Shortage of doctors shows vocational crisis in Ireland

In many parts of the country there is a shortage of GPs. Therefore, it is not just the priesthood that is suffering from a shortage of vocations.

Figures last week from the Irish Medical Council showed the scale of the problem. The worst hit county is Meath, which has only 54 doctors per 100,000 people. Next is Monaghan, with 57 GPs per 100,000.

The World Health Organisation recommends 100 GPs per 100,000 people and only two counties in Ireland reach that level, namely Galway and Waterford. Cork and Dublin are not too far off.

In general, midland counties are served more poorly than the rest of the country.

The situation nationwide is going to worsen. For a start, not enough GPs are in training. Secondly, a high number are due for retirement, and third, the population of the country is growing faster than we can accommodate.

According to the Irish College of General Practitioners, there are currently around 3,500 GPs in the country. Per head of population, this is almost a third lower than in Britain, where GPs are also under strain.

Overall, it is estimated that we need an additional 1,600 GPs in just four years-time. Is that feasible?”

Around a fifth of GPs, or 700 or so, are due to retire in the next few years, but the total in training is only about 800. That might sound like it is just enough to cover retirements, but this is misleading because not all trainee GPs finish their training. Also, existing GPs sometimes drop out of the profession entirely or drop down to part-time work, and when a GP retires from a rural practice, it can be very hard to find a replacement.

GPs in rural areas can also find it hard to get holiday cover, meaning burn-out rates among them increase.

Overall, it is estimated that we need an additional 1,600 GPs in just four years-time. Is that feasible?

Trends

GPs are under a triple hammer of changing social trends. For a start, the population is getting older, fast. The number of over 65s is soaring. In fact, the CSO estimates that by the middle of the century, the number of people aged over 65 will outnumber children aged under 15 by hundreds of thousands.

A high percentage of patients seen by GPs are retired, and therefore the strain on the system is going to grow enormously.

Secondly, people expect more from the health system than they used to and there are more free schemes. This also increases the pressure on doctors. (I’ll come back to this).

Thirdly, it is hard to appreciate just how fast the population of Ireland is increasing. We tend to focus only on the numbers seeking asylum here, but actually a far bigger number of immigrants are coming here for economic reasons.

Net immigration is outstripping natural population growth by almost four to one”

For example, last year, net migration into the country came to almost 78,000 people. The rate of natural increase (births over deaths) was just 20,000.

Therefore, net immigration is outstripping natural population growth by almost four to one.

Now, last year was an exceptional one in terms of immigration, and we must take into account the war in Ukraine. Nonetheless ever since the late 1990s Ireland has seen high net immigration regularly with this pattern being interrupted only by the post-2008 property crash and then the Covid lockdowns. In 2007, we saw net immigration of 107,000 people. That is a huge number for a small country.

A recent report from the real estate agency, Savills, surveyed the rate of population growth in nine countries, including Ireland, and compared this with its rate of home building. It found that Ireland was building only one house for every 4.1 additional people in the population. This was the worst ratio in the countries considered.

A fast-growing population must create infrastructural and other strains. It increases demand for accommodation, and also for health services. It cannot be otherwise.

Over-encouraged

Is it possible also that people are too inclined now to go to a doctor and is this being over-encouraged by a State which has turned the pursuit of health and wellbeing into a sort of quasi-religion? In line with this, the number of free schemes is constantly increasing and ultimately the State will not be able to afford all these schemes.

If you speak to doctors and practice nurses, they will tell you that it is not uncommon for people to book appointments for no good reason. They might have something very minor like a cold.

There are also a growing number of what is called ‘the worried well’ in the population, that is, people who are basically in good health but are worried that they might not be and therefore go to see doctors more than they should.

And obviously when something is free, you will be more inclined to avail of it.

It is perfectly possible in the years ahead that the strain of an ageing, growing population of people more worried than in the past about their health will cause more GPs to drop out of the profession altogether, thereby adding even more strain to the system.

Being a doctor is a vocation, as is being a priest. At their best, both walks of life are a calling. In one case you are looking after someone’s body, and in the other case, their souls. Both vocations require tremendous patience and an orientation towards other people.

As with priests, some doctors don’t really have a vocation, or else lose it. They grow weary in the job and become burnt out. Plenty of others are, of course, able to keep their sense of vocation right to the end.

But being a doctor is not as high status as it once was, as it is the case with the priesthood.

In the past, there were far fewer high status and (relatively) highly paid jobs available, and clever people were often eager to enter the medical profession.

I think nearly all vocational professions are suffering from the severe competition being offered by other occupations”

Now there are lots of other high status, highly paid jobs on offer and therefore the medical profession has far more competition than was once the case.

But can it really be said that something like computer programming is a vocation? I don’t think so. In fact, I think nearly all vocational professions are suffering from the severe competition being offered by other occupations.

I believe there is a growing vocational crisis in Ireland overall, and it is not just affecting the priesthood. I think it is affecting the medical profession as well, and to judge from the growing difficulty the Gardai have attracting recruits, police work also. At the end of the day, this is a very bad trend for society.