International Medical Graduates in Ireland: trends, 2000– 2010

Professor Ruairí Brugha1

Posy Bidwell2, Pat Dicker1, Dr Niamh Humphries1, Dr Steve Thomas2, Prof Charles Normand2

1. Dept of Epidemiology and Public Health MedicineRoyal College of Surgeons in Ireland (RCSI)2. Centre for Health Policy & Management, Trinity College Dublin (TCD)

The Global Health Workforce: Pathways to Health.Why are health workers important?

Irish Forum for Global Health Conference, 20123rd February, 2012, RCSI Dublin,

TCD LOGO

1. Study aim and method2. Trends in country of qualification for doctors

registered with the Irish Medical Council3. Discussion and Conclusions

This presentation

2

Study Aim“to provide a better understanding of the scale of Ireland’s

reliance on non-EU doctors working in Ireland , and to report and analyse their experiences and career plans

Study Method for this presentation

• Irish Medical Council supplied dataset of doctors registration data, removed of personal information, years 2000 to 2010

• PD cleaned, recoded and converted data into a database searchable by a unique identifier

• Annual entries and exits from IMC register can be calculated• NOTE: IMC register reports country (medical school) of

qualification – not nationality

Doctor Migration Study: HRB 2011-13

3

Trends in country of qualification for doctors registered in Ireland

Irish Medical Council registrants by country of qualification, categorised as Irish, non-Irish EU and Non-EU for the period 2000-2010

Ireland ranked 2nd for foreign doctors (35%) New Zealand 1st (39%): OECD 2008

Trends in foreign-trained doctors as % of national medical council registrants: selected OECD countries, 2000-2008

Canada

Ireland

New ZealandUnited Kingdom

United States

10

15

20

25

30

35

40

2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

Fore

ign

doct

ors

as %

of t

he w

orkf

orce

Canada Ireland New Zealand United Kingdom United States

Irish Medical Council registrants , 2000, 2005, 2010

Year * Irish graduates (n)

** International medical graduates (IMGs) (n)

IMGs as % of total registrants

2000 11,300 1,752 13.4

2005 12,611 4,279 25.3

2010 12,459 6,261 33.4

* Includes non-Irish (non-EU) nationals graduated in Irish medical schools** Includes Irish nationals graduated in other EU and non-EU medical schools

Country of qualification for EU graduates (excl Ireland) 2000 + 2010

3.7%7.0%

76.9%

0% 0.3% 0.3%

11.9%

44.2%

7.9%

3.1%

15.1%

5.5%3.6%

12.1%

0

100

200

300

400

500

600

700

UK Germany Italy Poland Hungary Romania Other

num

ber (

n) o

f doc

tors

on

regi

ster

2000 2010

% indicates the proportion of total EU registrations

Country of qualification for non-EU graduates, 2000 + 2010

17.0%

3.8%5.6%6.7%8.3%19.4%

39.2%

22.7%

9.7%

4.1%

8.3%

33.4%

8.2%

13.4%

0

200

400

600

800

1000

1200

1400

1600

1800

Pakistan India Egypt Sudan SouthAfrica

Nigeria Other

num

ber o

f doc

tors

regi

ster

ed

2000 2010

% indicates the proportion of total non-EU registrations

Key source countries for non-EU doctors registered in 2000 and 2010

9

2000 2010

(n)

% of total non-EU doctors

registered (n)

% of total non-EU doctors

registered

Pakistan 375 39.2 1,075 22.7

India 18619.4

4609.7

Egypt 798.3

1944.1

Australia 586.1

1964.1

Sudan 646.7

4038.3

South Africa 545.6

1,58233.4

Nigeria 363.8

3898.2

Other 10511.0

4439.3

Total non-EU doctors registered 957 4,742

• — Ireland is among the highest of the OECD countries for the proportion of foreign trained doctors registered here as it was by the mid 2000s for nurses

• — Registration data (Medical and Nursing councils) may under or over-estimate the numbers of foreign nurses and doctors working in Ireland – • -under-estimate because of non-Irish doctors who qualified and are working in Ireland

-over-estimate because of Irish doctors who qualified elsewhere and are working here

• However, registration data are the best (and only) data we currently have

• — Having reached the targets for Irish (EU) medical school places, • Why are we so reliant on foreign trained doctors to make up the short-fall (departures)

of domestically trained doctors – IMO + Doctor Migration studies?• There is a clear need to track and quantify the numbers of Irish doctors leaving and the

measures that would attract them to stay or return to work in Ireland

• ? Ireland trains non-Irish as well as Irish doctors who leave to work overseas. In as much as we rely on large numbers of foreign trained doctors to staff our health services , are we vulnerable to accusations of over-reliance on an expensive investment in medical training by much poorer countries?

Discussion and Conclusions (1)

Mills et al. The Financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis. BMJ 2011

• ? How well is Ireland complying with the Global Code injunction: “Member states should train and retain a health workforce appropriate to its needs ”

• ? How reliable is passive and now active overseas recruitment as a policy response to Ireland’s inability to retain sufficient numbers of doctors?

• Evidence from the nurse migration study cautions against assuming that active overseas recruitment of health professionals is a sustainable long term strategy

• + Medical Council and Nursing Board registers provide a platform for developing a health workforce information system

• However, better data systems are needed to (i) monitor entries and exits from the workforce and (ii) the distribution of skilled staff, both of which are essential to national strategic workforce planning

• + Ireland is doing well in terms of north south partnerships to support training and capacity-building in Africa

• partnerships between researchers and policy makers can provide policy makers with the evidence to fulfil Ireland’s Global Code obligations

Discussion and Conclusions (2)

• Health Research Board research project grant HRA_HSR/2010/18

• Irish Medical Council

Acknowledgements