Ciara Kenny

The Irish Times forum by and for Irish citizens living overseas,

Dublin vs Adelaide: a junior doctor’s life

The hours, salary, work-life balance and health system are so much better in Australia, says Toby Gilbert

Toby Gilbert: 'Myself and my wife found everything we had heard about the better work-life balance in Australia was true'

Fri, Oct 18, 2013, 00:00


Toby Gilbert

I vividly remember the moment I decided to leave Ireland. I had just moved in with my girlfriend, and had done a 36-hour shift, starting on a Monday morning and running into Tuesday evening, followed by another on the Thursday into Friday

Since graduating from UCD in 2006, I had been training as a nephrologist, a kidney doctor. Working at St Vincent’s Hospital before I left, I was clocking up an average of 65 hours a week, which is pretty average for non-consultant hospital doctors (NCHDs). I didn’t mind the number of hours so much, but those on-call shifts were a killer.

That weekend, I had had enough. I hadn’t seen the girl I had just moved in with all week, and was thinking: is this the future for us? Will it still be the same if we settle down together, get married, have children? I realised then that I needed to leave.

Myself and my new wife moved to Adelaide in January last year, and found everything we had heard about the better work-life balance in Australia was true.

Culture shock

My first day at work at the Royal Adelaide Hospital was a total culture shock. I couldn’t believe how much more efficient the system was there than in any of the six Irish hospitals I had worked in.

The majority of my interactions with patients in Ireland began with an apology. Sorry it took so long for me to see you; we’re really busy. Sorry you are still sitting on a chair in the emergency department 24 hours after arriving. Sorry the scan won’t happen today, we only have one scanner and there’s a queue. Sorry your outpatient appointment won’t be for another 18 months.

As the human face of a system that was quite obviously failing, I felt I had to constantly make excuses. It was draining. In Australia I work in a system that works for the patients, which is much more fulfilling.

The Royal Adelaide Hospital is a public facility and very similar to an Irish hospital in size and style of medicine. The hierarchy is similar to that in Ireland, and there is a similar public-private divide. Irish doctors fit in really well here and are highly regarded.

That is one benefit of the long hours we put in as NCHDs in Ireland – we get a huge amount of experience. The consultants here really like taking on Irish-trained doctors. They think we are great value.

If I work more than eight days in a row, I start to get a hefty salary loading, which hits the hospital budget. There are also financial penalties for the hospital if I work more than 11 hours in a row, or six hours without a break. It really works, resulting in a happier workforce and a safer system of patient care that doesn’t rely on doctors who are overtired and overworked.

Better salary

I was expecting to take a pay cut, but actually the salaries are much better in Adelaide. Basic pay is higher and taxes lower, so my take-home pay is about 40 per cent more than it was, working 15-20 hours fewer per week. The cost of living is high, though, and we’re paying a mortgage on an unsellable house at home, but overall I am much better off financially.

I watched the strike action by NCHDs in Ireland last week with interest. I am sad it took a day of action for people to take notice of the conditions NCHDs are working under, because no doctor wants to have to go on strike. But hopefully it will have been worth it.

Lots of doctors leave Ireland when they finish training to go to the US or Australia to learn more about pioneering medicine: how to use the new robot or treat the new disease. But the motivations driving them to go overseas have changed. It is more about lifestyle factors and a better work-life balance than career advancement now.

I don’t think I could ever work as a registrar in Ireland again. I hope to stay here to finish my training, and hopefully I can get a consultant job. The consultant pay here is two to three times what it is in Ireland. We might move home eventually, but for the medium term we will be here.

Last weekend I drove to McLarren Vale, our nearest wine region, to do a 10k run in the morning followed by wine tasting in the afternoon. I would never have had the time or the energy to do something like that at the weekend at home.

But I didn’t leave my friends and family and country I grew up in to live on a beach drinking wine in the sunshine. I would much rather be carving out a career for myself in Ireland and contributing to patient care there. But I had no work-life balance at home. I had to go.

Emigrating wasn’t a choice for me, but I hope returning home eventually will be.

In conversation with Ciara Kenny

This article appears in the Life pages of The Irish Times today.