Our medical shortage, the reality of medical school, becoming a doctor and (hopefully) some context behind our perpetual healthcare crisis.

Hi All

I’d like to apologise in advance for the length of my rant I feel however that it’s an important one.

Why am I even writing it? I’d like to give some context for what the situation is actually like on the ground, Along with revealing some of the unending and unsurmountable barriers in the paths of prospective Doctors in Ireland. I’m hoping it might give **some** **insight** as to why you you’ve been waiting two weeks for a GP appointment, why your beloved retired GP STILL hasn’t been replaced, and why your family member has been on a waiting list for the past three years. I hope to do this by explaining why and how medicine is increasingly pricing out countless potential Doctors – why it is so difficult to get into medicine in the first place, why it’s difficult to stay in medicine, the reality on the ground post qualification and how this all contributes to our catastrophic ongoing shortages.

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TLDR: We are not training enough Doctors, and the vast majority of people who would make great doctors are being priced out. Medicine (even moreso than previously) is increasingly only available to the ultra rich. Of those lucky few who get to obtain a medical degree, 60% (and in some cases 80%+) leave after just one year. Any action to improve ongoing staff shortages is being taken 10-20 years too late and with laughable urgency/ambition.

**Getting in**

I’ve been accepted to study Graduate Entry Medicine in University College Dublin. Even the act of being granted the ability to study medicine is an incredibly difficult task, this event should have been one of the most memorable moments of my life, the culmination of my entire academic career thus far. Yet, I haven’t celebrated it and I don’t plan on celebrating it. In fact, next week Is my first week and I plan on meeting with my student advisor to discuss the possibility of dropping out. It’s not that I do not want to become a doctor, this has been my goal since 17. It’s the fact that the barriers in my path are simply insurmountable. I feel foolish for even accepting my college position and an even Moreso for telling anyone of my plans, as I’m not sure how on earth I’m going to realise them.

The nature of medicine, it’s intensity, it’s difficulty and high-pressure environment rules out many straight away. This is understandable – it is an absolutely rigorous and gruelling process of lifelong learning and responsibility. However, I know many, many friends and colleagues who have the drive, determination and intelligence to become fantastic Doctors. Unfortunately, while we as a country are in desperate need of Doctors [(some of the lowest per capita rates of doctors in Europe)](https://www.thejournal.ie/ireland-healthcare-system-compared-to-eu-5778807-Jun2022/#:~:text=Ireland%20ranks%2022nd%20of%2029,understaffed%20in%20relation%20to%20ours./), along with [the lowest number of consultants in the EU](https://www.belfasttelegraph.co.uk/news/republic-of-ireland/ireland-has-lowest-number-of-consultants-in-eu-report-finds/38286118.html) many hundreds/thousands will NEVER reach their potential as a result a variety of factors outside of their own control, not least of these financial constraints.

As mentioned previously getting into medical school is not an easy feat. When I sat the leaving Cert to gain entry via the CAO to an undergraduate medicine course, typically students would need to score AT MINIMUM 530 points, although most often this was closer to above 550 points. This does not include points from sitting the mandatory HPAT. For context just [5%](https://www2.cao.ie/app_scoring/points_stats/lc17pts.pdf) of leaving cert candidates achieved above 550 points in 2017 (my year). Students achieving these scores are disproportionately from affluent backgrounds and regions, who attended the best schools and could afford the best resources. For students from disadvantaged & immigrant backgrounds & postcodes (**myself** included) with some of the lowest entry rates to third level education, this task becomes exponentially more difficult.

This leaves students who could not access medicine initially with another option (graduate entry medicine). This is also a relentless process. Students must complete & finance an initial University degree, obtain a 2:1 in this degree and then sit & Pass the GAMSAT, a gruelling a 5.5 hour entrance exam with an [85% failure rate](https://www.acegamsat.com/gamsat-success-rate/#:~:text=This%20means%20they%20scored%20in,of%20approximately%2080%2D85%25./) to even get the opportunity to begin their studies.

All of this means that medicine is disproportionately a career path **only accessible to the upper middle class and wealthy.** As I’ll discuss below Increasingly even the middle class are being priced out of a medical education. I’ve worked up and down in teaching hospitals and encountered countless Doctors, yet I could not point out a single instance in which I encountered a Doctor with a working Class Dublin accent. It seems that the unfortunate reality is that if your parents were not doctors, your chances of becoming one are slim to none. ***How can we plug gaps in our system if only a sliver of the population are eligible, willing and able to access a medical degree?***

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**Staying in**

While getting in is difficult enough, staying in the degree programme and obtaining a medical degree is near impossible for countless students This academic year my bill will total €17,760. Over four years this will cost €70,000. I am fortunate enough to live in Dublin but with accommodation, for some, total costs could reach €100,000. For context there are no scholarships, there are no grants. Most importantly however, there are **no medical school loans in the entire country.** The sole loan for medical school was provided by Bank of Ireland and was unfortunately ceased in [2022](https://www.irishtimes.com/news/education/boi-decision-to-discontinue-graduate-medical-student-loan-catastrophic-1.4859618) . It was not perfect by any stretch of the imagination, but it at least provided some financial support to prospective students – crucially it provided a 4 year moratorium period in which repayments did not have to be made.

Currently there are no loans available that let one borrow the astronomical amount of money required or crucially even any amount with a grace period. Students must thus come up with €16,000-€17000 annually. Failing this, they must take out a loan of this amount annually and begin repayments immediately, only to have to do this again 3 more times throughout their studies. €17,760 works out to €1480 per month over 12 months. To makes things worse, tuition MUST be paid within a certain time period and students who do not pay fees CANNOT access exam results or progress to their next academic year. The typical Academic year is approximately 8 months long, giving a more daunting figure of €2200 per month just to stay in the degree programme. This does not include accommodation, laptop purchase, transport costs, textbook purchase etc.

**Challenge**: Do you know a single person full time worker who could afford to part with €1480 per month for four years, after bills, taxes, and housing expenses? To compound this even more due to the intense nature of graduate medicine (a typical 5-6 year medical degree, condensed into 4 years) students are HIGHLY advised by academic staff not to work, or to work very minimal hours during academic semesters. If we the students cannot pay for the degree ourselves, or access any loan services, that leaves only parents left to pay. Do your parents have a spare €17,000 per year? Mine don’t. Personally, I am blessed enough to have worked for two years post-graduation. After two years of working multiple jobs, taking on weekend and evening “nixers” on top of my normal job, minus expenses (laptop purchase, GAMSAT registration and tutoring) I can afford **one year** of medical school. Barring a miracle, there is no capacity for me to afford further years **-** **I WILL have to drop out after first year to afford my fees for further years.** Others have already deferred their offer to save ( also attempted to do this).

**The reality on the ground.**

Unfortunately for the foreseeable future post-graduation there’s not much to celebrate. Life after medical school is no more glamorous than student life. New graduates are greeted by what has been described as a “gruelling introduction to the Irish health service”, one that results in 60% of new interns [emigrating](https://www.joe.ie/news/cuban-doctors-ireland-771906) .

You may recall a tweet that went viral recently where a recent UCC graduate explained that 80.5% of their graduating class had [left for Australia](https://twitter.com/rory_holohan/status/1620454456587612160?lang=en) after intern year. This is **not** a freak story – annually we train about 750 Doctors however in 2022, [442 doctors](https://www.rte.ie/brainstorm/2023/0227/1359128-why-doctors-are-leaving-ireland-for-australia-in-droves/) were issued work visas to emigrate and work in Australia. Why wouldn’t Doctors flee? Opportunities abroad more often than not offer a much higher starting Salary, a guaranteed working week capped at 40 hours, easier access to specialist training programmes, and don’t forget Sun, Sea and Sand! The Irish alternative isn’t as attractive, new interns are greeted with a baptism of Fire. 24-36 hours shifts are not unheard of of and 60, 70 & 80 hour weeks are frequently and scarily [normalised](https://www.thejournal.ie/junior-doctors-burnout-overtime-working-conditions-5743137-Apr2022/). As a reminder the European Working Time Directive states that it is unsafe for Doctors to work above 48 hours [in a week](https://www.newstalk.com/news/youre-not-safe-to-look-after-patients-junior-doctor-warns-over-long-working-hours-1354224#:~:text=%22We%20have%20a%20thing%20called,48%20hours%20in%20a%20week./) . I challenge any reader to find single intern who worked even a single week below 50 hours in their first year post-graduation. Let alone SHOs and Registrar’s.

**Shortages and a bleak future.**

All of this has compounded to result in the devastating shortages we see today across the entire profession. As of 2023 we have a mind-boggling 900+ **EMPTY** [consultant roles](https://www.irishtimes.com/health/2023/07/09/almost-1000-hospital-consultant-posts-not-filled-with-some-vacant-for-years-figures-show/). The private sector doesn’t escape unscathed either, as Ireland requires an **additional** 1600 GPs by 2028 just to [keep up with population demand](https://www.thejournal.ie/more-gps-needed-5664914-Jan2022/#:~:text=Speaking%20to%20the%20committee%2C%20Dr,growing%20number%20of%20people%20aged). Even more worrying is the ageing trend among practicing GPs – where A staggering 27% of GPs nationally are above the age of 60, with counties such as Leitrim on track to see 50% of it’s GPs retire within the next [next 7 years](https://www.independent.ie/irish-news/rural-ireland-losing-another-lifeline-as-up-to-50pc-of-gps-to-retire/35916635.html) . This is not ideal in a population that continues to age, and who’s over 85 population will double by [2025](https://www.todayfm.com/news/ireland-could-see-shortage-of-1600-gps-in-the-next-few-years-1304068)

My main question is – why then are such insane barriers being put in place for prospective medical students who are willing and able to help tackle our perpetual crisis head-on? Myself and my classmates are willingly singing ourselves up for 80 hour weeks, for life and death responsibility yet it feels as if it’s being spit back in our faces. Many of my classmates have no idea whatsoever how they will get through their degree, with some (including myself) considering dropping out of the process entirely.

Finally, It’s also important when discussing medicine to remember who much of a short-lived career it really is. I takes an incredibly long time to train the specialists that we so desperately require. Becoming a GP can take anywhere from 10 to 13 years (shortest path: 5 years of undergraduate medicine, 1 intern year and assuming direct acceptance to a 4 year training programme). The shortest route to becoming a surgeon is 14 years (assuming 5 years of undergraduate medicine, 1 year of interning, followed by 8 years of surgical training) of which it is incredibly rare to gain direct access to a training programme, so 14 years may easily turn into 15,16 or 18 years. I say this not to complain, but as a reminder that the steps that we should have taken to ease of shortages and ongoing crisis, **should have been taken 15 years ago** – and that we may not see the benefits of any action that is taken **for another 10-20** years (assuming direct and decisive action is taken immediately).

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TLDR: We are not training enough Doctors, and the vast majority of people who would make great doctors are being priced out. Medicine (even moreso than previously) is increasingly only available to the ultra rich. Of those lucky few who get to obtain a medical degree, 60% (and in some cases 80%+) leave after just one year. Any action to improve ongoing staff shortages is being taken 10-20 years too late and with pathetic urgency/ambition.

by Clown_92