Why is Australia packed with Irish Doctors?

"Every fibre of my heart is dragging me home, and every wire in my brain is telling me to stay put."

My name is David. I am a 27-year-old man. I am terrified of spiders. I hate the sun, and the sun hates me. I hate the beach. I'm scared of sharks and I can’t find a chicken fillet roll or a good curry sauce to save my life. I live in Australia.

I love Ireland. I miss my family. I miss friends. I miss the warm Irish people who more than make up for the cold weather – which oddly, I miss too. Sure, we love to complain about Ireland – but who amongst us doesn’t love a good moan. I do miss home.

As a young doctor, I’m not over here "living it up" or on vacation.

Perth is a phenomenal city, and a great place to live. But I am in Perth for one reason only – because working in the Irish Healthcare system is appalling. Oh, and by the way, despite my aforementioned love of moaning - it’s not just me. This is a viewpoint held across the board, even by the doctors working in Ireland.

So, if it's so bad - why do they stay?

I’ll tell you why.

There are three things retaining Irish doctors:

1) The pull of home.

2) An overachiever’s tendency to walk the safer, travelled path.

3) The fear of excommunication from the Church of the HSE if one deviates for too long.

- “Ugh, these cry-baby healthcare workers again.”

I know, I get it. But unfortunately, the Irish Government keep trying to fix a hole on a sinking ship with duct tape – so, here we are again. Despite the utterly terrible situation we’re in, Covid-aside, I’ll try to inject some levity to keep you from tearing your hair out.

There are four main issues I plan to address here: Finances, Inadequate Staffing, Rigid Training Schemes and the Big Sibling Ethos.

Finances

A medical graduate would be a highly-valuable asset to any employer. They are a proven commodity with intelligence (me clever) and a high work ethic. Typically, they have spent years in secondary school working harder than their peers, and a further five or six years working even harder in college.

The last two years, of which, are in the hospitals. Nursing students are paid for clinical rotations. Medical students are not.

In these two years, it is impossible to maintain a part-time job and student loans are a requirement. You spend 8am to 4pm in the hospital, followed by two hours of lectures and likely three hours of studying after...

...a thirteen-hour day, five days a week, for two years, unpaid.

By the time we reach our intern year, we are so indoctrinated to feeling worthless that getting paid anything feels like hitting the jackpot.

An intern’s salary is under €40,000 ($60,000 AUD) a year. (4 years of college + 2 years of unpaid full-time work plus college requirements).

An SHO’s salary is €46,000 ($68,000 AUD) (approx.) a year. (Doctor with one year’s experience).

A Registrar’s salary is €58,000 ($85,000 AUD) (approx.) a year. This is a doctor with over three years’ working experience and six years of training.

But, what about overtime you ask?

Firstly, overtime is not something one should include in a salary discussion. Forty hours spent in a hospital, often at obscene hours, is enough for any person. Any more than that takes its toll, both on your mind and on your face (not mine though, obviously).

Overtime is not by choice. We can’t clock out at five if someone’s heart has stopped. Admittedly, actually getting paid for your overtime is something fairly new to the HSE. However, nowadays, any overtime you do earn goes into the new Irish tax bracket called:

“I’ll have half of that, thanks”.

The remaining pennies enforced overtime pays is not worth the lack of a life.

Of note, most young doctors need to work in Dublin due to the demand and the experience these hospitals provide. When you consider the nosebleed-inducing rent prices, most doctors are lucky to be able to gain mortgage approval by the time they turn thirty.

In a private market, I reckon that an individual with 6 years of hospital experience, who can run the whole place on their own overnight, walking the line of life and death, may earn over €60,000 ($90,000 AUD) a year. Just a hunch.

Inadequate Staffing

“Okay. So, we’re paying doctors half their value. Surely, we can hire more of them?”

“No no...not just yet...let them suffer”. *Strokes evil cat*

In a 600-bed hospital, one medical registrar is working overnight. They are responsible for anyone who deteriorates, all medical admissions or queries from ED, and are to conduct the management of cardiac arrests.

Is it fair to the doctor? No.

Is it safe for the doctor’s mental health? No.

Is it safe for the patients? A big, fat no.

Anecdote time: As an intern with three weeks’ experience, a patient suddenly went into cardiac arrest.

In between delivering chest compressions, I was asked to ring the patient’s son to inform him that his father had arrested. Unfortunately, we lost the patient, Subsequently, I had to pronounce the death and inform the patient’s family of the unexpected passing. In the midst of their grief, I slipped out to answer a phone call. A nurse berated me – telling me that I hadn’t attended to a particular job. I took out my phone and had thirty-six jobs on the list still pending. There was no time to process the event. There was no time to drink some water to replenish my sweat and tears. I had to soldier on, and soldier on I did.

Little did I know back then, this kind of shift isn’t a rarity. It’s more common than not. You are always chasing your tail.

In particular, the skeleton staff for on-call hours is simply ludicrous. You spend your whole shift on the verge of a panic attack, prioritising patients on their likelihood to die in the next few hours. This isn’t hyperbole, that’s the reality.

Rigid Training Schemes

You’ve done a few years as a doctor and now it’s time to enter a scheme. Most of the training schemes are very competitive, and the requirements for entry are getting more and more preposterous as desperate doctors try to outdo one another in a bid to leave the rat race.

On top of our busy work life, we are expected to do boring, tedious research projects that nobody is ever going to read – purely to be able to say we did it. It’s mundane CV padding at its finest. And, the floor of requirement is rising.

It’s not beyond the realm of possibility that soon, you will need a PhD to get an interview for certain schemes. It’s utterly mental – pointless academia.

Once on a training scheme (they range from 4 – 7+ years), the horizon of consultancy is in sight, but the nonsense is not over.

Example time:

A mother with two young children, living in Dublin, struggling to pay off a mortgage she barely secured, has been told to go to Galway for 6 months.

“Can I stay in Dublin?”

“No”.

“Please?”

“You have no choice if you want to progress on the scheme”.

“Will you help me financially with the rent in Galway, or additional childcare costs?”

“Hahaha...Bridget did you hear that?!” *Hangs up phone*

The decision-makers don’t care because it isn’t their life. You are a name on a spreadsheet that fits a space, and the click of a mouse - nothing more.

Big Sibling Ethos

“Stop complaining kid, we had it worse”.

Consultants are the top of the hospital hierarchy, and they traversed a tough plain to get there. Their salary is fair compensation for the multiple 36 hour shifts they got through. Calling a consultant overpaid is like complaining about an amputee-war veteran’s pension. They had it tough, and their resilience is commendable.

But with resilience comes stubbornness, and with that comes antipathy to change – especially change that makes the path they travelled smoother for the next person than they had it.

It’s human nature really. To this day, if my younger brother gets anything I didn’t, I’ll throw a tantrum.

As a result of this, there tends to be a ‘suck it up’ attitude that filters down through the hospital like a suffocating mist. If a doctor ever leaves early for a personal matter or calls in sick, it is looked down upon, gravely.

Why? It just is. Perhaps, because of understaffing, your absence means additional strain on your already-splintering colleagues.

The ‘suck it up’ environment promotes careerism and degrades other avenues of life's fulfilment. Basically, you can have a life when you’re forty, maybe. Until then, this is the only priority that matters.

Today’s consultants had it rough, no question. But I think it’s a fair point to mention that our generation has a unique issue .

The salary: cost of living ratio is the worst it’s ever been.

Assuming savings of €10,000 a year (difficult to do with today’s rental crisis), a very modest three-bedroom home in Dublin will cost approximately sixty times your net annual savings. Lovely jubbly.

What’s so great about Australia if you hate the sun?

Currently, I am living in Perth, Western Australia.

I am a SHO/RMO, meaning that in Ireland, I would be paid €45,000-€50,000 a year. Here, my salary is €75000 a year. Rent prices are expensive, but still better than Dublin. I am living in a nicer home than I could dream of in Ireland and still managed to save approximately €40,000 last year. A €600,000 home in Dublin would cost €325,000 here.

This means that my net savings: house ratio is under ten, instead of sixty.

The staffing isn’t ideal. However, it is a lot better than back home.

We still work incredibly hard, but there are additional staff members available to cover sick call or annual leave. There is a far better work-life balance, both culturally and practically. Their schemes are flexible, with huge amounts of control given to the individual.

Despite all of this, I would love to return home. On a personal note, my father became unwell last year and it was extremely difficult to be so far away from my family.

Thankfully, he is doing well, and I plan to visit for a full month soon.

Every fibre of my heart is dragging me home, and every wire in my brain is telling me to stay put. The financial differential alone is staggering. Like I said, my net savings to house price ratio is under ten here and sixty at home.

With today’s cost of living, especially in Dublin, I believe that junior doctors are being paid half of their worth. They came first in their year in school, work like savages and shoulder an incredible amount of responsibility. In the private sector, this would easily be worth €100,000 a year minimum.

Amongst junior doctors in Ireland, there have been talks of strikes recently. If junior doctors strike in any capacity, patients will die. If they don’t, their plight will continue to be ignored. It’s extremely hard to do garner attention and striking is the last thing doctors want to do.

This is an incredibly hard problem to solve. But perhaps, it is time that junior doctors are given something more tangible than a clap on a Thursday night or a one-thousand euro bonus.