The National and International Implications of a Decade of Doctor Migration in the Irish Context

Background: Between 2000 and 2010, Ireland became increasingly dependent on foreign-trained doctors to staff its health system. An inability to train and retain sufficient doctors to meet demand is the primary reason for the dependence on foreign-trained doctors. By 2008 the proportion of foreign-trained doctors was the second highest in the OECD. This increased dependence on international medical migration has both national and international policy implications. Methods: Registration data were obtained from the Medical Council of Ireland (MCI) for a ten year period: 2000-2010. Data indicate country of qualification but not nationality. The total number of registrants and entrants (n) was determined for each year. Immigration data were also obtained on the number of work visas issued to doctors. Registration and visa data were then compared in order to estimate doctor migration to Ireland 2000-2010. Results: The proportion of foreign-trained doctors rose from 13.4% of all registered doctors in 2000 to 33.4% by 2010. The largest increase was in foreign-trained doctors from outside the EU, rising from 972 (7.4%) in 2000 to 4,740 (25.3%) of registered doctors in 2010. The biggest source country in 2000 was Pakistan. By 2010, South Africa had become the biggest source country. The number of foreign-trained doctors from other EU countries doubled from 780 in 2000 to 1,521 in 2010. Conclusions: Registration data are likely to over-estimate and visa data under-estimate the numbers of doctors actively working in Ireland. However, they serve to illustrate Ireland’s rapidly increasing and potentially unsustainable reliance on foreign-trained doctors; and to highlight the need for better data to measure migratory flows. Improved measurement of health worker migration is necessary both for national workforce planning and to fulfil the requirements of the WHO Global Code on the International Recruitment of Health Personnel

Pressure-temperature diagram showing the calculated trapping conditions of the fluid inclusions in rodingites from the JM Asbestos mine and superimposed pressure-temperature-time (P-T-t) paths estimated by Whitehead et al

<p><b>Copyright information:</b></p><p>Taken from "Physicochemical conditions and timing of rodingite formation: evidence from rodingite-hosted fluid inclusions in the JM Asbestos mine, Asbestos, Québec"</p><p>http://www.geochemicaltransactions.com/content/8/1/11</p><p>Geochemical Transactions 2007;8():11-11.</p><p>Published online 25 Oct 2007</p><p>PMCID:PMC2174467.</p><p></p> [59] for the footwall at the base of the Thetford-Mines ophiolite (dashed lines). Only the paths that cross the P-T conditions determined by Clague et al. [65] and Feininger [66] for the metamorphism in the footwall at the base of the Thetford-Mines ophiolite are reproduced. The P-T-t paths define a range of geotherms that transect the calculated trapping conditions of type 2b fluid inclusions in rodingitized diorite. Trapping conditions for type 2a fluid inclusions in samples Gran-1b and Slate-1a, and for two type 1 fluid inclusions in vesuvianite (isochore indicated by solid line labelled 'Ves'), lie below those geotherms. The diagram also show the limits of stability of forsterite and antigorite in the system MgO-SiO-HO, and prehnite, in part, calculated using THERMOCALC v2.3 [42,43] assuming pure phases. The wet pelite solidus is after Thompson and Algor [67] and the limit for the stability of andalusite after Richardson et al. [68]. The diagram suggests emplacement of andalusite granites at relatively shallow levels in the Asbestos ophiolite, and possibly through peridotites that were already serpentinized

Pressure-temperature diagrams showing calculated trapping conditions for type 2b fluid inclusions in sample Dior-2 (A) and type 2a fluid inclusions in samples Gran-1b and Slate-1a (B)

<p><b>Copyright information:</b></p><p>Taken from "Physicochemical conditions and timing of rodingite formation: evidence from rodingite-hosted fluid inclusions in the JM Asbestos mine, Asbestos, Québec"</p><p>http://www.geochemicaltransactions.com/content/8/1/11</p><p>Geochemical Transactions 2007;8():11-11.</p><p>Published online 25 Oct 2007</p><p>PMCID:PMC2174467.</p><p></p> (A): The solid lines marked 1 and 2 (in white circles) represent P-T conditions at saturation (CH-rich fluid) for type 2b fluid inclusions with salinities of 18 and 24 wt.% eq. NaCl, respectively. The heavy long-dashed line represent the average isochore of type 1 fluid inclusions occurring in sample Dior-2, and the short-dashed lines form the ± 1σ envelope of the average isochore. Stars indicate the maximum P-T conditions of equilibration of calc-silicate layers from the Thetford Mines ophiolite calculated by Laird et al. [50]. Because quartz is absent from their reported assemblage, the actual conditions should plot at lower temperatures and pressures along the univariant reaction 5Pumpellyite = 5Zoisite + 2Prehnite + 2Grossular + Chlorite + 9HO which approximately parallels the isochores. (B): The grey shaded area represents the calculated trapping conditions for fluid inclusions in granite sample Gran-1b. The filled dot represents the calculated total homogenization conditions for a representative fluid inclusion in rodingitized slate sample Slate-1a. The solid line connected to the filled dot represents the calculated isochore of the corresponding fluid inclusion. Dashed lines represent isochores of type 1 fluid inclusions in sample Slate-1a. The occurrence of prehnite that formed contemporaneously with other calc-silicates in the studied rodingitized dykes and slate imposes the limit on homogenization pressures

A serie of photomicrographs showing the distribution, shape and interrelationships with host minerals and other inclusions of primary type 2 fluid inclusions

<p><b>Copyright information:</b></p><p>Taken from "Physicochemical conditions and timing of rodingite formation: evidence from rodingite-hosted fluid inclusions in the JM Asbestos mine, Asbestos, Québec"</p><p>http://www.geochemicaltransactions.com/content/8/1/11</p><p>Geochemical Transactions 2007;8():11-11.</p><p>Published online 25 Oct 2007</p><p>PMCID:PMC2174467.</p><p></p> (A): Comparatively large type 1 and type 2b fluid inclusion coexisting in the same zoisite crystal (sample Dior-2). The type 2b inclusion is isolated. Two smaller type 1 inclusions are present near the lower left part of the one indicated by a black arrow, which together form a small group. (B): Rod-shaped fluid inclusions in a diopside crystal (sample Dior-1). The inclusions are randomly distributed and are oriented parallel to the axis of the crystal. (C): Image showing acicular inclusions in grossular (Gr) from sample Gran-1b. Some of the inclusions consist of diopside needles and others are fluid filled. The occurrence of these inclusions is restricted to certain sectors within larger grossular crystals (black arrow). Type 2a fluid inclusions in grossular most commonly occur in these acicular clusters. Coarse-grained diopside crystals (Di) are abundant in the grossular and contain the same type of fluid inclusions. (D): Detail of an elongated type 2a fluid inclusion in grossular from sample Gran-1b. (E): Image showing diopside filling interstices between euhedral grossular crystals in veins from sample Slate-1a. A type 2a fluid inclusion in the diopside is shown by a black arrow. The grossular also contain type 2a fluid inclusions. Type 2a fluid inclusions in samples Slate-1a and Gran-1b showed the same behaviour during cryogenic experiments. (F): A type 1c fluid inclusion (black arrow) in vesuvianite sample Ves-2. This inclusion is oriented parallel to the axis of the host crystal. Other needle-shaped inclusions can be seen oriented in the same way. They consist mostly of empty cavities

MOESM1 of Protocol for a thematic synthesis to identify key themes and messages from a palliative care research network

Additional file 1. KINDLE Project Infographic

“I am kind of in stalemate”. The experiences of non-EU migrant doctors in Ireland

Introduction (extract): Although historically a source country for health workers, Ireland began actively recruiting health workers internationally in the early 2000s and is becoming the OECD country with the second highest dependency on foreign-trained doctors (OECD, 2010) and the highest dependency on foreign-trained nurses (OECD, 2010). Between 2000 and 2009, 40% of all newly registered nurses in Ireland were from outside the EU (Humphries, Brugha & McGee, 2009). The number of foreign-trained doctors registered on the Irish Medical Register1 increased by 259% between 2000 and 2010 (Bidwell et al., 2013). (continued in document)</p

Discrete choice experiment for eliciting preference for health services for patients with ALS and their informal caregivers

Background: Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative condition with a mean life expectancy of 3 years from first symptom. Understanding the factors that are important to both patients and their caregivers has the potential to enhance service delivery and engagement, and improve efficiency. The Discrete Choice Experiment (DCE) is a stated preferences method which asks service users to make trade-offs for various attributes of health services. This method is used to quantify preferences and shows the relative importance of the attributes in the experiment, to the service user. Methods: A DCE with nine choice sets was developed to measure the preferences for health services of ALS patients and their caregivers and the relative importance of various aspects of care, such as timing of care, availability of services, and decision making. The DCE was presented to patients with ALS, and their caregivers, recruited from a national multidisciplinary clinic. A random effects probit model was applied to estimate the impact of each attribute on a participant's choice. Results: Patients demonstrated the strongest preferences about timing of receiving information about ALS. A strong preference was also placed on seeing the hospice care team later rather than early on in the illness. Patients also indicated their willingness to consider the use of communication devices. Grouping by stage of disease, patients who were in earlier stages of disease showed a strong preference for receipt of extensive information about ALS at the time of diagnosis. Caregivers showed a strong preference for engagement with healthcare professionals, an attribute that was not prioritised by patients. Conclusions: The DCE method can be useful in uncovering priorities of patients and caregivers with ALS. Patients and caregivers have different priorities relating to health services and the provision of care in ALS, and patient preferences differ based on the stage and duration of their illness. Multidisciplinary teams must calibrate the delivery of care in the context of the differing expectations, needs and priorities of the patient/caregiver dyad.</p

Additional file 1 of Primary data on symptom burden and quality of life among elderly patients at risk of dying during unplanned admissions to an NHS hospital: a cohort study using EuroQoL and the integrated palliative care outcome scale

Supplementary Material

Predictors of career progression and obstacles and opportunities for non-EU hospital doctors to undertake postgraduate training in Ireland

Background The World Health Organization’s Global Code on the International Recruitment of Health Personnel urges Member States to observe fair recruitment practices and ensure equality of treatment of migrant and domestically-trained health personnel. However, international medical graduates (IMGs) have experienced difficulties in accessing postgraduate training and in progressing their careers in several destination countries. Ireland is highly dependent on IMGs, but also employs non-European Union (EU) doctors who qualified as doctors in Ireland. However, little is known regarding the career progression of these doctors. In this context, the present study assesses the determinants of career progression of non-EU doctors with particular focus on whether barriers to progression exist for those graduating outside Ireland compared to those who have graduated within. Methods The study utilises quantitative data from an online survey of non-EU doctors registered with the Medical Council of Ireland undertaken as part of the Doctor Migration Project (2011–2013). Non-EU doctors registered with the Medical Council of Ireland were asked to complete an online survey about their recruitment, training and career experiences in Ireland. Analysis was conducted on the responses of 231 non-EU hospital doctors whose first post in Ireland was not permanent. Career progression was analysed by means of binary logistic regression analysis. Results While some of the IMGs had succeeded in accessing specialist training, many experienced slow or stagnant career progression when compared with Irish-trained non-EU doctors. Key predictors of career progression for non-EU doctors working in Ireland showed that doctors who qualified outside of Ireland were less likely than Irish-trained non-EU doctors to experience career progression. Length of stay as a qualified doctor in Ireland was strongly associated with career progression. Those working in anaesthesia were significantly more likely to experience career progression than those in other specialities. Conclusions The present study highlights differences in terms of achieving career progression and training for Irish-trained non-EU doctors, compared to those trained elsewhere. However, the findings herein warrant further attention from a workforce planning and policy development perspective regarding Ireland’s obligations under the Global Code of hiring, promoting and remunerating migrant health personnel on the basis of equality of treatment with the domestically-trained health workforce.</p

Multivariable regression results for potentially inadequate medications.

Multivariable regression results for potentially inadequate medications.</p