The staffing requirements of the Irish healthcare system cannot be met by some 300 EU graduates qualifying annually from our medical schools, writes John Crowe.
In 2005, a significant majority of the 700 students graduating from the five Irish medical schools were from countries outside the EU. Four hundred were fee-paying non-nationals, mainly from Malaysia, the United States and Canada. The remaining 300 graduates were from the EU and, of these, 280 were Irish. A majority - 70 per cent - of the Irish graduates were female.
It is clear that the current and projected manpower requirements of the Irish healthcare system cannot be met by 300 EU graduates qualifying annually from Ireland's medical schools. Currently, 500 graduates at least are required for general practice, hospital consultancy and specialist registrar training. This does not include permanent posts in public health, occupational health and academic/teaching or non-consultant hospital posts at intern, senior house officer and registrar level. That non-EU medical graduates occupy 70 per cent of the latter posts further underlines the deficit.
These figures do not take into account the increasing need for medical graduates in the context of growth of the national population or the projected manpower requirements of an improved health service. Successive health ministers have endorsed the case for a consultant-provided hospital service, as also has the 2003 report of the National Task Force on Medical Staffing (the Hanly report). The recommended target is an increase in consultant numbers to 3,600 from 1,947 currently, with Hanly projecting that those 700-800 consultants would be required annually to provide a consultant-delivered service by 2013.
It follows therefore that Ireland will have to recruit substantial numbers of medical graduates from overseas to meet its manpower requirements for permanent posts in hospital medicine and general practice. There is evidence that this process, previously confined to the hospital sector, has now extended to general practice.
Against this background of medical manpower shortage, the access of Irish citizens to medical education in Ireland requires scrutiny.
In September 2004, 846 students began their medical studies in the five Irish medical schools. Of these, 540 were fee-paying undergraduates from outside the EU and 306 were from within the EU - 280 of the EU 306 were from Ireland. The Higher Education Authority allocates a quota of 306 first-year places to EU students. This quota, which has not changed in over 20 years, takes no account of current or projected manpower needs. Nor has it addressed the implications arising from the feminisation of the medical profession, where 70 per cent of graduates are now female.
Furthermore, Irish medical schools are chronically under-funded - currently each receives between €7,500 and €12,000 (the difference in allocation for each medical school remains unexplained) annually per student from the HEA. This compares with €26,500 annually for veterinary medicine at UCD. No rational explanation has been forthcoming from the HEA as to why human medicine receives less than 50 per cent of the annual allocation for veterinary medicine.
To secure a place in an Irish medical school, an Irish school-leaver currently requires at least 570-590 out of a possible 600 points in the Leaving Certificate examination, and only the most intelligent and the hardest-working of students can achieve this standard. In 2004, 2,247 (1,311 females, 936 males) made medicine their first choice in their application to the CAO, but only 256 (164 females, 92 males) first-time Irish school-leavers actually succeeded in securing a place.
Thus only 1 in 10 of Irish school-leavers who nominate medicine as their first choice on their CAO application will actually get a place in an Irish medical school. In contrast, the academic requirements for fee-paying non-EU students entering Ireland's medical schools are far less rigorous.
The high points requirement in the Leaving Certificate for medical school entry stems from the large numbers of students who apply for medicine each year through the CAO relative to the number of medical school places available to Irish school-leavers. In this competitive academic environment, girls significantly outperform boys in the Leaving Certificate, and this resulted in 70 per cent of Irish medical school entrants in 2004 being female.
The restriction of access to Irish medical schools has led to an anomaly whereby non-Irish medical graduates - who do not face as rigorous an entry to medical schools in their own countries as do Irish school-leavers here - are taking up the shortfall in Irish hospitals. Meanwhile, many Irish undergraduates and postgraduates who wanted to study medicine are pursuing careers of second choice because they could not meet the medical school entry requirements at home. Furthermore, Irish students do not have access to the fee-paying places in medical schools here which are available to non-nationals. Thus an unknown number of Irish students are pursuing fee-paying medical courses in universities outside Ireland.
The restricted entry to Irish medical schools, the inadequate number of medical graduates relative to national need and the feminisation of the medical profession in Ireland are having effects on the healthcare system and on healthcare delivery which are already becoming apparent.
This is a highly significant societal issue for Ireland and the Irish Government has a responsibility to ensure that the State produces enough doctors to meet the national need. Priority must be given to providing medical education for Irish students ahead of providing education for students from other countries without whose fees Ireland's medical schools could not continue to exist.
The number of places set aside for medicine in Irish universities must be immediately increased to reflect national manpower requirements in all areas of medicine, and this implies that the medical schools have to be given the funding they require to meet this need.
Prof John Crowe is a consultant gastroenterologist. He is vice-president of the Royal College of Physicians in Ireland and president of the Irish Society of Gastroenterology.