Shortage of doctors leads to positive employment prospects for grads

With the Covid-19 pandemic dominating the news for much of the past two years, the importance of medicine and healthcare has never been more obvious to members of the public.

Scientific terms such as the R-rate, personal protective equipment and exponential growth became part of the common vocabulary, as regular people gained a small understanding of virology and public health.

It would come as no surprise, then, that some students completing their Leaving Certificate might now be considering a career in healthcare.

But it is a decision one must not take lightly, with the courses having some of the highest entry requirements in the country and having one of the heaviest workloads for the duration of the course.

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Prof Arnold Hill, chair of surgery at the Royal College of Surgeons in Ireland (RCSI), said there are three main routes to studying medicine.

To earn a place on a medicine course in Ireland immediately after the Leaving Cert, students must first complete the Health Professions Admission Test (Hpat), which assesses whether students have the right aptitude for third-level medicine courses.

Registrations for the Hpat to ensure a place on courses for the upcoming year closed in January.

Students’ Hpat and Leaving Cert results are then combined to give a total overall result, which is then used to ascertain who will get a place on the courses.

In 2021 Irish Leaving Certificate or equivalent points for students who successfully entered the RCSI medicine programme ranged from 554 to 625 and HPAT-Ireland scores ranged from 172 to 224. The combined Hpat and points score required for admission to the undergraduate medicine programme in 2021 was 740.

Grade inflation

Entry points for all courses increased substantially between 2019 and 2021, a situation which has been attributed to the grade inflation caused by the calculated grade system that was introduced during the Covid-19 pandemic.

Last year there were about 85 students who received the maximum points in their Leaving Cert and were not accepted into medical school due to a lack of places.

According to Prof Hill, progressing directly from the Leaving Cert is the “hardest route” of entry to medicine courses in Ireland.

“The problem is with grade inflation last year there will be a significant cohort of excellent students who didn’t get in last year and will be applying again this year after repeating their Hpat,” he said.

“So if you’re doing your Leaving Cert for the first time, you’re competing with a cohort of excellent students who failed to get in last year.”

The Government is expected to increase the number of places on medicine courses by 200 by 2025, a move aimed at relieving the pressure in this area.

The plan will initially see an increase of 120 places over the coming two years, starting with the next academic year in September.

Another route of entry is the graduate entry route, available to students who have completed a level-eight degree and achieved a 2.1 or higher.

"You are then eligible to do another exam called Gamsat [Graduate Medical School Admissions Test]. And there are graduate entry places in four medical schools in Ireland. You could have done an undergraduate in history, music, whatever you want and then go into graduate medicine," Prof Hill said.

Mature student

If you’re a mature student over the age of 23, there are also a small number of mature places available.

Additionally, some students who undertake chemistry in their Leaving Cert are able to complete the course in medicine in five years, instead of six years, depending on which school in which they choose to study.

Furthermore, Prof Hill said more and more Irish students are choosing to study medicine abroad.

"Many Irish students are educating themselves in Eastern Europe, and there are a whole range of schools that welcome Irish students. I think that should be encouraged. Because there are excellent people that should have the opportunity [to study medicine]," he said.

He said Hungary, Poland and Croatia have schools that teach medicine through English.

Through these courses, students learn good communication skills and practical skills in order to enable them to practice as a doctor.

“Practical, clinical training is very intense in the latter year of these programmes. The majority of years three, four and five are in a clinical setting to get them ready to be a doctor,” he said.

“Because from day one on the wards, you have to be able to be safe and able to practice as a doctor.”

In terms of job options upon graduation, Prof Hill said the “beauty of medical school” is that the options are so great and vast.

“You can choose hospital medicine, primary care and a whole range of other things that you could go into. It’s now regarded as a basic qualifying degree for many other aspects. It’s probably one of the most diverse portfolios of what people can go into post graduation,” he said.

To specialise after graduation, you then go into specific, competitive training pathways to become a neurosurgeon, cardiologist, a physician or whichever other speciality a person may choose.

Positive outlook

The facts and figures for the courses paint a positive outlook. A study by the Higher Education Authority (HEA) found that in the 2019 to 2020 academic year, the dropout rate for students in health and welfare courses was 6 per cent, down from 9 per cent two years earlier.

However, those working within the sector say it is important that prospective students go into the field with their eyes open.

The hours can be long and taxing. According to a 2020 report by the Irish Medical Council, almost 60 per cent of doctors said they were working more than 40 hours a week, while a quarter said they were working more than 48 hours.

While the courses are intense, as are the jobs upon graduation, the pay can be quite rewarding.

Research from the Higher Education Authority (HEA), which tracked the earnings of tens of thousands of graduates who left third level between 2010 and 2017, found medicine graduates are by far the best paid within four years of leaving college, with average earnings of €1,085 per week.

However, salaries vary depending on which areas in the health sciences graduates decide to work in. A top consultant can earn about €200,000 a year but a registered and experienced nurse may be on only €40,000 a year.

Furthermore, Ireland is currently experiencing a shortage of doctors, meaning the employment prospects are very positive for graduates.

“I don’t think unemployed doctors are a part of Irish society,” Prof Hill added.

“It’s a perfect career. It is very rewarding, and that’s the bit that I like. I like the variety of patients, and I like the fact that you meet different people and doing something for someone is very rewarding. It’s certainly worthwhile to get up in the morning and realise that you’re doing something good for somebody else.”

There are a vast array of healthcare fields, for those who, perhaps, decide they want to work in the sector but don’t want to be a doctor.

General nursing courses are available at Trinity College, UL, UCC, UCD, NUI Galway, RCSI, Atlantic Technological University, DCU, the South East Technological University, St Angela's College and the technological University of the Shannon.

Plenty of options

There are also plenty of options for students who wish to train as mental health nurses with courses at DCU, Dundalk IT and UCD; as psychiatric nurses at Atlantic Technological University, the South East Technological university and Dunkdalk IT; as intellectual disability nurses at St Angela's College in Sligo, Trinity College, UCC and UL; or as children's nurses at DCU, Trinity, UCD and UCC.

Students can also consider midwifery at Trinity College, UCD, NUI Galway, UL and the South East Technological University.

Both UCC and Trinity College offer undergraduate courses in dentistry, while RCSI offers a postgraduate course. For dental nursing, the Technological University of the Shannon and UCC offer courses, while those who want to study dental hygiene can undertake level seven courses at UCC and Trinity.

Meanwhile, students seeking to study physiotherapy have courses available at UL, UCD, RCSI or Trinity College.

Jobs

Graduates of medicines have a huge number of career choices in which they can specialise.

The first choice is whether they will work in a hospital, primary care or laboratory-based diagnosis and research.

After that, graduates can choose to specialise in emergency care, neurology, cardiology, surgery, obstetrics and gynaecology, paediatrics and a whole host of other options.

Radiographers and pharmacists are also possible job options for those who choose to study these courses in medical school.

Outside of being a doctor, there are healthcare-related science jobs such as nursing, dentistry, dental nursing, mental health nursing and physiotherapy.

Skills

Teamwork is a key skill graduates of medicine learn, due to the fact that treating patients is a multidisciplinary effort.

Communication is also picked up through the course, with an emphasis on how to speak to patients and explain their medical conditions to them. Adding to that, the ability to give presentations is an incredibly important skill.

Analytical and critical thinking, as well as problem solving, are inherent for those working in medicine or healthcare, with many situations often requiring outside-the-box thinking.

Then, of course, graduates will be equipped with technical skills such as physically administering treatments, reading and understanding results and scans, and prescribing medication.

Katie Flynn, Bachelor of Science and Radiography in UCD, 2016

In school, I always knew I had an interest in health and the sciences would have been the subjects I enjoyed the most. I was looking at medicine, radiography, physio and occupational therapy, and then when I was in transition year I was able to go to a hospital for a day to see the radiography department. From there, I realised I really liked it.

It’s a challenging course but it is very enjoyable. There’s great variety in it. The UCD course is very well laid out, and it gives you really good knowledge in anatomy and physiology, and the technical aspects of radiography before you even go out on clinical placement.

It created an opportunity to have such a great knowledge of the human body. You start and you build on that base, and you get more confident in yourself in that knowledge.

When I finished in 2016, I came down to Waterford and I'm working in the hospital here. I love it, it's a great job. Each day you're coming in and you're getting to help people and it's challenging.

It’s such a privilege to be able to provide high quality patient care and to be able to help people and applying that knowledge all the time.

Dr Lorcán Ó Maoileannaigh, Medicine, NUI Galway, 2020

I did the six-year course. There’s no two ways about it, it’s a long course. You start off doing all of the basic sciences and then you slowly but surely progress into your clinical sciences, where you start applying your knowledge to human health and disease. And then you slowly progress from the lab and from the lecture hall to the hospital-based setting.

I probably learned the most when I was actually in the emergency department, because it was hands-on. You saw a variety of presentations and you got to become involved in the team. You got to assist in the procedures.

I repeated my Leaving Cert to get into this course and to pursue this profession. In many respects it’s seen as a vocation and something you dedicate your life to. It is quite the honour when you are involved in a life-saving case.

Sometimes with how busy things are and how hectic things are, and there are issues in terms of doctors’ health and wellbeing, but sometimes when I’m walking home after a shift, I pull it back and realise that this is where my journey has taken me and it’s quite an honour.