As students go abroad to train as doctors, overseas students are flocking to Ireland to study medicine. Fiona Tyrrell reports on a pattern that is causing concern
The number of students entering medical schools in Ireland has increased rapidly in recent years. However, this increase is confined exclusively to fee-paying overseas nationals.
Meanwhile, some Irish students who are failing to get one of the increasingly limited number of places available to medical students from the European Union are going to Eastern Europe for their medical training.
The new admission system into the medical profession will see graduates and second-level students sit an aptitude test for entry into medical schools. This system, however, fails to address the basic problem of a lack of places on medicine courses and it does little to address the difficulties faced by Irish students competing for a small number of places.
For every three Irish medical trainees entering our colleges, there are five overseas students. Increased competition for EU places has pushed points up and this year the minimum points for medical schools entry was 570 points. It is estimated by the Irish Medical Organisation that six out of 10 students who apply for medicine re-sit the Leaving Certificate after failing to get the points.
Meanwhile, it accepted in most quarters that we are not training enough doctors and are failing to hold onto those we train.
For those who failed to get places in Irish medical schools, the UK was always an option, but now alternative routes into the profession have emerged. This September, 20 Irish students began pre-medical courses at Yeats College in Galway and Waterford in the hope of gaining entry to medical and dentistry courses in Charles University, Prague next year, where the course is taught in English.
For these students, entrance to the university is based on Leaving Cert results, a pre-medical exam, a pre-entrance exam and an interview, all of which take place in Ireland. This is the first year of the course and students have paid €1,000 on top of the €4,800 fee for Leaving Certificate tuition for the course, which includes a Czech language course, an orientation programme and exam fees. Students pay €8,900 a year for medical training once in Prague.
Meanwhile, more than 30 students made the trip to Hungary this year to begin medical, veterinary or pharmacy training in one of the country's state colleges. There has been a big increase in the number of inquiries about medical training in Hungary in the past year, according to Timothy O'Leary, a vet in Co Cork who represents Hungarian state universities in Ireland.
Of the 50 or so students he has helped get into these courses in Hungarian state colleges in the past three years, 30 were this year.
Entrance is based on Leaving Certificate results and an entrance exam. A pre-university course for those who do not have the required science subjects or fail the entrance exam costs €5,000. Fees for medical courses are between €7,500 and €8,500 a year in Hungary and veterinary courses cost €10,000.
Although it is early days yet, David Hickey, head of registration with the Medical Council, believes a new trend of students going abroad to English-language courses will emerge.
However, for those who are involved in doctor recruitment and training, the trend is a worrying sign of a system that is not working.
"A sense of panic has crept into the health system when people look at manpower," said Prof O'Dowd, chairman of the Medical Council's education committee.
"The reality is we probably need up to 1,000 doctors a year in Ireland, but we are producing about 320 doctors for the Irish market a year.
"People want to study medicine, we need more doctors and people are worried about not having enough doctors treat them when they are old. We need to respond to this. We need to give decent opportunities to people here to study medicine."
Ireland has always had an international outlook and always had students from overseas, but now it had become a cash cow to pay for the training of our own doctors, he said.
"Medical education is not expensive. You can produce a very good doctor for €25,000 per annum. Ultimately, the issue lies in the hands of the Department of Finance," said Prof O'Dowd.
All the deans of medical faculties feel stuck for cash, said Prof Alan Johnson, the Royal College of Surgeons in Ireland's medical faculty dean. The RCSI school has always had a strong international dimension and out of the 270 medical entrants to the school, some 220 are non-EU. Although there are very good historical reasons to have links to overseas, the current situation really comes down to money, according to Prof Johnson.
From the coal face of medical management where recruitment difficulties are being experienced, the system is deeply problematic and unfair, according to Dr Detta Healy, medical manpower manager with Sligo General Hospital.
Many specialities now had "serious recruiting problems and are chronically short of staff", said Dr Healy. "The points required for medicine are nearly 100 per cent because the number of places are so limited. There are so many looking for so few places and yet we are giving away our places to non-EU students."
This is deeply unfair, according to Dr Healy, who is also the mother of one of the many medicine hopefuls who is repeating his Leaving Certificate. Despite having missed out on medical entry by 20 points, he is determined to become a doctor like many others in his family.
"Do these non-national students have to gain 570 points? Do I not have a constitutional right to pay for my son if I so wish rather than have to send him to Prague?"
It is not in the interests of safe medical care for Irish students to be missing out on Irish medical training that "is second to none", she said.
Aside from graduate production, graduate retention is a cause for concern, according to Dr Asim Ishtiaq, vice-president of the Irish Medical Organisation.
There was a serious shortage of specialist training positions for non-consultant hospital doctors across every speciality, he said, pointing out that there were only 800 specialist registrar positions (SRP) across all the specialists in Ireland and some 3,000 junior doctors compete for these posts.
Medical schools intake
In 2003 there was an intake of 813 students to Ireland's five medical schools - an increase of 14 per cent on the 2000 figure. This constituted a 9 per cent decrease in the EU intake and a 32 per cent increase in the intake of non-EU students.
Some 83 per cent of current funding for medical education comes from overseas students' fees. There were 516 non-EU entrants to medical schools here in 2003, who collectively paid €13.03 million in fees. The 315 EU entrants paid €2.63 million. The Medical Council has expressed "significant concerns" about the sustainability of this dependence on foreign students to "fund the training of our own doctors". A Medical Council report published earlier this year said: "We think it is time that Ireland paid its way in producing its own doctors for its own needs."
Now the University of Buckingham, in England, is to offer a three-year course for a medical degree instead of the customary five. With 10-hour days and only four weeks' holiday a year, the course will offer the fastest medical training in Europe. Studying medicine is not something that can be done in a hurry, says Prof O'Dowd, chairman of the Medical Council's education committee, but he adds that with Ireland's shortage of doctors we may have to consider a similar move.