Delving into Irish medical workforce data

The findings of the Medical Workforce Intelligence Report 2024 were presented at a recent Medical Council seminar. Catherine Reilly reports

Last year, just over half of NCHDs were employed in non-training posts, according to the Medical Workforce Intelligence Report 2024. This cohort also grew at a significantly higher rate than NCHDs in training.

The Medical Council’s annual workforce report contains data on the clinically active medical workforce in Ireland. It is based on information provided during the annual retention process. In tandem with the 2024 workforce report, the Council has published new data on doctors who left and joined the medical register last year. The findings were presented at a Medical Council seminar on 29 July.

NCHDs

The continuing rise in non-training scheme doctors (NTSDs) was a notable finding in the workforce report. It found just over half of the total 8,952 NCHDs were not in formal training posts.

Moreover, NTSDs grew at a substantially higher rate than trainees (12.6 per cent vs 4.6 per cent). Most NTSDs graduated outside of Ireland, the EU, and UK, while most trainees graduated in Ireland, according to the report.

Dr Bernadette Rock (PhD), the Council’s Head of Research and Regulatory Data Insights, referenced the general lack of clear career pathways and supervision for NTSDs.

The Council will be conducting an analysis of the general division of the register – where NTSDs are registered. The aim is to gain an enhanced understanding of doctors’ career plans and expectations and how they can be better supported, according to Dr Rock.

During her presentation, Dr Rock also noted that lack of access to specialist training and career progression, racism, and bullying, were among the issues being raised by international medical graduates who voluntarily left the medical register.

Working hours

In 2024, some 23.1 per cent of doctors self-reported working over 48 hours on average per week, which is a contravention of the European Working Time Directive. However, this figure had decreased from 28.6 per cent in 2022.

Doctors in surgery (50.9 per cent) and obstetrics and gynaecology (34.9 per cent) were the most likely to report working such hours. These working hours were especially evident in cardiothoracic surgery (58.3 per cent) and neurosurgery (57.6 per cent).

Overall, 37.1 per cent of all trainees reported working more than 48 hours on average per week. This compared with 22.5 per cent of doctors with general registration and 18.3 per cent of doctors with specialist registration.

A new question on hours spent working in direct patient care was included in the 2024 dataset. Some 10.7 per cent of doctors reported spending more than 48 hours per week delivering direct patient care.

“The majority of those doctors are on the general division and the trainee specialist division,” outlined Dr Rock. “For us, that highlights a challenge, because many of those doctors have limited training, limited supervision, and their pathways are quite precarious. So it is a concern to see they are spending that number of hours in direct care.” She said it is known that excessive working hours are linked with attrition, stress, burnout, and adverse event involvement.

A new question was also included on how frequently doctors found it difficult to provide a patient with the sufficient level of care required (over the previous 12 months).

Some 26.1 per cent reported experiencing this difficulty at least once a week or more frequently. However, 33.6 per cent reported never experiencing this difficulty – a finding the Council will be further analysing. ‘Pressure on workloads’ was the main reported barrier to providing a sufficient level of care.

GPs

Some 4,764 doctors reported that they worked in general practice and that their role was a GP. The mean age of GPs was 49.2 years and 31.1 per cent were aged 55 years or older. There were slightly more females (52.4 per cent). Most GPs were registered in the specialist division; however, one in five had general registration.

Dr Rachael Kelly (PhD), the Council’s Research and Regulatory Data Insights Manager, said most GPs worked as a principal or partner in a GP practice – with a relatively even gender breakdown among this cohort. However, most out-of-hours, locum and single-handed GPs, were male. In contrast, most GP assistants and sessional GPs were female. Dr Kelly noted the importance of this type of analysis, especially as the proportion of female GPs is set to increase.

Just over one in 10 GPs reported working over 48 hours on an average week and over half of this cohort spent 40 hours or less in direct patient care. This suggested that these doctors could be spending at least eight hours per week on administrative work or other non-core tasks, according to the report. This aligned with research demonstrating that a significant proportion of GP workload comprised of clinical paperwork, administrative work, and other work types.

“There is therefore a significant workload burden outside of the direct patient consultation that can impact GP retention and patient safety,” stated the report.

In her concluding remarks, Dr Rock noted the importance of retention, improved working conditions, and better access to flexible working and training options.

She also said the Council will include new questions relating to disability, ethnicity, and regional health areas in the 2026 workforce survey.

CEO

Council CEO Dr Maria O’Kane told the Medical Independent the regulator will raise findings on working hours during its training site inspections. It will also seek the views of trainees on working hours and conditions.

“Certainly, we will be highlighting it as part of the accreditation visit, and encouraging the organisations to take this seriously, but certainly from our point of view, I know they do take it seriously.”

Dr O’Kane, who took up her post in June, referenced wider system and workforce pressures. However, she said there must be a continued focus on improving the working lives of trainees.

She also confirmed the Council wanted to better understand the working experiences of NTSDs – and the factors contributing to a positive experience. The Council intends to develop case studies of best practice, which other settings could replicate, she said.