‘Everything was just getting worse and worse’: deteriorating job quality as a driver of doctor emigration from Ireland

Abstract

BackgroundMedicine is a high-status, high-skill occupation which has traditionally provided access to good quality jobs and relatively high salaries. In Ireland, historic underfunding combined with austerity-related cutbacks has negatively impacted job quality to the extent that hospital medical jobs have begun to resemble extreme jobs. Extreme jobs combine components of a good quality job—high pay, high job control, challenging demands, with those of a low-quality job—long working hours, heavy workloads. Deteriorating job quality and the normalisation of extreme working is driving doctor emigration from Ireland and deterring return.MethodsSemi-structured qualitative interviews were conducted with 40 Irish emigrant doctors in Australia who had emigrated from Ireland since 2008. Interviews were held in July–August 2018.ResultsRespondents reflected on their experiences of working in the Irish health system, describing hospital workplaces that were understaffed, overstretched and within which extreme working had become normalised, particularly in relation to long working hours, fast working pace, doing more with less and fighting a climate of negativity. Drawing on Hirschman’s work on exit, voice and loyalty (1970), the authors consider doctor emigration as exit and present respondent experiences of voice prior to emigration. Only 14/40 respondent emigrant doctors intend to return to work in Ireland.DiscussionThe deterioration in medical job quality and the normalisation of extreme working is a key driver of doctor emigration from Ireland, and deterring return. Irish trained hospital doctors emigrate to access good quality jobs in Australia and are increasingly likely to remain abroad once they have secured them. To improve doctor retention, health systems and employers must mitigate a gainst the emergence of extreme work in healthcare. Employee voice (about working conditions, about patient safety, etc.) should be encouraged and used to inform health system improvement and to mitigate exit.

Exit only: harms from silencing employee voice

“…3 The VA hospital system in Los Angeles made their PPE equipment economic appeal of reducing worker protections and privatizing public goods like health care has made inroads in other countries. Macklin and Spurgin's argument about employee speech limitations in Australia notes recent acts that have reduced employee rights [2007], and of course austerity practices in many European countries have in some instances led to employees' perception of lack of autonomy at work [see Humphries et al, 2019].…”

“…2 While Hirschman's text is 50 years old, it has continually been applied and extended to analyses of worker rights and voice. For recent examples, see for instance Stoker [2005], Chen and Lai [2014], Hoffmann [2006], Humphries et al [2019] and MacGregor and Stuebs [2014].…”

Hospital doctors in Ireland and the struggle for work–life balance

“… 1–3 Austerity measures introduced following the 2008 global financial crisis reduced health spending, 1 staffing levels, hospital bed numbers 4 and new entrant salaries. One study of Irish-trained doctors who emigrated to Australia between 2008 and 2018 found that they did so in response to deteriorating working conditions 5 in the Irish health system. Moving to Australia, which had escaped the worst effects of the global financial crisis, 1 enabled these doctors to access better working conditions and a better work–life balance.…”

“…Moving to Australia, which had escaped the worst effects of the global financial crisis, 1 enabled these doctors to access better working conditions and a better work–life balance. 5 …”

The effect of breaches of the psychological contract on the job satisfaction and wellbeing of doctors in Ireland: a quantitative study

“…This is in contrast with, for example, the NHS, where most junior doctors work in shift patterns. There is a significant issue with retention of doctors in Ireland, the normalization of extreme working hours identified as a key driver of doctor emigration and a key deterrent of repatriation [12,13] has been implicated as a cause for significant issues with retention of doctors in Ireland [14].…”