Doctors’ pay and workplace conditions in Northern Ireland are forcing many medical students to plan for careers in health systems elsewhere, with the majority of those planning to leave opting to work in Australia, according to a new survey from BMA Northern Ireland.

Final and penultimate year medical students at Northern Ireland’s two medical schools were asked to complete a survey* on their career intentions once they graduate, including whether they plan to stay and work in Northern Ireland and what factors are influencing their decisions.

Over half of the respondents (54%) said they were either planning to leave Northern Ireland or are currently undecided where they will work once they finish their foundation training.**

Other survey findings include:

• Over 66% of those who do plan to leave say they are heading to Australia to work.
• Of those who reported planning to leave either Northern Ireland or medicine entirely after foundation training, over 81% said their decision was because of pay and conditions, followed by the poor state of the health service, and over 51% cited poor experiences of training or medical education as their reason for leaving.
• Only 3.92% of respondents consider doctors’ pay, and reward is fair in Northern Ireland.
• Over 83% of respondents said that “improved pay” would encourage them to remain in Northern Ireland to continue training, with almost 77% citing “improved working conditions”.
• Those choosing to stay in Northern Ireland cite family and support networks as the overwhelming reason to remain here.

As part of the survey, respondents were asked for further comments on why they were looking to work as doctors outside of Northern Ireland:

“[doctors] Not treated with the value that is deserved. Underpaid compared to other counties. Too competitive for training programmes.”

“I have no intentions of working long term in the NHS. I plan to move to Australia or New Zealand, either to train or upon achieving CCT***. Better lifestyle, better remuneration. UK is a race to the bottom - doctors no longer valued; disrespected and vilified.”

“I would love to stay in Northern Ireland, but if better pay and training opportunities can be achieved elsewhere, I will move.”

“I honestly dread the thought of working as an F1 (foundation programme year 1) in NI with current conditions. Extremely sad after five years you should be excited to graduate and work.”

“Heard that a lot of the core training programmes (IMT / surgical CT****) are becoming very service provision focused, more opportunities / better training elsewhere in the UK. Competition in NI for certain programmes extremely competitive - great candidates held at the bottle neck and choosing to take better opportunities in the rest of the UK.”

Speaking about the results, Milan Kapoor, chair of BMA’s Northern Ireland medical students committee (NIMSC), said: “It should be deeply concerning to all of us that a significant number of medical students on the verge of graduating are already planning for careers elsewhere after they complete foundation training.

“Northern Ireland medical students graduate with high levels of debt*****. They also have first-hand experience of workplace pressures in the health service and this has a huge impact on the quality of education and training while on clinical placements. It should therefore come as no surprise that they are looking elsewhere for better pay and training quality in health systems outside of Northern Ireland.” 

“However, this can be turned around. Over 90% of those surveyed said they still wanted to pursue a career in medicine so it is imperative that the government do all they can to encourage these newly qualified doctors to stay here for the duration of their careers. 

“Aside from addressing doctors pay and workplace conditions, one area they can tackle to help this is fixing the unfair and complicated student finance system. It saddles students with a large amount of debt as soon as they start work and penalises those from lower-socio economic backgrounds from studying medicine. These debts are another factor in resident doctors’ seeking work in better paid health systems in other countries.”

Dr Alan Stout, chair of BMA’s Northern Ireland Council, reiterated Milan’s calls for action to address the survey findings.

“This sounds an alarm for an increasing workforce crisis with worrying implications for a health service system that is already operating with unsafe staffing levels,” said Dr Stout.

“We owe it to the patient population to encourage these doctors of the future to stay and work in Northern Ireland. That means valuing doctors with timely and adequate pay uplifts alongside targeted workforce planning. Long-term, we need to see urgent roll-out of HSC transformation as outlined in countless transformation reports, and transformation that is properly funded by ring-fenced, multi-year budgets.”

Notes to editors

*Full copy of the report can be read here. The survey was open for three weeks and received a total of 191 responses out of a total of 770 final and penultimate year students at both NI medical schools, equating to a response rate of around 24%.

** The ‘Foundation Programme’ is a two-year, work-based training programme for newly qualified resident doctors across the UK which is intended to bridge the gap between medical school and specialty/general practice training. For more information click here.

*** ‘Certificate of Completion of Training’, received once a resident doctor has completed a specialty training programme and can apply for a consultant or GP role. 

**** Once Foundation programme training is completed, resident doctors can apply for core specialty training programs typically in areas such as surgery and internal medicine. On completion, they can apply for higher specialty training programmes which can be more competitive, with the length and structure of training varying by specialty. 

*****Some students can graduate medical school with upwards of £70k in debt.