Medical graduates


Sir, – It is now ten years since I wrote to The Irish Times, lamenting the declining retention rate among our precious medical graduates. Far too many of them were opting out of full-time careers to pursue “work-life-balance”, I argued, while many Irish teenagers who might stay the course were denied access to medical school by our fatuous points (and subsequently HPAT) system. And I suggested that – in addition to the shortages of beds and other resources in our creaking health service – we should be just as worried by the shortage of home-grown doctors in Ireland, our strategically disastrous reliance on the international medical manpower market, and the failure to recruit medical students willing to become the round-the-clock doctors that our citizens desperately needed.

Since then, we have had attitudinal surveys, worthy reports, and anxious editorials (March 16th) but the medical manpower situation here is actually worse, with all that that implies for patients, and for those few of us who remain to care for them at the healthcare “frontline”.

So can I make some suggestions directed at breaking a vicious circle which apparently means that the current working conditions for doctors may deter medical graduates from ever working in Ireland?

First, can we establish what our graduates are actually doing after graduation? We often hear that they head off immediately after qualification to seek better “terms, conditions and prospects” yet many of them go off on a (minimally medical) “gap year”. This is crucial because few charges are more corrosive than the notion that “you can’t properly train in Ireland” (implying failure on the part of existing consultants and flying in the face of the reality).

Second, can we find out if this “gap year” is good or bad for our graduates’ prospects, or whether it is just good for their mental health (and thus a highly laudable idea)?

Third, can we then work around the gap year, by arranging employment “proleptically” – an old-fashioned idea of deferred recruitment, which allows people to travel and then return to posts all over the health service?

Fourth, can we establish if our first-year graduates are as “attractive” to potential overseas employers as their forebears, ie the majority of Irish doctors, who emigrated for training purposes after spending a few years locally acquiring (a very great deal of ) basic experience?

All this matters because we can work more effectively around “facts” than “intentions”. Of course, prospects reflect the former, not the latter.

And, finally, can we, er, “rearrange” the people in charge of medical manpower in this country? – Yours, etc,


Consultant in

Emergency Medicine,

Mercy University Hospital,

Grenville Place, Cork.

Sir, – T Gerard Bennett (March 14th) believes that we taxpayers deserve a better level of return on our investment in high-cost educational courses such as medicine. Of course I agree with him on this point. However, we must not forget that up to one-in-three Irish medical students have had to take the Graduate Entry Medical Studies (GEMS) route. Because the Student Universal Support Ireland (SUSI) grant is not available to them they must borrow a sum of €100,000 to cover their fees and cost of living.

According to the GEM Debt Campaign, when GEMS students graduate they must immediately begin monthly repayments of up to €1,178 on loans taken out to fund their medical degree. Average loan repayments are too high to be covered by the starting NCHD salary of €2,114 monthly after tax when cost of living is taken into consideration. This inability of current GEM programme graduates to meet repayments has resulted in banks reducing the maximum loan facility for prospective GEM students from €100,000 to €60,000. The effect of this is to exclude many families who cannot afford to cover living expenses directly.

Other countries with graduate-entry programmes have solved this problem by the introduction of tax relief on repayments of approved loan products. When we lose a doctor who has graduated from a graduate entry medical programme, we are losing somebody who wanted to be an Irish doctor. The tax relief being sought would both enable, as well as require, highly qualified doctors to stay and work in this country in order to avail of it. Relief would be permitted as a deduction against an individual’s taxable income at their marginal rate rather than as a standard rate tax credit. The income tax relief would reduce loan repayments for GEM graduates by 37 to 38 per cent. The annual cost of the scheme would be approximately €5 million.

Such a very small investment now that will bring huge returns later! – Yours, etc,



Co Galway.