Cutback of intern posts squeezes out many Irish-trained doctors

Many international medical graduates who trained in Irish colleges have missed out on a job with the HSE this year, and some will be forced to leave Ireland in search of work.

Graduating medical students who wish to work in Ireland must complete an intern year before they can practise medicine and receive further training.

The intern posts are offered based on nationality, and Irish and EU citizens are prioritised over non-EU citizens. Each year, the HSE offers 734 intern posts to graduates.

However, it last year created an extra 300 posts because of the Covid-19 pandemic, with 258 of these filled.

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In March, ahead of the next round of intern offers, the Keep Our Doctors Campaign was started by graduating medical students. It aims to increase the number of intern posts, so more international graduates can stay and work for the HSE.

The HSE announced in March that 120 extra intern posts would be offered this year, bringing the total number of posts available to 854. Last year, 992 posts were filled.

Dr Isadora Lamego, who is involved in the Keep Our Doctors Campaign, says there are not enough intern posts to meet demand. The Royal College of Surgeons graduate was initially was put on a waiting list for an intern post, but has since been offered a job.

However, Dr Lamego says she knows of many other international students who are on the waiting list, despite graduating with high marks. They have also done research and spoken at conferences.

She is uncertain exactly how many graduates lost out, but she estimates it must be more than 100.

“In the opinion of our campaign and honestly most doctors I’ve talked to, the additional intern jobs in 2020 were a big change in the health system,” she says.

“They were seen by many as one way to address the under-staffing issues within the HSE.”

One such doctor who has missed out is Dr Margo Henkhaus from Arizona. She graduated from RCSI this year but was not offered an intern post.

“I was devastated. I knew it was a possibility, but in my mind I truly believed that I was going to spend the rest of my life in Ireland. I can honestly say it has been the worst heartbreak I have ever experienced.”

Dr Henkhaus has returned home to the US to look for work.

“Unfortunately with the way intern selection works in Ireland I would be no more likely to get an intern year job next year; thereby ending my ability to pursue the career in medicine that I have worked so hard for.”

She is already missing Ireland. “More than anything it feels home for me, and that is feeling that you don’t get just anywhere you live. The people in Ireland are amazing; everyone is so kind and has an amazing sense of humour. People are friendly and welcoming. The country itself is breathtakingly beautiful and each city and town has its own charm.”

She thinks that politicians and the HSE do not realise how busy clinics and wards are. “They don’t understand how overworked hospital staff already are.

“I have also heard the arguments that registrar and consultant positions go unfilled every year, but they are not taking into account that many people leave the country because of the working conditions, to seek employment in countries where there is better pay and more support.”

A spokesperson for the Irish Medical Organisation said the union was “disappointed” that the Minister for Health did not expand intern numbers.

“Given the requirement to reorient the health service as we emerge from the most recent phases of the Covid pandemic, facing into ever increasing waiting lists, it would have been wise to ensure that the health service availed of all of the medical expertise that could be accessed.

“However, the reduction in intern places from the 2020 figure means that doctors who wish to begin their careers in our health service, where the demand for care is so great, will not be able to do so.”

In response, the HSE said it applies the Employment Permits Act when recruiting for intern posts.

“This means that all applicants who will not require a permit to work in Ireland will be allocated to posts ahead of applicants who will require a permit.”

The HSE said that all eligible CAO entrants to Irish medical schools who are work-permit exempt are guaranteed an intern post, and the usual 734 posts are in line with the number of CAO applicants.

“Non-EEA applicants have always been subject to work permit legislation requirements and are offered intern places that have not been taken up by EEA applicants at the first stage of offers.”

When asked why the extra 300 intern posts from 2020 were not continued into 2021, the HSE said the increase was an emergency measure.

However, the HSE said that it would be undertaking a formal review of the number of intern posts available over the next few months. “As part of this review, the clinical sites where additional intern posts are most needed will be considered,” it said.

“Following the review, a proposal will be developed and presented to the Department of Health with the recommended number of intern places going forward from July 2022.”