Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle

Document Type : Original Article

Authors

1 RCSI Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland

2 School of Psychology, Dublin City University, Dublin, Ireland

3 National Doctors Training and Planning, Health Service Executive, Dublin 8, Ireland

4 Department of Mathematics & Statistics, University of Limerick, Limerick, Ireland

Abstract

Background
The failure of some high-income countries to retain their medical graduates is one driver of doctor immigration from low- and middle-income countries. Ireland, which attracts many international medical graduates, implemented a doctor retention strategy from early 2015. This study measures junior doctors’ migration intentions, the reasons they leave and likelihood of them returning. The aim is to identify the characteristics and patterns of doctors who plan to emigrate to inform targeted measures to retain these doctors.

 
Methods
A national sample of 1148 junior hospital doctors completed an online survey in early 2018, eliciting their experiences of training and working conditions. Respondents were asked to choose between the following career options: remain in Ireland, go and return, go and stay away, or quit medicine. Bivariate analyses and a two-stage multivariable analysis were used to model the factors associated with these outcomes.

 
Results
45% of respondents planned to remain in Ireland, 35% leave but return later, 17% leave and not return; and 3% to quit medicine. An intention to go abroad versus remain in Ireland was independently associated (P < .05) with the doctor being under 30 years (odds ratio [OR] = 1.09 per year under 30), a non-European Union (EU) national (OR = 1.54), a trainee (OR = 1.50), and with hospital specialization, especially in Anesthesiology (OR = 5.09). Respondents were more likely to remain if they had experienced improvements in supervision and training costs. Intention to go abroad and not return versus go and return was independently associated (P < .05) with: age over 30 years (OR = 1.16 per year over 30); being a non-EU (OR = 9.85) or non-Irish EU (OR = 3.42) national; having trained through a graduate entry pathway (OR = 2.17), specializing in Psychiatry (OR = 4.76) and reporting that mentoring had become worse (OR = 5.85).
 

Conclusion
Ireland’s doctor retention strategy has not addressed the root causes of poor training and working experiences in Irish hospitals. It needs a more diversified retention strategy that addresses under-staffing, facilitates circular migration by younger trainees who choose to train abroad, identifies and addresses specialty-specific factors, and builds mentoring linkages between trainees and senior specialists.

Highlights

Supplementary File 1 (Download)

 

Commentaries Published on this Paper

  • Doctor Retention in Ireland - What it may mean for the Global Health Workforce Reform Agenda; Comment on “Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle”

         Abstract | PDF

 

  •  Doctor Retention in Ireland - Where Are the Failings That Prolong the Problem?; Comment on “Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle”

          Abstract | PDF

 

  • Doctor Retention or Migration: From Ireland to the World?; Comment on “Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle”

        Abstract | PDF

 

  •  Training, Migration and Retention of Doctors: Is Ireland a Danaides’ Jar?; Comment on “Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle”

          Abstract | PDF

 

  • African Physician Migration to High-Income Nations: Diverse Motives to Emigrate (“We Are not Florence Nightingale”) or Stay in Africa (“There Is No Place Like Home”); Comment on “Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle”

         Abstract | PDF

 

  • Expanding Medical Education and Task Shifting; Comment on “Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle”

        Abstract | PDF

 

  • Migration, Retention and Return Migration of Health Professionals; Comment on “Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle”

        Abstract | PDF

 

 

Author's Response to the Commentaries

  •  Doctor Retention in a COVID-World: An Opportunity to Reconfigure the Health Workforce, or “Plus ça change plus c’est la meme chose”? A Response to the Recent Commentaries

          Abstract | PDF

 

Keywords

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International Journal of Health Policy and Management
Volume 10, Issue 6
June 2021
Pages 299-309

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History

  • Receive Date: 10 October 2019
  • Revise Date: 09 April 2020
  • Accept Date: 11 April 2020
  • First Publish Date: 01 June 2021

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