Positive data on retention, but NDTP recommendations need support

The latest report from HSE National Doctors Training and Planning (NDTP) makes for illuminating reading for anyone interested in the ongoing challenges around retaining the medical workforce in Ireland.

The problem of young Irish-trained doctors leaving the health service to work abroad has been well-documented in recent years, in particular by Senior Lecturer at the RCSI, Dr Niamh Humphries (PhD).

The new NDTP document – Annual Medical Retention Report 2023 – finds that approximately half of interns leave the Irish public health system after their internship. However, it points out that for the 2015-2018 intern cohorts, 82 per cent had started basic specialist training (BST), or GP training prior to 2023. The retention rates of Irish interns are substantially higher than for EU/UK or non-EU interns.

For the 2015 to 2018 intern cohorts, on average 87 per cent of Irish doctors returned to the Irish public health system by 2023. This is compared to 63 per cent of EU/UK doctors and 59 per cent of non-EU doctors.

Of greater concern than attracting qualified interns back to the Irish health service is the rate at which qualified specialists leave and return, according to the report.

However, the document delivers some positive news on this front as well. Of the 2016 and 2017 cohorts of doctors who were awarded certificates of satisfactory completion of specialist training, on average 68 per cent were working in the Irish health service in 2023 across both the public and private sectors.

There has been a “substantial improvement” in the retention rates of the 2018 and 2019 cohorts with 75 per cent and 78 per cent respectively working in public or private posts in Ireland in 2023, according to the report.

“Two potential explanations for this trend include the large increase in consultant posts available over the last few years and the effects of Covid-19,” the report states.

However, as Medical Director of the NDTP Prof Brian Kinirons points out in his foreword to the report, the expansion in the number of consultants in recent years has been mainly focused on large model 4 hospitals. He writes that there are significant unmet demands across a variety of specialties in the regional model 3 hospitals.

“These roles are currently viewed as less attractive to many prospective candidates,” according to Prof Kinirons.

Further improvement in the retention of qualified specialists is needed. However, improving retention while focusing growth in a range of specialties in the model 3 hospitals “will provide an additional challenge”.

The issue of recruitment and retention in model 3 hospitals was the subject of another NDTP report published at the end of 2023. Both that report and the new document put forward recommendations to improve the situation.

For example, the NDTP suggests that reviewing the structure of approved consultant posts – specifically the manner in which the posts are split between larger and smaller sites – may help to make working in model 3 hospitals more attractive.

The ongoing examination of data to support policy decisions is crucial. That is why these reports from the NDTP are to be welcomed. And even more crucial is for the well-informed recommendations in the reports to be implemented by those with the power to do so.