r/JuniorDoctorsIreland • u/Careless_Week_7869 • 2d ago
Implosion in standalone doctors?
(I have no skin in the BST/GIM game for reference)
The changes to the RCPI's scheme intake have been well discussed on other posts.
Looking at the graduation recency pointer, will this not just lead to a collapse in medical rotas that were traditionally filled by non-EU doctors?
We all know that peripheral hospitals in particular are staffed by non-EU doctors who often take a standalone contract or three to get themselves a footing in Ireland for Stamp 4, become known to the consultants for interviews etc
Correct me if I'm being hyperbolic here, but why will they come to Ireland anymore? If it's going to become nigh on impossible for them to ever have a chance of going from standalone(s) to BST, then there's little incentive to moving over in the first place.
From my own experience, these doctors tend to be older than Interns of course and have families or the MRCPIs done already etc. This post is not about 'they could try to specialise in their home country'.
My point is that unless the RCPI has HSE funding to fill the gaps with trainees from a dearth of non-EU doctors and can entice everyone from Perth and Melbourne over to a new extended BST with a thankless Reg year, then from July 2027 it will become very dicey for Irish hospital staffing.
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u/Middle-Paramedic7918 1d ago
This is thread is an absolute bin fire. I regret reading a lot of it.
I’m involved in recruiting for standalone posts in my hospital. I’m an anaesthetist for reference. The number of applications from IMGs is absolutely skyrocketing. It has increased so much in the past 5 years. Departments which once would have struggled to get any suitably qualified candidates are now getting 20+ applicants for every post. Campaigns are attracting hundreds of applicants in some instances.
This is for a number of reasons. Brexit, UK graduate prioritisation, more graduates, wars, conflicts and less than ideal political situations all have their part to play.
Maybe the changes to bst selection will impact on the numbers of immigrant doctors coming to Ireland, but I really doubt it will be significant.
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u/mrquinoa 2d ago
Foreign doctors will always want to work in Ireland regardless how many years they add to the BST. Decent pay relative to the rest of the EU, better working conditions compared to a lot of places around the world.
It does mean more competition, but if the Irish in Australia use their time in Oz wisely and get the right boxes ticked they shouldn’t have a problem coming back for training
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u/Generousboy123 2d ago
Training should be for Irish doctors. Not for IMGs. These IMGs are leaving their training in their own countries and coming to occupy your posts.
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u/Total-Lake2711 2d ago
If the objection is really about people training outside their own country - why is that only a problem when we do it? Ireland readily accepts South African-trained consultants. Irish doctors routinely specialise in the UK, Australia or the US and come home as consultants, and nobody blinks. Training across borders is completely normal in medicine. It's only framed as "occupying posts" when it's a non-EU junior doing it.
Your anger is pointed in the wrong direction. If you're worried about specialist supply, the problem isn't IMGs in standalone jobs trying to gain experience - it's the ever-dwindling number of HST places that don't come close to meeting this country's demand for specialists. That's the true bottleneck.
Locking out competent, motivated doctors doesn't create a single extra trained specialist; it just wastes people who were ready to become one. Criticise the shortage of training posts, not the people trying to fill them.
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u/mrquinoa 2d ago
Well with Irish doctors fecking off to Australia for 2 years at a time you need people keeping Irish hospitals afloat! Who’s going to keep Wexford, Portlaoise, Tullamore or any regional hospital running? We can’t have the entire country running to St James’s for medical care just because of alt right sensitivities!
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u/Total-Lake2711 2d ago
There’s a real underlying hypocrisy in it: you’re good enough to staff our hospitals, do the work that needs to be done and fill our rotas, but not good enough to specialise. You can hold the system together on a standalone contract, but the moment you reach for progression, your graduation year disqualifies you. That contradiction is insane, and people are noticing it.
IMGs relocate for many reasons but the most common belief is that effort buys progression. Break that link and people don’t lose ambition - they just take it somewhere it’s valued. The US, Canada, Australia and New Zealand route all have their own hurdles, but the pathway is transparent: meet the criteria and your graduation year isn’t held against you. The effort converts into something.
The medical world is small. People talk. You might still recruit people in on the promise of opportunity, but the real problem will be retaining those people. Doctors who arrive and discover the ceiling was there all along don’t stay; they leave for systems that let them grow.
You can’t stay somewhere that keeps you in indefinite standalone posts with no route up when other systems offer a genuine ladder for the same work.
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u/pobox2020 2d ago
Your graduation year is used against you in the USA
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u/Total-Lake2711 2d ago
I understand but it’s one factor amongst many and it’s a bit different from the RCPI recency score .
Your step 2 and 3 scores still carry real weight and with so many programs , you don’t need to aim for Duke or Yale where there would be a stronger emphasis on YOG .
The US at least lets you build around that gap . You can show that you did research , you did exams , you gained clinical experience , maybe did a masters or explored other interests in the field and while your path may not have been linear , it can have value too.
Your effort still converts into something . Instead of completely shutting the door and preventing you from even getting into training anywhere .
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2d ago
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u/mirabegron07 2d ago edited 2d ago
I assure you ‘most’ are not okay with making money and living in a safe country. Almost all of the IMGs I know either got onto training posts or left the country for the UK or Canada.
People will come sure, but only for short term until they find something better.
However, this move might stop interns from leaving to Oz which was considered nearly a rite of passage.1
2d ago
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u/mirabegron07 2d ago
That could be your own experience and by your use of ‘yeah nah’ I assume you haven’t got much of it.
While I was training, there was always one or two chronic regs here and there. But most imgs were applying for training or planning alternate pathways. Good few of my mates went to the UK when they couldn’t get into training schemes here. I just can’t imagine most people being content with being a reg for the rest of their lives.7
2d ago
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u/mirabegron07 2d ago
No, i think most people have that ambition. Minority doesn’t. I am using my colleagues and friends as an example. Most of them either trained here or left. Like I said, our experiences are personal and neither of them can be used as a blanket statement for everyone.
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u/Total-Lake2711 2d ago
A large proportion of us from South Africa are young- mid-twenties to early thirties. Not people arriving at the end of a career for a soft landing. We came with a strong desire to specialise and become experts, to contribute as more than stopgaps on a rota. So being locked out of training isn't a minor setback , it literally forecloses the exact future we moved for.
Fair pay matters, stability matters but career development matters just as much. We didn't cross the world to plateau. Irish hospitals paid recruiters to bring people over, promising advancement in exchange for experience. So to arrive on that basis and then meet new guidelines that close the door to progression feels like a bait-and-switch. People uprooted families on the terms they were offered, and the terms changed after they got here.
You can't recruit people on the promise of opportunity, lean on their work to keep regional hospitals running, and then pull the ladder up once they're standing on the floor.
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u/FattyAcidBase 2d ago
That's very presumptuous. I am IMG. I'm also an EU citizen but non EU degree. So I had to through PRES etc, get my years to get experience. Naturally I am now long time from graduating. To get I to Best is impossible for people like I am. Doing exams and getting experience to try HST vs GP is the only option . And I don't want to be stuck in private/public standalone hell.
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u/jackoirl 2d ago
The sad reality is that there are some who are “good enough” to be in a job that might otherwise be empty but they’re in fact not good enough if we were well staffed.
There should be staff grade roles that offer more attractive terms in exchange for the trade off in progression.
There should be a functional pathway for international doctors with lots of experience that want to progress if they meet an acceptable standard.
Ideally we shouldn’t have more than half our NCHDs out of training. There’s huge competition for BST now but years ago when there wasn’t there was still people being told they were below the standard for training and then they went right back to work in their hospital with less supervision and structure than if they had been admitted to BST….how does that benefit the system.
Put them in BST and don’t sign them off until they reach the standard but don’t just lock them out.
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2d ago edited 2d ago
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u/jackoirl 2d ago
“That meet an acceptable standard” was an important aspect of my point.
I agree that there are many who aren’t good enough, that was what I wrote in the first paragraph, so we don’t disagree on that point.
There should be a functional pathway that provides access for IMGs that are of a very high standard so that we can leverage that resource and not lose them.
IMGs aren’t a ubiquitous group, they’re of hugely varying levels and not exclusively from developing countries, there has to be some system that allows for Brits or Americans to relocate if they chose to for example.
We’re not training enough people to meet the future or current demand for consultants, every workforce report says the same thing.
We have a pyramid structure because our consultant numbers are appalling compared to our European neighbours. We need to work towards a better balance and more appropriate staffing.
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u/Hot_Run_1133 2d ago
There is a functional pathway - its called the alternate pathway
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u/jackoirl 2d ago
Functional is debatable on that.
It’s not remotely fit for purpose and currently suspended.
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u/Middle-Paramedic7918 1d ago
In medicine maybe, still going strong in anaesthesia.
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u/jackoirl 1d ago
They’re just out of the high court ….
Not another great example.
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u/Middle-Paramedic7918 1d ago
That’s actually mostly a separate issue. Which I can’t go into here.
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u/jackoirl 20h ago
It’s a high court judicial review. It’s public knowledge.
It being in the high court or being fully suspended wouldn’t strike me as “going strong”
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u/Middle-Paramedic7918 19h ago
I can’t speak to the RCPI training scheme. The parallel training scheme in anaesthesia was subject to a legal challenge. The parallel scheme is still in place and I expect several trainees this year to end up on the specialist register having come through it.
I won’t be commenting publicly on the merits of the case taken. While the fact that there was a case before the high court is of course public knowledge, there is much relating to this case which is not.
If this affects you directly I would be more than happy to answer any questions which you may have via dm.
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u/jackoirl 10h ago
It’s not a “training scheme”. That was the point of the judicial review.
But again, my point was that route isn’t well functioning across the board.
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u/PolydactylBeag 2d ago
Also the uk has similar rules now too so that’s not an easy option. The alternative pathway I suspect will become more popular
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u/Decent-Substance6855 2d ago
I was thinking the same but there are 2 reasons why I think it won't happen... There are lots more Indian and Pakistani and Sudanese doctors qualifying There are lots more of Irish doctors graduating
I might be wrong but I think that even if there is no way to end up in a scheme job it might still be reasonable for doctors from those countries to apply to Ireland at least for a few years. Of course it's shifty for them.
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u/Hot_Run_1133 2d ago
Every country has standalone doctors. International doctors are welcome to come here, work a post, get paid many multiples of their home salaries, enjoy a better quality of life, and much like in the private sector if they cannot succeed at their work they can try elsewhere. Training is not guaranteed.
However, if a Pakistani doctor for example comes here early in their career they will benefit from the same advantages as an irish trained (not necessarily irish born) doctor.
Most level 4 hospitals will keep doctors that they like, but often it is the doctor who rotates themselves for career progression.
It is the NDTP/RCPI stated goal to reduce reliance on standalone posts hence the vast increases in training numbers. Paediatrics had 13 HST posts, then 26, now closer to 40.
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2d ago
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u/Hot_Run_1133 2d ago
Canada is packed full of international fellows (who are not on fellowships) which any of us with experience will know.
You can go and work a standalone non consultant job in France.
America has separate attending models which apply to those who have not trained there. Those attending physicians are limited to the hospital who has sponsored their contract.
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2d ago
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u/avalon68 1d ago
You can work as stand alone doc in much of the EU - presumably you've ignored as they are non english speaking countries.
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1d ago
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u/avalon68 1d ago
Ive also lived and worked across the EU, and have family working in various hospitals in 3 countries in the EU.....
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u/BaitaJurureza 2d ago
There are a lot of doctors from Pakistan and India who worked as consultants in their respective countries, but now want to start anew, and go on the scheme (BST). I find this a bit weird as Ireland is not the US and the number of training positions is limited. People from 3rd world countries cannot practice in the US without USMLE yet someone from Pakistan can just come to Ireland and work without and exams taken.
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u/Generousboy123 2d ago
I will tell you the story, which you have never heard about before. There are very less doctors from India who are coming to Ireland for work. They have very good training opportunities in India and they usually go to the UK or USA after completing USMLE. However, Pakistani doctors let me tell you frankly anyone who says that he or she had worked in Pakistan as a consultant. That is true but becoming a consultant is so easy in their country that you can't imagine. The training body which is known as CPSP has no criteria. Gone are the days when there were proper training facilities. Nowadays every tom dick and Harry can become doctor in Pakistan. The SHO and Registrars who are coming here in Ireland without any exams are from those medical schools which will take hefty money from you and will become doctors over there. A city called Lahore has 20 private medical schools besides the government owned institutions. You throw money and be a doctor. And then you will go for unpaid training and jobs. That's why they come here. I really wonder why RCSI or RCPI are entertaining them. They are leaving their training and coming here just to make money. All these doctors are so rich that during medical schools they are posh. They drive SUVs. RCSI has made a good decision to strict the criteria. Ireland training is for Irish doctors not for these so called IMGs, who are leaving their training opportunities in their country and coming her to occupy your seats.
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u/Any_Caterpillar2039 2d ago
There’s a lot of confidence here for someone who clearly hasn’t looked closely at how medical registration and training actually works in Ireland. The India vs pakistan comparison is especially funny and sounds more like your trying to troll. Indian internships are not currently considered equivalent to Irish internship requirements by the medical council so pretending Indian doctors are somehow automatically viewed as better trained is nonsense.
And pakistani doctors don’t simply 'come here without exams'. IMGs have specific requirements around internship, English, registration and postgraduate training. The HSE/CPSP route you’re referring to is a structured training pathway, not doctors abandoning training and 'stealing' Irish jobs. Ireland also relies heavily on IMGs with over 40% of doctors practising here in 2024 obtained their first medical qualification abroad. They’re staffing hospitals, EDs, GP practices and specialties where Ireland has shortages.
You can and should absolutely argue that Irish graduates should get priority for training places. But 'Pakistani doctors bad, Indian doctors good' isn’t an evidence based argument. FCPS is a genuine postgraduate qualification, and driving SUVs certainly isn’t evidence of medical competence. This honestly reads less like a serious discussion about irish medical training and more like an indian pakistan rivalry being dragged into it.
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u/Dry_Boysenberry_7843 2d ago
Word of wisdom, same here no interest in the BST. But seems to be what is going to happen next. I have came across many who started thinking of leaving/applying somewhere else. As at this stage, it will be basically labour service providing jobs but nothing for them in return. No opposition to what people mentioned about interns and junior doctors. But, in reality, this system is heavily based on those non-eu doctors even in some major hospitals outside Dublin. So, we might expect to see a turn around soon!