Dear Editor, As we all know, the recent significant pay reduction for new consultants has made Ireland an unfavourable destination for both Irish trained and overseas doctors. In addition to that, historically, non-EU doctors have been finding it very challenging to reach higher speciality training (HST) in Ireland and many of them spend most of their lives in non-training posts across the country for several years, mostly in non-training registrar grades. To make things worse foroverseas doctors, a recent mandatory requirement by the HSE for English proficiency has been forcing many overseas doctors to consider leaving Ireland. Doctors who completed their medical school in a country where their first language is not English have been asked to submit an IELTS (English proficiency exam) score with a minimum grade of 7 in all four modules (speaking, listening, reading and writing) and an overall score of 7.5 out of a maximum score of 9. Although this is a welcome step from the HSE for overseas doctors who are starting their first NCHD job in Ireland, the application process also requires the same from overseas doctors who are already working as NCHDs in Ireland. These overseas doctors have been employed as NCHDs in Ireland for the last several years after having completed their IELTS exams (as per Medical Council regulations) several years ago, before they first commenced working in Ireland. This has created a scenario where an overseas doctor, from a country where English is not their first language, would have to produce a new IELTS exam certificate every two years (as it is valid for only two years) irrespective of whether or not they have been working in Ireland as an NCHD, as long as they want to apply for a NCHD job. These rules announced recently have taken non-EU NCHDs by surprise as, in many cases, their applications have not been accepted for HST because of the need for an IELTS test score less than two years old even though these non-EU NCHDs have been working in Ireland for the last number of years as a junior doctor. It is also interesting to note that the Medical Council of Ireland requires an IELTS score of 7 out of an overall of 9 and a minimum of 6.5 which is a bit lower than that required by the HSE to work in a training post. If an overseas doctor clears the two levels of PRES exams (entry level exams before a non-EU doctor starts working in Ireland) with the IELTS score required for the Medical Council, at least they can then be registered on the ‘General Register’ which will in turn allow them to work in non-training posts. Also, the Medical Council does not request a repeat IELTS score unlike the HSE , as long as the doctor has continued to work in Ireland and gives a declaration of maintaining his English proficiency while renewing his or her registration every year. This begs the question, why is there a discrepancy in the IELTS score requirement for the Medical Council and the HSE? Is it not enough for the overseas NCHD to submit a required English proficiency test (IELTS) just once when they start their first job as an NCHD in Ireland rather than having to submit it every two years? Is this not going to make life more difficult for overseas NCHDs – particularly the non-EU doctors – to get into HST where only around 20 to 30 per cent are from non- EU countries compared to around 60 per cent at registrar levels? To add to the non-EU doctor’s woes, the Department of Justice recently increased the fees for non-EU visa/renewal from €150 euros to €300 euros per immigrant (in addition to the €100 for multiple entry visa) which would mean that a non-EU doctor with a spouse and two children will be paying €1,600 every year or every two years (depending on their duration of job contract) instead of the €1,000 they were paying in the last four years (it was nearly without fees around seven years ago). With the reductions in salaries, high taxes, difficulty accessing HST, lack of career progression, and long working hours, further complicated by the unreasonable need to repeat IELTS exams every two years and the increase in the cost of extending visas, Ireland appears to be making itself a less favourable destination for overseas doctors, particularly from the non-EU region. This will force another exodus of non-EU doctors from Ireland and attract less overseas NCHDs, in addition to the Irish-trained doctors who plan to leave the shores of Ireland with the recent drastic decrease in salaries for new consultants. There is little doubt that this may lead to another shortage of junior doctors which will in turn compromise patient safety in our health service. Dr Narayanan Subramanian, Senior Registrar in Psychiatry, Vice Chairman, Overseas Medics of Ireland Source
