Diagnosis critical as doctors flee Ireland
Saturday August 27 2005
Dr Liz Bernard trained in Cork and did her residency there. Today she is a GP in Swansea. She wanted to train as a GP in Cork, but she wasn't accepted for the scheme. And she is just one of many medical school graduates who have left Ireland.
"I was really disappointed," says the 29-year-old. "I'd been in Australia for a year, and wanted to be near my family and friends. I thought of working and applying again the following year, but I knew people who had tried reapplying and been unsuccessful again. A friend and I applied to various places in the UK. Both of us were accepted in Swansea, so we went to Wales together."
Liz planned to qualify as a GP in Wales and then return, but now she's not sure she ever wants to work in the Irish system.
"I'm really apprehensive at the idea," she says. "I feel settled here and I'm used to the system. The career options are better here and there's a better working practice. We have at least five partners, a beautifully equipped surgery, and a lot of support staff. My working day is predictable - I don't have to work any unsocial shifts. Here, all GPs are appraised regularly, and there are more target-driven national guidelines.
"The patient care is better too - it's easy to refer patients on quickly in an emergency. There's a huge emphasis on chronic disease management and on prevention. It's easier working in the NHS. You can ask a patient to come back and see you in two or three weeks. If you do that in Ireland they might think you have an ulterior motive. Money changes the dynamic."
The situation depresses Liz, because she would prefer to live in Ireland.
"I might have to compromise, but for the medium term at least, I'd rather work here," she says.
Liz is not alone, according to a study carried out by the Medical Education and Training Group (MET) which was released this week. Having tracked Irish medical school graduates, the report found that one in five of our young doctors leaves the health service in the Republic, without ever intending to return to it. That figure didn't include foreign students who were returning to their country of origin. The findings don't surprise Professor Muiris Fitzgerald, Dean of Medicine at UCD. But they worry him profoundly.
"Their main motive in going abroad is to get advanced postgraduate qualifications," he says.
And while some training abroad is beneficial to doctors to further their career, Prof Fitzgerald hates to see them moving abroad too soon.
"A graduate who wants to become a cardiac surgeon, for example, sees the training here as sub-standard. He'll leave Ireland early in his career and spend a longer time abroad. And that's unhealthy. We are losing our brightest and our best."
So what is the answer?
"We need to throw money at it. Ireland has to invest in a good robust post-graduate service. We have to invest in it and fund it."
When the CAO offers came out at the start of this week, there were worries at the low numbers of Irish students being admitted to medical schools here. Of 2,252 Leaving Certificate students putting medicine as number one on their CAO forms, only 305 are guaranteed places.
Yet we train 515 non-EU students here. This realisation has led to calls for reform. Many people want this figure revised so that Irish students are allocated 725 places. They feel only then will we end up with enough doctors. But such knee-jerk reactions, though understandable, are not the answer, says Prof Fitzgerald.
"If we didn't take non-EU fee-paying medical students, we would have to close the medical schools," he says. "Or else the government subvention would have to increase dramatically."
At the moment the government subsidises each Irish medical student for a year to the tune of an average ?8,000 to ?9,000. Compare this to the ?34,250 annual fee paid by the non-EU students of the Royal College of Surgeons in 2004. Or to the subventions of ?36,000 or ?40,000 given to students at Queen's University Belfast or the University of Glasgow.
"The Fottrell report set up by the Medical Council found that medicine has been historically under-invested," says Prof Fitzgerald. "They said there needs to be major investment urgently."
The MET report highlighted that 6% of those leaving the Irish Medical Service quit medicine altogether. Rowan Manahan, managing director of Fortify Services, a consultancy and career management firm, has had many career-changing doctors through his books. He believes that the CAO system is to blame. It attracts the wrong people to medicine. Hence the dissatisfaction and career change.
"High achievers, who once would have gone for maths or literature, are entering medicine because it has acquired this currency value," he says. "There is this whole perception that you should not 'waste your points'. We have to check doctors over. We have to see if they are suitable."
Many people feel that the entry system for medical school needs changing. This year Trinity medical students require 585 points - the highest ever. And it's not much better at UCD. "Twenty-three of our new uptake have a minimum six A1s," says Prof Fitzgerald.
We're not the only country hoping to reform the entry system. "It's a worldwide debate, because there are always at least five or 10 people after every place, but the debate varies," says Prof Fitzgerald. "In London they feel that the system is socially biased. They need a baseline of As at A Level, but they want the 'right chap'. In Ireland the debate is, 'it should not all be academic', but in other countries, they feel it would be fairer if it was all based on academic grounds."
With many medical places going to non-EU students, there's a perception that it must, therefore, be easy for foreign students to get into medical school.
But this isn't the case. It's highly competitive for them too, says Prof Fitzgerald.
How do these fee-paying students rate the training here? "It's a fantastic training," says Celia Loan, 29, from Nigeria. "I really enjoyed my time at the Royal College of Surgeons."
Once she'd trained, though, she applied to Britain to do her residences. But they'd changed the rules and she ended up staying in Ireland. "I was allocated rotations in Beaumont and Drogheda," she says. "And since then, I've been working in paediatrics. I love working with children."
Recently, though, the strain has been getting to Celia.
"There were things that I wanted to do with my life that I couldn't do in that hospital routine," she says. "I wanted to be able to dance and to have more control over my life."
At present, Celia is working as a locum in GP practices. She loves having her weekends free, and enjoys the relatively relaxed pace of life. But what will she do in the future?
"I'm trying to decide what to do next," she says. "I love being in a GP practice but I do miss working with children. I love paediatrics. It's difficult. I'm not sure how long I will stay in Ireland."
