An embedded culture of emigration

Irish Medical emigration is not a new phenomenon. During the late 19th and 20th Centuries, there was a steady pipeline of doctors leaving Ireland, although any data collection was haphazard and often anecdotal. Therefore a paper in 2010 (Med Hist. 2010 Jan; 54(1): 55-74. doi:10.1017/s0025727300004312) sought to drill a little deeper into the figures between the years of 1860 and 1905.

The majority of these doctors ended up working in England, or with the British military in some far-flung destination. The author notes: “To sum up, around 53 per cent were practicing outside Ireland after 10 years. The majority were in England. Another substantial number served in the military or the colonies of the British Empire, and emigrant destinations such as Australasia.”

One of the main reasons for emigration back then was simply to earn a living. Many Irish doctors at the time were not particularly well-off, although there were exceptions. One example is the case of Dr Robert V Fletcher, who was appointed Medical Superintendent of Ballinasloe District Asylum in 1875. His starting salary was £450 per annum, plus £145 in allowances, equating to a fairly standard income of £595 from a public appointment. This was a good wage at the time, although some other doctors were struggling when it came to making a decent living.

In the 100 years from 1860-1960, our little island produced more medical graduates than the system could absorb, which was another reason for emigration.

However, then as now, opportunity for advancement was a strong motivator for emigration. Distinguished surgeon Sir Thomas Myles, addressing RCSI graduates in 1901, told them they could either settle for “a life of servitude” made worse by “insane competition for the position of dispensary doctor”, or they could pursue “a vista of success in one of the large towns of England or subsequently settling in one of the colonies”. He was not, he stressed, “urging you to emigrate; to do so would,

I know, bring down on me the wrath of many well-meaning people who think that Irish workhouses are not sufficiently overcrowded.” Rather, he was encouraging these fledgling medical professionals to “shake themselves free from the spirit of narrow parochialism and strike out boldly for the big prizes that are available to you”. This, of course, was against the backdrop of Myles being a fervent nationalist who owned a yacht that was used for the importation of 600 Mauser rifles and 20,000 rounds of ammunition.

The issue of Irish medical emigration is a complex one, and all that these column inches allow is a skim across its surface, rather than a deep dive. One thing is clear: Doctors who opt to go abroad and work in international centres of excellence bring home a veritable treasure trove of knowledge and experience. But this makes the bold assumption that opportunities here are good enough to attract them back.

In the centuries gone by, it was an accepted fact that many of the doctors who graduated would emigrate. It could be argued that not much has changed, in that regard at least. We now know that a dysfunctional system and poorly staffed hospitals cause many of our doctors to continue to emigrate.

In 2024, there is no excuse for not making urgent efforts to give them fewer reasons to leave.