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Key Points

• Each year, the Medical Council invites doctors to retain registration and, since 2012, has invited doctors to complete a survey which gathers up-to-date information about their public practice arrangements.
• Medical workforce intelligence underpins the work of the Medical Council in setting and monitoring standards for doctors.
• This report is based on analysis of data gathered by the Medical Council through its annual retention of registration process, carried out in June 2013.
• The findings of the report are presented under eight thematic headings.

Profile of the Medical Workforce: Doctors Retained in the Medical Council Register

• 17,378 doctors were invited to retain registration for the period July 2013 to June 2014.
• 16,189 (93.2%) of doctors retained registration.
• The female: male ratio among doctors retaining registration was 4:6 and 21.4% were aged 55 years and older.
• 28.5% of specialists were aged 55 years and older; the proportion of older doctors varied across specialty and, Occupational Medicine (48.6%), Public Health Medicine (41.7%), Psychiatry (35.2%), General Surgery (34.9%), and General Practice (33.3%) were among the larger specialities with higher than average proportions of older doctors.
• 65.7% of doctors retaining registration with the Medical Council graduated from an Irish medical school.
• The specialist: general: trainee specialist division ratio among doctors retaining registration was 3.9:3.5:1.
• The top three areas most commonly reported by doctors as their current area of practice were General Practice, Anaesthesia and Psychiatry.

Medical Practitioner Density in Ireland

• At the end of 2013, there were 395.4 doctors per 100,000 people in Ireland.
• Areas of practice with the highest density of specialists were General Practice (56.4 specialists per 1000,000 population,) General Internal Medicine (13.9 specialists per 100,000 population), Anaesthesia (12.0 specialists per 100,000 population), Psychiatry (10.3 specialists per 100,000 population and Radiology (7.6 specialists per 100,000 population)
• Estimates for licensed to practise and professionally active doctors in Ireland are compared with a selection of OECD countries.

Doctors Exiting the Register in 2013

• 6.8% of doctors exited the Register at the time of the annual retention process in 2013; the exit rate for graduates of Irish medical schools was 4.7%.
• The exit rate among males was higher than the rate among females (7.4% versus 6%).
• The exit rate was higher among younger doctors, 9.7% and 8.5% for doctors aged 25-29 years and 30-34 years respectively (all doctors); and an exit rate of 7.9% and 6.0% for doctors aged 25-29 years and 30-34 years respectively (graduates of Irish medical schools).
• Among graduates of Irish medical schools aged 25-29, there was a relative increase of 23% in the exit rate between 2012 and 2013 (6.4% in 2012 to 7.9% in 2013).
• Across the divisions of the Register, the highest exit rate was observed in the Supervised Division. Since registration in this Division is limited under law to a 2 year period, and given that a cohort of doctors entered in 2011, the high exit rate among doctors registered in the Supervised Division is expected.
• A relatively low exit rate was observed among doctors registered in the Specialist Division. However, a higher than average exit rate was observed among some specialties including Geriatric Medicine (12.1%), Urology (9.2%) and Child and Adolescent Psychiatry (7.2%).

Doctors Entering the Register 2013

• During 2013, 1,576 doctors entered the Register for the first time.
• Over half (52.6%) of new entrants were aged under 30 years.
• The commonest registration type taken up by new entrants was General Division registration (47.2%), followed by Internship registration (40.9%).
• During 2013, 509 doctors entered the Specialist Division for the first time, bringing the proportion of doctors registered with the Medical Council who were specialist to 41.7%; this represents a relative increase of 30% in specialists registered with the Medical Council in the previous 5 year period.
• 65.4% of new specialists were aged 40 years or under at the time of entry to the Specialist Division; the age profile of new specialists varied across specialties.
• 57.0% of doctors with a new specialty were graduates of an Irish medical school and 56.3% had completed an Irish training programme.
• The relative growth in specialists from 2012-2013 was, on average, 2.8% and varied by specialty with some specialties experiencing greater than average growth and others experiencing less than average growth; eight specialties, experienced a relative reduction in the number of specialists in this period, with Psychiatry of Learning Disability and Oral and Maxillo-Facial Surgery experiencing the largest relative reduction.

Globalisation of Medical Practice in Ireland

• In 2013, 34.3% of doctors retaining registration with the Medical Council graduated with a basic medical qualification from a medical school outside Ireland; this compares with 34.9% in 2012. Ireland’s reliance on international medical graduates is among the highest compared with other OECD countries.
• The five leading countries of qualification for doctors who did not qualify in Ireland were Pakistan, South Africa, the United Kingdom, Sudan and India.
• The skill mix and roles of international medical graduates were different to Irish medical graduates. 30.6% of doctors who graduated from Irish medial schools are registered in the General Division, compared with 63.4% of international medical graduates; 74.1% of doctors who work as non-consultant hospital doctors and who were not in training were international medical graduates.
• The proportion of international graduates in the medical workforce varied across areas of practice; the leading areas of practice with high proportions of international medical graduates were Obstetrics and Gynaecology, Surgery and Emergency Medicine.

Skill Mix and Models of Care

• The three most common roles identified by doctors who retained registration in 2013 were General Practitioner (28.1%), Hospital Consultant (26.2%) and Non-Consultant Hospital Doctor in Training (22.1%).
• Among doctors registered in the Specialist Division, the most common role was Hospital Consultant (48.6%) followed by General Practitioner (35.9%); among doctors registered in the General Division, the most common role was Non-Consultant Hospital Doctor Not in Training (28.0%) followed by General Practitioner (26.3%).
• While, in general, 46.3% of doctors were registered in the Specialist Division, the ratio of specialists to non-specialists varied across areas of practice. While some areas were predominantly delivered by specialists (e.g 64.1% of doctors working in Ophthalmology were specialists), other areas were predominantly delivered by non-specialists (e.g. only 17.2% of doctors working in Emergency Medicine were specialists).
• The blend of roles also varied across areas of practice with some areas, such as Emergency Medicine, Surgery and Obstetrics and Gynaecology having a higher than average proportion of Non-Consultant Hospital Doctors Not in Training.

Doctors' Participation in Practice in Ireland

• 4% of doctors who retained registration did not practise medicine in the previous 12 months; among doctors 65 years and older, 15.4% reported that they had not practised medicine in the last year.
• 79.8% of doctors who retained registration practised medicine in Ireland only; compared with doctors who graduated from an Irish medical school, a lower proportion of international medical graduated reported that they practised medicine in Ireland only.
• The proportion of doctors who reported that they practised medicine in Ireland only varied across area of practice; practice in Ireland only was higher than average in some areas, for example public health medicine, psychiatry and general practice, and lower than average in others, for example Sports and Exercise Medicine, Radiology and Emergency Medicine.
• 14.1% of doctors who retained registration reported that they practised medicine part-time. Compared with men, a higher proportion of women practised medicine part-time (9.9% versus 20.5%) and the proportion of doctors practising medicine part-time is greater among older doctors.
• Part-time practice of medicine was more common in some areas of practice, for example Public Health Medicine (33.6%) Sports & Exercise Medicine (29.7%) and General Practice (22.2%).
• Among doctors registered in the Specialist Division, 3% reported that they were practising in an area which was different to their registered specialty.

Womens' Participation in Medical Practice

• In total, at the end of 2013, 41.3% of registered doctors were women; this was a 12% relative increase versus 2008.
• 58.3% of doctors registered in the Trainee Specialist division were women. Among doctors aged under 35 years who graduated from an Irish medical school, 69.6% registered in the Specialist Division were women.
• The proportion of women working in different roles varied: 76.3% of Community Health doctors were women compared with 28.9% of Hospital Consultants; however, among Hospital Consultants aged under 35 years and who graduated from an Irish medical school 64.3% were women.
• Among specialists, gender patterning of specialisation was evident. In some specialties there was a higher than average proportion of women practising (e.g. Genito-Urinary Medicine, Public Health Medicine, and Psychiatry of Learning Disability) while in other specialties there was a lower than average proportion of women practising (for example, Neurosurgery, Trauma and Orthopaedic Surgery and Oral and Maxillo-Facial Surgery).
• The practise arrangements reported by women doctors were different to those of men.

View Previous Report

The first Medical Workforce Report was published in 2013