Consultants call for measures to allow non-EU doctors develop careers in Ireland

Only 4.5% of doctors registered for specialist training here come from outside EU, says Medical Council

Dr Faraz Rafey from India  has interviewed four times for the national specialist scheme in endocrinology. One  year he was ranked first on the panel but still  could not be offered the position. Photograph: Alan Betson

Dr Faraz Rafey from India has interviewed four times for the national specialist scheme in endocrinology. One year he was ranked first on the panel but still could not be offered the position. Photograph: Alan Betson

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More than 40 consultants and medical professors from Dublin’s Beaumont Hospital have called on the Government to “find the innovation and flexibility” to enable non-EU doctors to develop their medical careers in Ireland.

A letter, sent by the senior Beaumont doctors to Minister for Health Stephen Donnelly last month, says it is “galling” to see colleagues, who have put their own health at risk to care for patients during the Covid-19 pandemic, “stalled in their career progress”.

“Doctors who have proven themselves appointable to higher specialist training and have worked so hard for the HSE, and who are eligible for citizenship should be allowed progress in their careers,” the letter states.

However, doctors from Pakistan, Sudan and many other non-EU countries, who are “suitable and desirable for specialist training”, cannot be appointed because of EU employment law, it adds.

The missive is signed by some of the hospital’s most senior practitioners including Prof Christopher Thompson, Royal College of Physicians (RCPI) national speciality director for endocrinology; Dr Aoibhlinn O’Toole, RCPI national speciality director for gastroenterology; and dean of postgraduate education with the Royal College of Surgeons of Ireland Prof Peter Brannigan.

Consultant posts

Higher specialist training is the final step on the path to specialisation in medicine. It is a four- to six-year training programme and on completion doctors become eligible to register with the Medical Council as a specialist and can begin to apply for consultant posts.

Currently, non-EU doctors who apply for basic and higher specialist training programmes in Ireland are ranked bottom of the list because of a preference system that allocates first places to Irish citizens, followed by EU nationals, applicants with European family members and those who are married to an Irish or EU citizen and hold long-term immigration permission.

Doctors educated outside the EU, who hold Stamp 4 immigration permission but do not fall under family or marriage categories, are only considered if training places are unfilled after the first round.

It was hoped legislative changes introduced in November 2020, which now allow foreign trained doctors with internships previously not recognised by the Irish Medical Council to apply for training programmes, would enable career development for non-EU doctors in Ireland. However, in reality, it has made little difference because of the programme’s preference system.

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Some 44 per cent of doctors on the council’s general register are trained outside the EU, while 4.5 per cent of doctors registered on the trainee specialist division are non-EU, according to data from the council.

Data provided by it shows 88 non-EU doctors voluntarily withdrew from its register last year, many citing a lack of “flexible training options” and “limited career progress opportunities”.

The Beaumont letter warns that Ireland has “the lowest number of specialists per head of population in the EU” and so “it is clearly in everyone’s best interest that we train and retrain as many of our medical workforce as we can”.

‘Ethnic diversity’

During the latest interviews for higher specialist training “there was a clear deficit of the ethnic diversity that is reflective of our medical work force” among applicants, the letter notes, adding that there is “widespread discomfort that excellent candidates were not offered the opportunity to obtain specialist training due to lack of EU status”.

It cites the example of Dr Faraz Rafey from India who attended medical school in Romania and moved to Ireland in 2014. Dr Rafey has interviewed four times for the national specialist scheme in endocrinology and each year was ranked highly enough to be offered a post. One year he was ranked first on the panel but still he could not be offered the position as a non-EU national.

“I have lived here for seven years now, have permanent residence since the last 19 months,” Dr Rafey told The Irish Times. “I think they should consider giving equal status to someone who has Stamp 4 and committed their life to the healthcare system.

“Waiting for the Irish naturalisation process is something inevitable and should not delay us doctors once we have Stamp 4 to proceed in getting our specialist training posts,” he said, adding that the system should be “based on excellence and merit, not on nationality or EU status”.

Medical Council president Dr Rita Doyle said the departure of non-EU doctors to other countries where they can avail of further training “has been a drain on our healthcare system” and that “training numbers need to be increased in a planned and considered way”.

“While the amendments to legislation late last year was a welcomed development, and long sought by the Medical Council, more needs to be done,” said Dr Doyle.

Dr Amna Syeda is running a separate campaign calling for non-EU doctors on Stamp 4 immigration permission to be ranked equally to their Irish and European peers when applying for specialist training and argues that “naturalisation should not be the only way out for non-EU graduates to progress”. Foreign doctors have earned equal treatment “through their commitments and selfless sacrifice on the frontlines of the Covid-19 pandemic”, she says.

Citizenship process

Delays in the citizenship process should not hinder doctors from developing their careers, she adds.

“These issues have been brushed under the carpet for a very long time. These doctors are the first ones to cover the bank holidays and Christmas holidays in this country. It’s fine for us to cover emergencies but then all we get is a ‘well done’. We need more than lip service.”

Asked to comment on the letter from the Beaumont doctors, a spokeswoman for the Department of Health said the HSE had requested a “formal review” of the use of the EU community preference system when recruiting for postgraduate training places.

“The department have agreed to early engagement with the HSE so that clarity can be given to potential candidates and training bodies well in advance of the commencement of the recruitment process for the July 2022 intake this autumn,” she said. “As part of this wider review the inclusion of all Stamp 4 holders, regardless of how the Stamp 4 permission was received, will be considered.”

She also noted that Mr Donnelly had raised the issue of delays in the processing of citizenship applications for frontline healthcare workers with the Minister for Justice and said a temporary online system introduced in January to replace in-person citizenship ceremonies was enabling applicants to complete the naturalisation process during the pandemic.