Poor conditions ‘still driving doctors from Ireland’ – RCSI research

Conducted by RCSI’s Health Workforce Research Group, the research reveals that over 30 per cent of trainee doctors report improvements in supervision of their training and better mentoring supports. However, one-in-five trainees say that supervision and mentoring are worse and there has been little improvement in designated training time. Moreover, over half report that the financial costs for them in undertaking training courses, much of which are mandatory, are increasing.

The new research confirms earlier findings, showing that poor working conditions persist, with trainees continuing to be required to complete ‘non-core tasks’ that divert them from patient-care and training.

Furthermore, over 50 per cent of trainee doctors report that staffing levels and work-related stress had become worse or much worse. Worryingly, this latest study confirms earlier research that poor training and working conditions continue to be associated with an intention to go abroad and not return. The ‘level of stress in my workplace’ is worse or much worse, according to 65 per cent of those who plan to leave Ireland for good, compared with 43 per cent of those who plan to make their long-term careers in Ireland.

According to Prof Ruairi Brugha, Head of the Department of Epidemiology and Public Health Medicine at RCSI, who has led the Research Group for the last six years: “The research has some good news about doctor emigration. Only 14 per cent of trainees said that they planned to go abroad and not return; 42 per cent said they planned to go abroad and then return to practice medicine in Ireland, 41 per cent planned to remain here; and 3 per cent planned to leave medicine”.

He continued: “This new finding that 83 per cent of Irish trainees wish to ultimately make their careers in Ireland is positive. However, once doctors leave to work abroad, they often establish roots and the window of opportunity for getting them back closes over time. In two of our earlier studies, Irish doctors working abroad reported that training, working and career opportunities are usually better in the countries to which our doctors go; and that Irish trained doctors are highly sought after in these countries.”

Prof Brugha said that implementation of the 2014 Strategic Review of Medical Training and Career Structure recommendations has produced some important wins. The six monthly progress reports, produced by the Department of Health, show that an effective NCHD Lead initiative is in place, including a full-time National Lead and a Lead NCHD in each hospital. Other achievements include flexible and predictable training schemes, reduced paperwork when NCHDs rotate to a new hospital; and better career planning information.

However, these new findings show that progress in addressing some of the critical training and working conditions factors is at a standstill, or is getting worse. Underlying them is the lack of consultants to deliver training and to take a greater share of routine service work in hospitals, so as to allow NCHDs do the training they need to become specialists.

Prof Brugha said “other research has shown that stress and burnout are a reality for consultants as well as NCHDs, and some of the NCHDs in our research reported that the life of a consultant in Ireland was a disincentive to them considering making a permanent career here.

”Over the years, our work has shown that many of our doctors are leaving because of the lack of acceptable working conditions and training opportunities; but also, as recent specialty workforce reviews produced by the HSE help to confirm, because the permanent posts for which we train them are not there. Addressing the root causes, including establishing more consultant posts to implement the policy of a consultant-delivered health service, will ultimately come down to political commitment.”

The report summarises six years of medical workforce research from RCSI, supplemented by routine data from the HSE’s National Doctor Training and Planning (NDTP) unit and the Medical Council. Most of the findings in this report, covering 2013-18, were presented by RCSI researchers to a meeting of national medical workforce stakeholders in November 2017. Those who attended included senior representatives from the Department of Health, the HSE, national training bodies and NCHDs.