A disproportionate number of those who graduate from Irish medical schools do not progress on to become consultants in Ireland, where the number of specialists is the sixth lowest of OECD countries for which data is available, according to an official report presented to The Health Minister, Stephen Donnelly and Public Expenditure, NDP Delivery and Reform Minister, Pascal Donohue.
Irish medical workforce policy aims to train an adequate number of medical doctors within Ireland and have sufficient numbers of medical specialists to provide a Consultant delivered health service.
The paper was produced by Irish Government Economic and Evaluation Service (IGEES) staff in the Department of Health Research Services and Policy Unit. * It describes the medical education and training system in Ireland and examines some of challenges facing the health system in meeting the WHO-GCP commitment to reduce Ireland’s reliance on the foreign educated medical workforce and in achieving a Consultant-Delivered health service.
The paper says its analysis demonstrates the need to significantly increase Ireland’s domestic production of medical doctors through increased medical degree places for EU/UK medical students and increased specialist training capacity.
Published as part of the Government Spending Review process to improve the evidence base for policy decisions, the paper xamines the challenges facing the health system in meeting our commitment to reduce Ireland’s reliance on a foreign educated medical workforce and in achieving a Consultant-Delivered health service.
It says the number of doctors per capita in Ireland is similar to the average across the OECD. However, the proportion of foreign-trained doctors in Ireland stood at 40% in 2021 – the fourth highest of all member states. Furthermore, Ireland has a significantly below average number of specialist doctors. The number of specialists is the sixth lowest of OECD countries for which data is available.
The research highlights that in the 2021/22 academic year, there were 1,403 medical student places available in the Irish Higher Education System. This is the highest medical graduate output per capita amongst OECD countries However a very large proportion of those students are Non-EU students (46%). “This means that this historic undersupply of doctors within the Irish medical education and training system has contributed to a situation where there is an overreliance on foreign-educated doctors and relatively few Consultants when compared against our international peers,” said the report.
The paper developed a medical workforce supply model, using systems dynamics modelling, to understand the implications of substituting Non-EU/UK places in Irish medical schools for students from the EU or UK and how this might better align student intake with specialist training capacity in the health system.
This model highlights that a long timeframe is required to increase medical education and training places. “Even with large-scale increases in medical degree student intake in the short term, reducing Ireland’s reliance on foreign educated medical workforce will be a long-term endeavour. Because of the high proportion of Non-EU students educated here there is significant capacity to increase EU/UK student places within the educational system already. There are greater supply constraints within the postgraduate training system, though growth in capacity in recent years has been high.”
It says medical education and training places need to be carefully aligned to ensure the optimal pathway from student to consultant. Increased medical degree places necessary to redress the undersupply of Irish educated doctors require increased downstream capacity in specialist training programmes. “For example, increasing undergraduate places in medicine by 100 requires an increase in internship places of 92 five years later and an increase in specialist training places (IST or GP training) of 75 approximately eight years later. These results are sensitive to modelling assumptions on student dropouts rates, attrition and emigration which may vary into the future.”
‘An Analysis of Medical Workforce Supply,’ was produced by the Irish Government Economic and Evaluation Service (IGEES) staff in the Department of Health Research Services and Policy Unit. The paper was published as part of the Spending Review process and has been subject to extensive peer review. The Spending Review is a key platform for evidence-informed policymaking across the Civil Service. This research was undertaken to assist workforce planning in the health sector.
The analysis looked at a range of scenarios which increased EU/UK medical student and specialist training intake. However, it did not define the optimal student intake. Further work is underway to identify the optimal medical student intake in Ireland, in particular estimating the total demand for doctors across the whole health system and the supply-side capacity required to meet this demand.
The aim of this work was to provide an evidence base to help inform policymakers inform medical workforce planning to ensure a safe, effective and responsive health system.
Minister for Health, Stephen Donnelly T.D. welcomed the publication saying, “Workforce planning in healthcare is a key priority for me and this Government. We have seen an unprecedented increase in the number of healthcare staff employed in our public health service during the life of this Government, with more than 18,500 staff recruited by the HSE, including 1,773 doctors and dentists since the beginning of 2020. I have made clear that we need to urgently double the number of Irish and EU students in medicine in order to meet the challenges of our growing and aging population, and to meet our international obligation to reduce our reliance on foreign trained doctors. I am delighted to support the publication of ‘An Analysis of Medical Workforce Supply’. This paper will help us to address workforce challenges, help to meet the challenge of expected increases in demand, provide a path to reduce Ireland’s over reliance on the recruitment of foreign educated medical doctors and to deliver a health system which is safer, more effective and more responsive to public need.”
The paper is published as part of the Spending Review process and has been subject to extensive peer review. The Spending Review is a key platform for evidence-informed policymaking across the Civil Service. This research was undertaken to assist workforce planning in the health sector.
Terence Hynes, Peter O’Connor, Research Services & Policy Unit, Department of Health, Irish Government Economic and Evaluation Service
