Peter Maguire, an anaesthetist with three decades of experience, decided to leave his role as a consultant in Northern Ireland’s NHS five years ago due to a harsh working environment, the collapse of Stormont, and Brexit uncertainties. He chose instead to work on a part-time basis at a hospital in Dublin, Republic of Ireland, a decision he applauds as one of the best he’s ever made.
In Dublin, Maguire earns as much in a single day as he would acquire in a week in Northern Ireland’s NHS. He counts among a growing trend of senior doctors from Northern Ireland switching to fill full-time and temporary positions in the Republic.
This migration is not limited to the senior doctors; other specialists such as oncologists, radiologists, gynaecologists, and emergency department consultants have also transitioned recently, according to a prominent member of the North’s leading doctors’ union, the British Medical Association (BMA). Doctors taking on permanent roles in the Republic can look forward to more than doubling, or in some instances tripling, their NHS wages.
General practitioners, including those early in their medical careers, are part of these exodus too. A recently released workforce report raised alarms about the profession nearing a breaking point, calling urgently for measures to avert further exits.
Michael McKenna, a Belfast GP, notes that while the work environment in the Republic might not be entirely perfect, it certainly isn’t as chaotic as the disintegrating NHS. There has been an increase in younger GPs transitioning, as well as more experienced consultants leaving due to frustration. Alarmingly, half the GP trainees in the North have no intention to stay after their training; instead, they plan to return to the South.
A newly qualified GP in the South earns over twice as much as their peer in the North, where the median wage is about £92,000 (€107,000). McKenna points out.
Alan Stout, co-chair of the British Medical Association’s GP committee, admits finding doctors to work in border areas like Enniskillen and Armagh is difficult due to the disparity in remuneration offered across the board. The starting wage for consultants in Northern Ireland is £88,000 annually, for a 40-hour week, capping at £118,000. In contrast, their counterparts in the Republic of Ireland, under the Sláintecare contract, receive a starting salary between €217,325 and €261,051 for a lesser 37-hour week.
The GMC, the UK’s primary regulatory body for doctors, states that Ireland now ranks behind only Australia and New Zealand as the preferred locations for UK doctors contemplating work overseas. The generous pay packages offered in the Republic of Ireland, teamed with a generally more well-staffed and organized hospital setting, is, as one senior medical practitioner put it, “super attractive” to doctors in the North, who receive lower salaries than their UK peers.
Highlighting his experiences, Maguire, who spent 16 years working at Daisy Hill Hospital in Newry, expressed his satisfaction working in the South, citing better pay, less bureaucracy, and thus enjoyable work experience as key attractions. Despite the stigma of discussing money, he candidly shared that while his former NHS consultant job earned him about £4,500 monthly after taxes, he took home €9,600 for a week’s work covering holidays in Letterkenny. With the improved work conditions, coupled with higher remuneration, Maguire cannot see himself returning to the NHS.
Whilst there’s no concrete data on the count of medical practitioners from Northern Ireland working in Southern Ireland, the regulatory body noted an increase in inquiries for a certificate that authorises UK doctors to work in Southern Ireland; there was a rise in requests for Certificate of Good Standing (CGS) from 507 in 2022 to 804 the following year.
The GMC advises that the requests “don’t directly indicate a certain departure from the country, but show an inclination.” Among the applicants in 2023, 632 were registered and had their licenses intact in the UK.
Equal pay, scarcity of staff, and Northern Ireland’s ailing health service, constantly topping the NHS waiting lists for the past ten years, are the undeniable reasons for the migration.
Brexit, Covid, and a two-year political stalemate have inarguably influenced the move, with trainee doctors going on a strike for the first time last month over pay.
Following the re-establishment of Stormont in February, Northern Ireland’s Health Minister, Robin Swann, vowed to develop the GP workforce and retain more seasoned physicians.
However, he hasn’t been successful in stemming the flow.
Anne Carson, a radiologist and consultant, resigned from her NHS position of 25 years, and chose locum actions in Letterkenny and Portlaoise.
“As an experienced radiologist, the pressure in any NHS department within the North is unbearable,” she explains, adding, “There has been a turnover; the doctors from the South used to work in the North, but now, it’s usually the reverse, owing to the difference in pay, terms, and workload.”
Nevertheless, Carson admits that it’s not all smooth sailing for doctors in the South, as their issues vary, and the workload can be excessively stressful for those in permanent roles.
The Northern Ireland health department, when questioned about the Southward shift, admitted that pay issues were being discussed with consultant representatives. A spokesman commented saying, “It continues to actively hire clinicians on a regional, national, and international level.”
“David Farren, chair of the BMA consultants’ committee in Northern Ireland, disputes the department’s claim that their healthcare service is expanding. He points out the increasing consultant vacancies, which rose by 80% since March 2017, reaching a total of 182 openings in September the previous year. Farren, a consultant medical microbiologist at Antrim Area Hospital, asserts that many of his colleagues are considering a move to the South. He reflects on his own decision to not relocate due to familial obligations despite being posed with the possibility.
A number of his peers, according to Farren, have opted to partly split their work week between Antrim and Dublin. He further notes the departure of some of his radiology and obstetrics and gynaecology colleagues to Dublin.
Farren also underscores the potential of greater earning and lifestyle benefits in the South. He could notably increase his weekly income with better working hours and no on-call duties. Additionally, living in Lisburn, he appreciates the convenience of getting to Dublin in under two hours by train, where he can relax or work during transit.
The continuous movement of Northern Irish health professionals across the border could potentially result in enhanced cross-border health services, besides the existing cancer treatments and paediatric heart surgery provisions. Farren wouldn’t be taken aback if this trend continues and feels this constant relocation might lead to united all-island health services. Alan Stout, agreeing with this sentiment, states that if the majority of Northern Ireland’s doctors opt to practice in the Republic, shared services will inevitably become a necessity.
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