In Ireland hundreds of hospital consultant posts remain unfilled, so why do so many medical professionals leave this country, and choose to work elsewhere? It can hardly be a matter of pay, as the latest OECD figures show Irish hospital consultants are now among the best paid in the world. The economic downturn had a depressing effect on health spending in Ireland. Between 2009 and 2013 the health sector contracted by 4 per cent annually, reversing the very rapid (5.4 per cent) annual rate of growth in the 2005 to 2009 period. Although last year the income of medical specialists in Ireland fell by 5 per cent to €164,494, that figure nevertheless was still higher than in all but two – Australia and Luxembourg – of the 34 OECD member countries surveyed.
Certainly, the high gross pay on offer to consultants should be sufficient to attract applications for the vacant medical posts. Even accepting that Ireland’s high marginal tax rates apply at relatively low income levels – a possible disincentive for some – nevertheless the net pay remains attractive and is competitive with the salaries offered to consultants in other OECD countries. Of course there may well be other considerations influencing the decisions of doctors who emigrate: concerns about the lack of a clear career structure within the medical profession, or dissatisfaction with the funding and administration of the Irish health service, where there are obvious structural problems.
The Irish Hospital Consultants Association has criticised aspects of the OECD data, claiming inconsistencies in income comparisons made between some countries, whether salaries are gross or net of tax. But these criticisms hardly invalidate the OECD’s overall findings. Medical education is expensive, both for taxpayers who subsidise it, and for student doctors who must finance long years of study before qualifying. This OECD study has raised a question that others, such as the Minister for Health, are best placed to answer. Why, despite top pay rates offered to consultants, do so many choose to work abroad, rather than at home?