1. International Medical Graduates in Ireland:trends, 2000– 2010 Professor Ruairí Brugha 1 Posy Bidwell 2, Pat Dicker 1, Dr Niamh Humphries 1, Dr Steve Thomas 2, Prof Charles Normand 2 1. Dept of Epidemiology and Public Health Medicine Royal 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, 2012 3 rd February, 2012, RCSI Dublin, TCD LOGO

2. 1.Study aim and method 2.Trends in country of qualification for doctors registered with the Irish Medical Council 3.Discussion and Conclusions This presentation 2

3. 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 the unique identifier (IMC registration number) 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

4. Trends in country of qualification for doctors registered in Ireland Irish Medical Council registrations by country of qualification, categorised as Irish, non-Irish EU and Non-EU for the period 2000-2010 Ireland ranked 2 nd for foreign doctors (35%) New Zealand 1 st (39%): OECD 2008

5. Trends in foreign-trained doctors as % of the national medical workforce: selected OECD countries, 2000-2008

6. Total registrations Irish Medical Council, 2000, 2005, 2010 Year * Irish graduates (n) ** International medical graduates (IMGs) (n) IMGs as % of workforce 200011,3001,75213.4 200512,6114,27925.3 201012,4596,26133.4 * Includes non-Irish (non-EU) nationals graduated in Irish medical schools ** Includes Irish nationals graduated in other EU and non-EU medical schools

7. Country of qualification for EU graduates (excl Ireland) 2000 + 2010 % indicates the proportion of total EU registrations

8. Country of qualification for non-EU graduates, 2000 + 2010 % indicates the proportion of total non-EU registrations

9. Key source countries for non-EU doctors registered in 2000 and 2010 9 20002010 (n) % of total non-EU doctors registered (n) % of total non-EU doctors registered Pakistan375 39.2 1,075 22.7 India186 19.4 460 9.7 Egypt79 8.3 194 4.1 Australia58 6.1 196 4.1 Sudan64 6.7 403 8.3 South Africa54 5.6 1,582 33.4 Nigeria36 3.8 389 8.2 Other105 11.0 443 9.3 Total non-EU doctors registered9574,742

10. — Ireland is among the highest of the OECD countries for the proportion of foreign trained doctors it employs 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 in Ireland Over-estimate because of Irish doctors who qualified elsewhere 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 ? Is Ireland, in as much as it relies on foreign trained doctors, vulnerable to accusations that it is delivering its health services on the back of 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

11. ? 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)

12. Health Research Board research project grant HRA_HSR/2010/18 Irish Medical Council Acknowledgements