Doctor retention: A cross-sectional study of how Ireland has been losing the battle

Background: The failure of some high-income countries to retain their medical graduates is one driver of doctor immigration from low- and middle-income countries. Ireland, which attracts many international medical graduates, implemented a doctor retention strategy from early 2015. This study measures junior doctors’ migration intentions, the reasons they leave and likelihood of them returning. The aim is to identify the characteristics and patterns of doctors who plan to emigrate to inform targeted measures to retain these doctors. Methods: A national sample of 1148 junior hospital doctors completed an online survey in early 2018, eliciting their experiences of training and working conditions. Respondents were asked to choose between the following career options: remain in Ireland, go and return, go and stay away, or quit medicine. Bivariate analyses and a two-stage multivariable analysis were used to model the factors associated with these outcomes. Results: 45% of respondents planned to remain in Ireland, 35% leave but return later, 17% leave and not return; and 3% to quit medicine. An intention to go abroad versus remain in Ireland was independently associated (P < .05) with the doctor being under 30 years (odds ratio [OR] = 1.09 per year under 30), a non-European Union (EU) national (OR = 1.54), a trainee (OR = 1.50), and with hospital specialization, especially in Anesthesiology (OR = 5.09). Respondents were more likely to remain if they had experienced improvements in supervision and training costs. Intention to go abroad and not return versus go and return was independently associated (P < .05) with: age over 30 years (OR = 1.16 per year over 30); being a non-EU (OR = 9.85) or non-Irish EU (OR = 3.42) national; having trained through a graduate entry pathway (OR = 2.17), specializing in Psychiatry (OR = 4.76) and reporting that mentoring had become worse (OR = 5.85). Conclusion: Ireland’s doctor retention strategy has not addressed the root causes of poor training and working experiences in Irish hospitals. It needs a more diversified retention strategy that addresses under-staffing, facilitates circular migration by younger trainees who choose to train abroad, identifies and addresses specialty-specific factors, and builds mentoring linkages between trainees and senior specialists

Doctor retention: a cross-sectional study of how Ireland has been losing the battle

Background: The failure of some high-income countries to retain their medical graduates is one driver of doctor immigration from low- and middle-income countries. Ireland, which attracts many international medical graduates, implemented a doctor retention strategy from early 2015. This study measures junior doctors' migration intentions, the reasons they leave and likelihood of them returning. The aim is to identify the characteristics and patterns of doctors who plan to emigrate to inform targeted measures to retain these doctors. Methods: A national sample of 1148 junior hospital doctors completed an online survey in early 2018, eliciting their experiences of training and working conditions. Respondents were asked to choose between the following career options: remain in Ireland, go and return, go and stay away, or quit medicine. Bivariate analyses and a two-stage multivariable analysis were used to model the factors associated with these outcomes. Results: 45% of respondents planned to remain in Ireland, 35% leave but return later, 17% leave and not return; and 3% to quit medicine. An intention to go abroad versus remain in Ireland was independently associated (PP Conclusion: Ireland's doctor retention strategy has not addressed the root causes of poor training and working experiences in Irish hospitals. It needs a more diversified retention strategy that addresses under-staffing, facilitates circular migration by younger trainees who choose to train abroad, identifies and addresses specialty-specific factors, and builds mentoring linkages between trainees and senior specialists.</p

Contrasting impact of whole-tree-harvesting on chemical quality of plant foliage in coastal versus inland forest

<p>Whole-tree-harvesting (WTH) is gaining support as a means to obtain more bioenergy from forests. One aspect that is scarcely addressed is its impact on the chemical quality of post-harvest plant growth, which may initiate ecological cascade effects through, for example, altered patterns of herbivory and decomposition. We measured C:N ratios and phenolic compounds in foliage from birch <i>Betula</i> spp. that had grown naturally after WTH and conventional harvest (CH) on two boreal sites in inland and more coastal Norway, three or five years after harvest. We found that carbon concentrations were higher after WTH compared to CH on the near-coastal site in spring and summer, but not on the inland site. The only observed change in nitrogen concentration after WTH was that it was lower compared to CH on the near-coastal site in autumn. In line with these changes, the C:N ratio was higher with WTH throughout the season on the near-coastal site, ostensibly favouring production or accumulation of plant defence metabolites. Expectedly, we observed altered concentrations of several phenolic compounds with WTH, particularly at the near-coastal site. Further studies are needed to clarify patterns, but our data strongly suggest that sustainability assessments of WTH should not ignore impact on plant chemical quality, and its potential consequences for trophic interactions.</p

The impacts of training pathways and experiences during intern year on doctor emigration from Ireland.

Background: Emigration of domestically-trained health professionals is widespread, including in Ireland which has the highest rate of medical graduates in the OECD. Ireland's failure to retain graduates necessitates high levels of international recruitment. This study aimed to identify factors associated with recently graduated doctors' intention to migrate, focusing on their work experiences during the mandatory post-graduation year, their wellbeing, and their perceptions of postgraduate training in Ireland.Methods: A baseline survey was administered online to all final year students in Ireland's six medical schools. A subsequent sweep surveyed those who consented to follow-up (n = 483) during the final month of first year of practice.Results: Of the 232 respondents (48% response rate), 210 (94%) were Irish passport holders. Of these, only 36% intended to remain in Ireland after their internship, 57% intended to leave but return later, and 7% intended to leave permanently. A strong predictor of intention was study pathway: 60% of Graduate Entry Medicine (GEM) graduates and 25% of Direct Entry Medicine (DEM) graduates intended to remain in Ireland. Equal proportions intended to leave permanently (8% DEM, 6% GEM). Being a GEM graduate significantly reduced the likelihood of leaving to return (relative risk ratio (RRR) 0.20, 95% confidence interval (CI) (0.11-0.39), p Conclusions: Increasing GEM training places might improve Ireland's retention of domestically-trained doctors, reducing reliance on non-EU-trained doctors. However, improvements in the working experiences, perceptions of training, and protection of wellbeing are essential for retaining this highly sought-after and geographically mobile cohort.</p

Retaining our Doctors Medical Workforce Evidence, 2013-18. Challenges and Responses

The RCSI Health Workforce Research Group held a policy dialogue in November 2017 at the Royal College of Surgeons in Ireland. The event was attended by senior staff of the Department of Health, the Health Service Executive, postgraduate medical training bodies, NCHD representatives and other national stakeholders with an interest in, or remit for, medical workforce strategy. Copies of the evidence pack, Retaining our Doctors, Medical Workforce Evidence, 2013-17, which forms the body of this report, were provided to attendees. The report, which we have updated with new 2018 research findings, incorporates a summary of research evidence on the intentions, migration patterns and reasons why many NCHDs leave Ireland to train and work abroad; and why they often do not return. A brief summary of the most recent findings, together with questions used to stimulate discussion, was presented at the November 2017 event. In order to assist and encourage free discussion, the meeting was held under the following interpretation of the Chatham House Rule: issues discussed in the meeting can be discussed outside of the meeting but ideas, views and any positions expressed in the meeting will not be attributed to either organisations or individuals attending the meeting. A summary of the Challenges and Responses that emerged during the stakeholder discussions was prepared and sent to those who participated, which engendered further feedback. It should be noted that nothing stated in the following summary can be attributed to any individual, agency or body that participated in the event.</p

Retaining our Doctors Medical Workforce Evidence, 2013-18. Summary

This report summarises original research findings on the scale and causes of outward migration of non-consultant hospital doctors (NCHDs1 ) from Ireland. It draws on findings from five mixed methods research studies undertaken by the Royal College of Surgeons in Ireland’s (RCSI’s) Health Workforce Research Group 2014-18, together with an analysis of routine data published since 2011 by Ireland Health Service Executive (HSE) National Doctor Training and Planning Unit (NDTP) and the Irish Medical Council (IMC). A consistent picture emerges of the factors that ‘push’ Irish and international medical graduates to leave Ireland, namely poor working conditions, and inadequate training and career opportunities. Research findings from 2018 show that, while trainees report improvements in mentoring and supervision of their training, they also report a worsening of work-related stress and staffing levels in Irish hospitals. Furthermore, there is evidence to suggest that shortages of consultants are contributing to NCHD emigration. This report starts with a summary of the Challenges and Responses that emerged from a policy dialogue of key national stakeholders conducted at the Royal College of Surgeons (RCSI) in November 2017. Each chapter summarises different dimensions of the evidence, ending with questions that were proposed and discussed at the policy dialogue, with a view to framing interventions to retain Ireland’s doctors, specifically NCHDs. Most of the focus of the report and much of the research has been on trainees, who are NCHDs in post-graduate training programmes. However, the report and some of the research and routine data also focus on non-trainees, on whom Ireland is increasingly reliant for the delivery of its health services. Most NCHDs in long-term non-training posts are international medical graduates (IMGs), who are recruited to non-training posts, to which Irish-trained doctors will not apply.</p

Factors influencing specialty choice and the effect of recall bias on findings from Irish medical graduates: a cross-sectional, longitudinal study.

Background: Despite being a vital part of medical workforce planning and development, how medical students and graduates choose their career specialty is still not well understood. This study aimed to identify the factors medical graduates consider important influences in their choice of specialty after their first year of practice, and to test the validity of relying on respondent recall to measure changes in specialty choice.Methods: The baseline survey was administered online to all final year students in Ireland's six medical schools. Those who consented to follow-up (n = 483) were surveyed 18 months later (June 2018), during the final month of first year of practice.Results: The baseline survey had a 67% (n = 483) response rate. At the follow-up survey, (n = 232, 48% response rate) the top specialty choices were: Medicine, n = 54 (26%); Surgery, n = 34 (16%); General Practice, n = 28 (13%); Anaesthesia, n = 16 (8%) and Paediatrics, n = 14 (7%). Of the 49 respondents (28%) reporting a change of specialty since baseline, 13 (27%) selected the same specialty in both surveys; of the 121 (69%) reporting no change, 22 (18%) selected a different specialty at follow-up. Over 90% of respondents rated as 'important or 'very important': 'Own aptitude', 'Work-life balance' and 'What I really want to do'. Over 75% rated as 'not at all', or 'not very important' 'Current financial debt' and 'Inclinations before medical school'. When adjusted for sex and age, compared with Medicine, General Practice rated as more important: continuity of patient care (RRR 3.20 CI(1.59-6.41), p = 0.001); working hours/conditions (RRR 4.61 CI(1.03-20.60), p = 0.045) and a career that fit their domestic circumstances (RRR 3.19 CI(1.27-8.02), p = 0.014). Those choosing Surgery rated as less important: patient contact (RRR 0.56 CI(0.33-0.95), p = 0.033) and working hours/conditions (RRR 0.55 CI(0.31-0.96), p = 0.035).Conclusions: The different demographic and motivational profiles by specialty choice are consistent with other studies suggesting a distinct profile for doctors intending to enter General Practice. In addition, our results suggest longitudinal study designs guard against recall bias and so provide more robust medical workforce models to inform and direct recruitment drives and interventions in future medical workforce planning.</p