A qualitative study exploring the migration decisions of Irish-trained specialist doctors

Following completion of Higher Specialist Training (HST) in Ireland the majority of doctors pursue a fellowship abroad. Previous research has identified that while most of these doctors return to Ireland within 5 years, a substantial minority remain abroad. This paper aims to explore doctors' decision-making processes along the pathway between qualifying as a specialist and taking up a consultant post in Ireland.

For this qualitative study, 27 semi-structured interviews were conducted with doctors who qualified in Ireland as a specialist between 2016 and 2021. Maximum Variation Sampling was used to capture the perspectives of doctors across medical disciplines, genders and their current country of residence. Participants were contacted through social media, publicly available email addresses or through gatekeepers. Interviews focused on the personal and professional factors that influenced their career decisions since qualifying as a specialist.

Participants went abroad after qualifying as a specialist, as this was seen as a requirement for career progression. Participants left with the intention of returning to Ireland. Personal factors, which included proximity to family, a partner's career plan and children's needs, are paramount in the decision to return to Ireland. Personal factors were identified as important both in terms of participants' decision to return to Ireland and the locations within Ireland that they considered. Professional factors acted as a barrier to returning to work in the Irish healthcare system. Participant narratives highlighted that the pathway to an attractive consultant post was not straightforward or predictable. After going abroad, intentions to return to Ireland changed due to children starting school, partners' career plans and securing a permanent consultant post abroad.

Policies to reduce the risk of qualified specialists becoming settled abroad include: regional strategic workforce planning; training for the correct level of specialisation; increased regional training; increasing the speed and flexibility of the consultant recruitment process; and restructuring and increasing the domestic fellowship programme.