Factors influencing trainee doctor emigration in a high income country: a mixed methods study

Abstract

BackgroundThe Global Code of Practice on the International Recruitment of Health Personnel focuses particularly on migration of doctors from low- and middle-income countries. Less is understood about migration from high-income countries. Recession has impacted several European countries in recent years, and in some cases emigration has reached unprecedented levels. This study measures and explores the predictors of trainee doctor emigration from Ireland.MethodsUsing a partially mixed sequential dominant (quantitative) study design, a nationally representative sample of 893 trainee doctors was invited to complete an online survey. Of the 523 who responded (58.6% response rate), 423 were still in Ireland and responded to questions on factors influencing intention to practice medicine abroad and are the subjects of this study. Explanatory factors for intention to practice medicine in Ireland in the foreseeable future, the primary outcome, included demographic variables and experiences of working within the Irish health system. Associations were examined using univariable and multivariable logistic regression to estimate odds ratios for factors influencing the primary outcome. Qualitative interviews were conducted with 50 trainee doctors and analysed thematically, exploring issues associated with intention to practice medicine abroad.ResultsThere were high levels of dissatisfaction among trainee doctors around working conditions, training and career progression opportunities in Ireland. However, most factors did not discriminate between intention to leave or stay. Factors that did predict intention to leave included dissatisfaction with one’s work-life balance (odds ratio (OR) 2.51; 95% confidence interval (CI) 1.53–4.10; P < 0.001); feeling that the quality of training in Ireland was poor (OR 1.82; 95% CI 1.09–3.05; P = 0.002) and leaving for family or personal reasons (OR 1.85; 95% CI 1.08–3.17; P = 0.027). Qualitative findings illustrated the stress of doing postgraduate training with inadequate supervision, lack of ring-fenced training time and pressures on personal and family life.ConclusionsLarge-scale dissatisfaction with working, training and career opportunities point to systemic factors that need to be addressed by health workforce planners if Ireland is to retain and benefit from a motivated medical workforce, given trainees’ perceptions that there are better opportunities abroad.Electronic supplementary materialThe online version of this article (10.1186/s12960-017-0239-7) contains supplementary material, which is available to authorized users.

Exploring Satisfaction and Migration Intentions of Physicians in Three University Hospitals in Poland

“…Only these respondents were asked about reasons for migration. This part of the questionnaire was developed based on a previous study completed in Ireland [17], adapted and validated for Polish settings [25]. The content validity of the questionnaire in Polish was previously evaluated by a committee of experts [26] and practicing physicians [25].…”

“…Physician satisfaction is a complex and multidimensional concept which can be affected by personal and external factors [13,14]. Physicians' satisfaction has significant effects on their productivity, their work ability, and the quality of patient care, as well as their intentions to leave the job or their intent to continue practicing medicine [15][16][17].In 2018 in Poland, there were 36 university hospitals owned and operated by 13 public medical universities. These hospitals are financed via mixed sources: By the public health insurance payer for medical service provision; by the Ministry of Health and Ministry of Science and Higher Education for didactic activities; and via diverse external sources for research activities.…”

“…Physician satisfaction is a complex and multidimensional concept which can be affected by personal and external factors [13,14]. Physicians' satisfaction has significant effects on their productivity, their work ability, and the quality of patient care, as well as their intentions to leave the job or their intent to continue practicing medicine [15][16][17].…”

Public policy failure in healthcare: The effect of salary reduction for new entrant consultants on recruitment in public hospitals

“…Correlation is not causation, and factors other than salary have been recognised as being important in doctors' decisions to migrate. For instance, dissatisfaction with work-life balance, the quality of training provided and the stress of postgraduate training have been shown to be important factors, along with low salaries (Clarke et al, 2017). Indeed, when theories of labour market migration have been examined for healthcare professionals (as opposed to other professions) in an international context, non-wage factors were deemed to be particularly important in the decision to emigrate (Vujicic, 2004).…”

“…However, despite the fact that potential alternative reasons exist for the difficulty in recruiting and retaining staff, the pay differential remains the most plausible theory. It is important to question studies reporting that work-life balance is a driver of emigration involving those in postgraduate training (Clarke et al, 2017). In reality, issues of work-life balance -in particular, issues related to workplace understaffing and conditions -are not a new phenomenon in Irish healthcare.…”