For over a year, health workers worldwide have mobilised to treat those with covid-19; educated the public about the virus and how best to avoid catching it; tested those with symptoms; treated and traced the contacts of those who tested positive; and rolled out vaccination programmes. The health workforce has been our best defence against covid-19 and, both individually and collectively, health workers are worthy of our highest praise.
The covid-19 pandemic has highlighted key health system capacity challenges in Ireland, as elsewhere.  An under-resourced medical workforce is one of those challenges. Ireland does not have enough doctors, or enough specialist doctors, and has, in recent years, struggled to fill vacant posts at consultant level.
The pandemic has once again focussed attention on the medical workforce, primarily on the need to strengthen the workforce in response to covid-19. In late November 2020, the Irish Government announced plans to recruit an additional 772 medical/dental staff to assist with the pandemic response.  Leaving aside the logistical challenges associated with recruiting such a large number of doctors during a global pandemic, it is important to question the idea that Ireland’s medical workforce challenges can be solved by recruitment alone.
The 2008 recession and subsequent austerity period triggered widespread doctor emigration from Ireland, a trend which, as of 2019, showed no sign of slowing.  Pre-pandemic, dissatisfaction with deteriorating working conditions was a driver of doctor emigration from Ireland and was a cause of considerable frustration for hospital doctors working in the Irish health system. 
Focussing on recruitment, without addressing the reasons for weak doctor retention and high doctor emigration, is a strategy that has already failed the Irish health system.
This has been a key focus of the Hospital Doctor Retention and Motivation (HDRM) project, a research project funded by the Irish Health Research Board and focussed on the working conditions and wellbeing of Ireland’s hospital doctors.
In June/July 2020, we spoke to hospital doctors in Ireland about their experiences of working through the first wave of the covid-19 pandemic. Several of those interviewed noted that working through the pandemic was easier than a “regular” winter working in the Irish health system. Although they did not welcome the pandemic, they welcomed the crisis response which was considered a long-overdue acknowledgement of a health system in crisis, one where winter overcrowding is an annual occurrence and trolley counts and waiting lists are all-too-familiar metrics of delayed care. 
Challenging working conditions and extreme ways of working have become normalised for Ireland’s hospital doctors.  For instance, pre-pandemic, it was standard practice for junior hospital doctors to attend work when unwell. They could not take sick leave unless they could find a colleague willing to cover their shift. This led to a culture of presenteeism as junior hospital doctors avoided taking sick leave for fear of inconveniencing colleagues and letting down the team. 
The covid-19 pandemic saw the introduction of mandated periods of restricted movement for hospital doctors who tested positive for covid-19 or were a close contact of a positive case. Cover was arranged for those doctors who needed to take sick leave or isolation leave. These measures meant that hospital doctors were afforded time and space to recover from illness. However, doctors also expressed a fear of a post-pandemic return to business-as-usual in the Irish health system. They were keen to maintain (and build upon) any work-related improvements that had emerged during the first wave of the pandemic. [5, 6]
The covid-19 pandemic has illustrated that health systems are only as strong as the people who staff them. Our timely access to healthcare requires that hospital doctors have working conditions which enable them to protect their own health and wellbeing.
The Irish health system must better protect the people behind its pandemic response by improving their working conditions and ensuring they can protect their own wellbeing (and that of their families), while continuing to deliver care. Our interviews illustrated some of the ways in which hospital doctor working conditions could be improved by ensuring that hospital doctors have reasonable working hours, a work-life balance and the ability to take leave without having to arrange replacement cover. [4,6]
To successfully strengthen and scale-up the medical workforce during and after the covid-19 pandemic will require improving the working conditions of Ireland’s hospital doctors via a combination of recruitment and retention measures.
Niamh Humphries is a reader in Health Systems Research at the Royal College of Physicians of Ireland and holds a HRB Emerging Investigator Award (EIA-2017-022). Twitter @humphries_niamh
Jennifer Creese is a social anthropologist and postdoctoral researcher at the Royal College of Physicians of Ireland. Twitter @jennifer_creese
John-Paul Byrne is a sociologist and postdoctoral researcher at the Royal College of Physicians of Ireland. Twitter @jpbyrne7
Richard W. Costello is a clinician scientist and vice president of the Royal College of Physicians of Ireland
Illustrator: Eoin Kelleher is an anaesthesia trainee and cartoonist from Dublin, Ireland. Twitter @EoinKr
Competing interests: none declared.
- Department of Health and HSE: Update on Health System Preparedness for Covid-19. In. Dublin Department of Health and HSE; 2020.
- OECD: State of Health in the EU. Ireland Country Health Profile 2019. In: The Country Health Profile series. 2019
- Humphries N, Connell J, Negin J, Buchan J: Tracking the leavers: towards a better understanding of doctor migration from Ireland to Australia 2008-18. BMC Human Resources for Health 2019 17(36).
- Humphries N, McDermott AM, Conway E, Byrne JP, Prihodova L, Costello R, Matthews A: ‘Everything was just getting worse and worse’: deteriorating job quality as a driver of doctor emigration from Ireland. Human resources for health 2019, 17(1):97.
- Humphries, N., Creese, J., Byrne, JP. and Connell, J. COVID-19 and doctor emigration: the case of Ireland. BMC Hum Resources for Health 19, 29 (2021). https://doi.org/10.1186/s12960-021-00573-4
- Creese, J.; Byrne, J.-P.; Conway, E.; Barrett, E.; Prihodova, L.; Humphries, N. “We All Really Need to just Take a Breath”: Composite Narratives of Hospital Doctors’ Well-Being during the COVID-19 Pandemic. Int. J. Environ. Res. Public Health2021, 18, 2051. https://doi.org/10.3390/ijerph18042051