare staff

It is time for greater ambition in medical workforce design

The news that almost 7,000 healthcare staff moved to Australia in 2025 surprised no one working in academic programmes or hospitals. Large numbers have been choosing to work abroad since well before the pandemic.

Working conditions are often cited as the main driver. Research by Dr Niamh Humphries at the RCSI has given weight to what many suspected: Graduates are deeply dissatisfied with work/life balance in Ireland and the incompatibility of training with family life. But the story is broader than working conditions alone.

In 2024, the NCHD taskforce published recommendations to improve conditions. Progress has been slow. Junior staff still report used bed linen in cold bedrooms and no access to hot food overnight. Emergency tax errors, incorrect salary scales, delayed overtime payments, and lack of protected administrative or training time all persist, albeit less frequently. Trust in the system’s commitment to reform remains low. Reversing the narrative for today’s students will require faster and sustained change.

To outsiders, the absence of hot food may seem trivial. It is not. Basic facilities signal whether staff are valued. Companies such as Google understand this well.

Culture, of course, goes beyond food. It means listening to concerns about safe staffing levels and skill mix. It requires meaningful engagement with patients, families, and staff, and a willingness to address problems promptly. Above all, a positive culture attributes value –  not blame – to individuals.

Irish healthcare staffing has changed significantly over the past 30 years. Numbers have expanded, but largely in a reactive rather than strategic way. The growth of clinical nurse specialists, advanced nurse practitioners, and physician associates has been welcome. Medicine, by contrast, has seen little comparable role development. Graduate-entry medicine (GEM) and limited less-than-full-time training posts remain the principal innovations.

At the same time, evolving roles across nursing and allied health have coincided with fewer junior medical posts. Senior house officer (SHO) jobs have contracted even as medical school and intern places have increased. Newly graduated doctors – and those who relocate to Ireland early in their careers – are increasingly struggling to secure their first posts. One intern who contacted me was not even shortlisted for a SHO role in their own hospital. Weak early career prospects are further fuelling the move to Australia.

Training structures have also been slow to adjust to the reality of older GEM graduates, many of whom have dependants and significant debt. Other countries offering paired residencies for couples, competitive salaries, and subsidised childcare and accommodation are understandably attractive to graduates of all ages.

Meanwhile, the taxpayer is increasingly looking for value. Research from the HSE National Doctors Training and Planning division in 2023 suggests that 30 per cent of graduates who leave for Australia have not returned after five years. Losing one-third of graduates annually – after an expensive degree – inevitably raises questions for the Exchequer. Their departure has also fuelled a boom in international healthcare recruitment.

Ireland cannot replicate Australia’s climate or outdoor lifestyle. But decisive cultural change, backed by coherent strategy, could stem the flow. Respect and value must be visible in the basics: Proper induction, correct pay, and facilities that meet fundamental human needs. Patient care must remain the shared purpose guiding improvement, risk management, and escalation.

It is time for greater ambition in medical workforce design. Wider career pathways, recognition of prior learning, accommodation of caring responsibilities, and genuine flexible working are essential to retaining staff. The traditional linear route from student to GP or consultant is no longer sufficient for today’s workforce.

A renewed culture and innovative training model must sit within a properly funded, regionally mapped workforce plan. The Department of Health has set out its 15-year vision in Ireland’s Future Health and Social Care Workforce. The detailed implementation plan is still awaited.

Given the scale of graduate loss, it must deliver far more than simply increasing training places.