'Why wouldn't I want to go?': doctor migration, retention, return, and Ireland's future medical workforce

Health workforce shortages pose a challenge to European health systems. Challenging working conditions in healthcare were intensified by the global financial crisis and the coronavirus disease of 2019 (COVID-19) pandemic. In Ireland deteriorating working conditions for hospital doctors triggered a pattern of emigration and an increased dependence on international medical graduates. This article seeks to better understand doctor emigration and its implications for Ireland's future workforce, drawing on the case of Irish doctors who emigrated to Australia. The paper draws on three forms of data: (i) secondary data from the Australian Department of Home Affairs on visas issued to Irish citizen doctors; (ii) open-ended survey responses from hospital doctors working in Ireland (2019, N = 469) and, (iii) qualitative interview data from Irish doctors (2018, N = 51) in Australia. Research ethics permission was granted by the host institution. Significantly more Irish doctors were issued with Australian work visas in 2024 (624) than in 2005 (72). Hospital doctor survey respondents described how emigration decision-making was informed by poor working conditions, inadequate staffing levels, poor wellbeing, and dissatisfaction with the quality of care delivered. Emigrant Irish doctors in Australia indicated that similar issues deterred their return. This article shows that Ireland has high rates of outward and inward doctor migration a limited policy focus on retention or return. Our findings indicate that challenging working conditions are a driver of emigration and a deterrent to return. We call for a more person-centred approach to the medical workforce which would improve doctor working conditions, prioritize their wellbeing and promote retention/return.