‘Significant headwinds’ in doctor recruitment and retention

Two new reports describe the growth in the numbers of consultants and trainees, but also warn of challenges ahead, writes David Lynch

A cross a combined 168 pages of detailed statistics and data analysis, two new reports from HSE National Doctors Training and Planning (NDTP) outline the state of doctor recruitment and retention in Ireland.

While the Medical Workforce Analysis Report 2024-2025 and Medical Recruitment and Retention Report 2024 are densely packed with facts and figures, some trends are clearly discernible.

Most significantly, workforce numbers are rising.

In his introduction to the analysis report, NDTP Medical Director Prof Anthony O’Regan writes that the number of consultants employed by the HSE has “increased dramatically” since 2018 – from 3,089 to 4,620 in 2024.

The number of consultants per 100,000 also increased from 63.8 to 86.3 over the same period. While this expansion is to be welcomed, Prof O’Regan cautioned that the figures remain below comparable countries.

The data also finds the number of doctors in postgraduate medical training has continued its recent rise. In 2024, the figure was 5,681, up from 5,435 in 2023.

There have also been “substantial improvements” in the retention of doctors post-certificate of satisfactory completion of specialist training (CSCST).

Of the doctors who completed higher specialist training (HST) in 2019, some 78 per cent were working in Ireland in either a public or private post in 2023. This figure rose to 82 per cent in 2024,

However, despite some encouraging data, Prof O’Regan has also raised concerns.

Prof O’Regan, Consultant in Respiratory and Internal Medicine at University Hospital Galway, warned of “significant headwinds to recruitment and retention”. These included the recent fall-off in the number of new consultant posts approved by the consultant applications advisory committee (CAAC).

This decline will likely “impact” the retention of HST specialist trainees “in the short- and medium-term”. In addition, the barriers to attracting doctors to work in model 3 hospitals may also result in “reduced retention rates”.

While consultant numbers are rising, there is still considerable workforce demand in the system, according to Mr Tom Pierse, Medical Workforce Analytics Lead, NDTP.

Mr Pierse was speaking at an NDTP webinar last month. He pointed to recently published NDTP specialty specific reviews, which focused on surgery, emergency medicine, and the dual-training specialty of medicine and clinical genetics. 

“These reports are saying that there are still substantial demands at a specialty level,” Mr Pierse told attendees.

“When you add those together, there is going to be a need for much more growth in the consultant workforce, both at an absolute value and per capita level.”

A “key challenge” for the health service is creating “a long-term plan” to grow consultant staffing, along with the broader health workforce that needs to expand in parallel.

Ms Aimée Maguire, Data Analyst, HSE Medical Workforce Planning, showed how between 2018 and 2024 there was a significant growth in consultant numbers. She noted “substantial increases” in the number of new posts approved by the CAAC between 2021 and 2023.

“These increases were seen as… a positive step in being able to expand the consultant workforce,” she told the webinar. 

However, as reported in the Medical Independent (MI) in April, there was a 36 per cent fall in the number of consultant posts processed by the HSE last year, according to the CAAC Annual Report 2024. The HSE’s consultant division processed 347 applications in 2024, which represented a reduction of 194 applications compared to 2023.

Ms Maguire pointed out the amount of consultant posts processed fell to “pre-2021 numbers”.

“So, I suppose, it will be important to monitor how this will affect the consultant workforce growth in the future and how it will affect the retention of consultants and post-CSCTs in the future as well.”

HDRM project

While workforce and training numbers rise, representative bodies and academic researchers continue to shine a light on recruitment and retention difficulties.

The hospital doctor retention and motivation (HDRM) project, which published considerable data in recent years, came to an end in December 2024.

Dr Niamh Humphries (PhD), who worked on the project, noted that when the HDRM began in 2017/2018, 300 Irish doctors obtained Australian work visas. In comparison, 624 Irish doctors had obtained Australian work visas in 2023/2024.

“I would say there’s still work to be done to better understand emigration, its impact on the Irish health system and how to retain doctors and reduce that level of turnover,” said Dr Humphries, Senior Lecturer, RCSI Graduate School of Healthcare Management. 

Ireland will find it “difficult, if not impossible” to achieve a self-sufficient medical workforce if it continues to lose so many doctors to emigration. Dr Humphries defined a self-sufficient workforce as one where enough doctors are trained and retained to deliver healthcare to an ageing population.

She said the HDRM project generated “huge insights” into how hospital doctors feel about work and how their conditions could be improved. The research found that Ireland’s hospital doctors endure difficult working conditions, long working hours, and a heavy workload. Doctors described working in an overstretched, understaffed health system leading to stress, exhaustion, and burnout among staff members. 

Dr Humphries believes the HDRM succeeded in voicing the concerns of the medical workforce and generating debate on these issues.

“In terms of the policy response, I’m not sure that the health system has been as responsive as it needs to be,” she told MI. “I think that improved working conditions for hospital doctors are the key to improving doctor retention and doctor wellbeing and it would be good to see a greater policy focus on these important topics.”

IHCA

In response to the two new NDTP reports, the IHCA has also raised concerns over the “considerable drop” in the new and replacement consultant posts approved by the CAAC.

The Association warned that this “dramatic fall” is likely to deepen in 2025, potentially undermining both the retention of qualified specialists and efforts to expand the workforce in line with rising demand.

IHCA President Prof Gabrielle Colleran welcomed the appointment of additional consultants in recent years. However, she said Ireland was “still has the lowest number of medical specialists per 1,000 population in the EU, approximately one-third below the European average”.

“Addressing this specialist workforce deficit, in parallel with rapidly increasing the number of hospital beds, theatres, diagnostic and other facilities, will start the health service on its journey towards a better and more productive future.”

The recruitment difficulties for the model 3 hospital sector have been a particular focus for NDTP. These were highlighted in the Model 3 Hospitals Report published in late 2023.

However, speaking at the recent webinar, Ms Maguire outlined that model 3 hospitals witnessed an 11 per cent growth in the number of consultants in 2024, compared to an 8 per cent growth in model 4 hospitals. In absolute terms, more consultants were added to model 4 hospitals (172) than to model 3 hospitals (104).

Ms Maguire said the model 3 increase “suggests a large recruitment drive”. However, she added that a recent NDTP survey showed that NCHDs were less likely to take up posts at such hospitals.

In the new workforce analysis report, Prof O’Regan writes that notwithstanding the “substantial increases” in the consultant workforce in model 3 hospitals, “significant challenges” remain. These include high rates of temporary employment of consultants (23 per cent) and an older demographic of consultants (37 per cent over 55 years old).

The new NDTP reports are available here: www.hse.ie/eng/staff/leadership-education-development/met/