Eimear Nic Siacais is sipping a cup of tea in a quiet corner of a Belfast cafe where she once worked.
It is late afternoon on a gridlocked Falls Road and she has just walked the short distance from Northern Ireland’s biggest hospital, the Royal Victoria Hospital, in preparation for her next round of student medical training.
Beaming, the west Belfast-born woman stirs a sachet of sugar into the tea and shouts “slán” to her father as he heads to a building where she had a part-time cleaner’s job.
This time next year, she will be sitting her final medical exams.
The 33-year-old shakes her head in disbelief at the idea.
Growing up in the working class Ballymurphy area – where she still lives and credits its “great community” – she knew no one with a profession.
“I thought that someone like me could not become a doctor,” she says. “Where I come from, people don’t do medicine. You’re lucky if you get a good job, you’re lucky if you get into the Royal as a domestic. But medicine? No, it’s not even on your radar.”
Nic Siacais is considering a career as a GP at a time when the sector is struggling to attract staff.
During a Stormont scrutiny committee session last week, a doctor gave evidence on the “crisis in general practice” in Northern Ireland, with a spike in surgeries handing back their NHS contracts and closing over the past decade.
“It is the most visible indication of the crisis we’re in … 11 per cent of our practices are gone. The situation is untenable and without a solution, it’s going to get worse,” Frances O’Hagan told the Public Accounts Committee.
Areas of high deprivation as well as Border towns and villages – which historically recruited trainee doctors, including many from the Republic – are hardest hit, the committee heard.
The warning comes as a growing number of Northern GPs and consultants are now choosing to work in the Republic where they can expect to double – and in some cases triple – their NHS earnings.
Nic Siacais says she wants to remain in west Belfast, which consistently ranks as one the most deprived constituencies in the North.
However, she expresses frustration at the barriers preventing “many capable people” from entering the medical profession.
The mother of three, who became pregnant at 16 when studying for her A-levels, is in her third year of a four-year graduate medicine course at Ulster University’s (UU) Magee campus in Derry.
Beset by funding delays, the medical school finally opened in 2021 and has a particular focus on increased GP training; its first graduations will take place this summer.
Nic Siacais recalls being given advice before her first placement at a GP surgery in west Belfast.
“The practice was actually right behind my house over the peace wall. The patients were working-class people and I really liked that,” she says.
“We were told at university that we had to get to know the area and find out the demographic. I was given this whole talk about it being one of the highest deprivation stats and that I had to be ‘sensitive’ talking to patients.”
Laughing, she says she told the university: “I know, I live round the corner.”
During last week’s Stormont committee session, concerns were also raised about the number of trainee GP doctors from the Republic returning home after completing their medical training in the North.
Figures provided by Ulster University show there has been huge interest in the postgraduate medical course from the Republic; the number of enrolments from across the Border more than quadrupled from 20 in 2021/22 to 87 in 2024/25, representing “around a third” of its overall medical student population.
Until 2021, Queen’s University Belfast was the only place to study medicine in the North; it has also seen a jump in entrants from the Republic, rising from 6 per cent of its intake in 2020 to around 11 per cent this year.
For students such as Nic Siacais – who is one of a handful on a full scholarship – the Magee course allowed her to pursue a career in medicine after strict criteria prevented her from studying the undergraduate course at Queen’s.
When she was in her early 20s, she returned to education after spending a year at home with her three children during a period she was ill ; she graduated from Queen’s with a degree in human biology followed by a first-class master’s degree in clinical anatomy.
“When I started my master’s, I realised I wanted to do medicine. But I didn’t know how I was going to get there,” she says.
“Med students generally come from medical families and go to grammar schools. So it’s not only finance that’s a barrier, it’s the culture as well.
“Grammar school students are sat down and told, ‘If you want to do medicine, this is what you need to do’. They carve out a path for themselves, they go and spend a week in South America in seventh year or they spend a week with their father’s colleague, who’s a rheumatologist. That’s what you’re up against.”
In a statement, Queen’s said about a quarter of its entrants to medicine each year were from lower socioeconomic backgrounds “as per the Northern Ireland multiple deprivation measures”.
Nic Siacais expresses surprise at this figure.
“Queen’s would never have taken me as a medical undergraduate as you can only get in with science A-levels on your first attempt. Moving away wasn’t an option because of my kids and my husband was working in Belfast. I also couldn’t have afforded it,” she says.
Significantly lower fee costs at Magee compared with medical postgraduate courses in the Republic have also proved a huge draw in attracting students from different backgrounds.
Dubliner Sinéad Doyle (26) is in her second year at the Ulster University course.
A behavioural therapist who worked with autistic children, she says the hike in the Republic’s university fees and scrapping of the Bank of Ireland student medical loan were factors in her decision to apply in the North.
The Ulster University fees are £4,750 (€5,662) a year compared to €17,460 per year for University College Dublin’s graduate entry medicine course.
“I just don’t know how I would have done it in Dublin. My parents would have had a massive debt,” says Doyle, who grew up in Firhouse.
Living with five medical students in Derry city, she works as a carer at weekends.
Rent and cost of living are “so much cheaper”. She and her housemates are each paying £437 a month in rent “with bills included”.
“That’s for a double bed and en suite for each of us. My friend was paying €10,000 for six months for a room and shared bathroom close to UCD back in 2017; when you compare it, it’s just insane,” she says.
I still have impostor syndrome, especially on surgical placement. You think, ‘It’s my second week in second year and I’m standing in theatre’
Despite the lure of higher salaries in the Republic, she wants to remain in the NHS.
“I am personally on the side of staying; I’ve got so used to Derry, I love it here. I’m in Antrim next year on placement and then I’ll be in Belfast,” she says.
Doyle studied applied psychology at the Institute of Art, Design and Technology in Dún Laoghaire, Co Dublin, and decided she wanted to become a doctor after working as a heathcare assistant during the pandemic.
She is the first person in her family to study medicine.
“I still have impostor syndrome, especially on surgical placement. You think, ‘It’s my second week in second year and I’m standing in theatre’,” she says.
“But it is starting to come together this year. You’re given more responsibility now, which is nice. Another thing that pushed me up here is that we do clinical placements from early on. We’ve been seeing patients since our fourth week. I know some medical undergraduates in Dublin who still haven’t had a clinical placement by third and fourth year.”
Northern Ireland’s main doctors’ union supports the new cohort of postgraduate doctors being trained in Derry, but it echoes concerns about the number of junior doctors from the Republic going back there for jobs.
“I think we need to be very focused on our future workforce in Northern Ireland – and we’re not,” says Alan Stout, chair of the NI British Medical Association.
“We need to make sure that the workforce we’re training is going to stay here and work here. This is one of the biggest challenges we have. It’s a worldwide market at the moment: everybody is looking for doctors. But we have the particular challenge of Sláintecare in the South … it is attracting our doctors to work there.”
Dr Stout points to the extra 25 student medical places at Queen’s being funded by the Irish government from this September – it brings the total number to 50 – “with an expectation” that they will work in Republic’s heath service.
“It’s very much train here, go back there,” he says.
As she leaves the cafe in west Belfast, Nic Siacais is adamant she will never work in the more lucrative private medical sector amid spiralling NHS waiting lists.
Her latest GP placement is in a south Belfast suburb, where the demographic is “very different” to west Belfast.
“They’re coming in looking for their referral letter for private care. If you don’t have money, you’re sitting on a waiting list for eight years for a speciality like neurology. It’s a disgrace,” she says.
“I would like to be a GP because I would love to work in the community. My parents, who encouraged me to educate myself, and siblings all work in the community.
“Skills should stay in communities. People get professional degrees and leave. I won’t be going anywhere. I’ll never leave the Falls Road.”
