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