Training more doctors in the developed English speaking world: Impact on post-graduate training and employment

Dear Sir

Over the past 10–15 years, there has been a drive to increase medical student numbers in the US, Canada, Australia, New Zealand, the UK and Ireland. In England, medical school places have already increased by 71% between 1997–1998 and 2006–2007 (HEFCE 2010). Ireland has experienced an even more dramatic increase in the intake of EU/domestic students. Canada, the US, Australia and New Zealand have also seen significant increases in student numbers over the past decade.

While the expansion of medical school places will no doubt help to increase the supply of doctors and reduce the brain drain from less developed countries, there needs to be a greater level of debate on the impact of rapid expansion of medical student numbers. While there may be insufficient doctors today, the possibility of future oversupply cannot be ruled out.

In this respect, Ireland is particularly interesting. The intake of EU/domestic students to medical school has roughly doubled since the publication of the ‘Fottrell Report’ (an official government report) in 2006. However, the Irish economy has suffered badly since the global economic crisis started in 2008 and emigration has soared. Forecasting the future need for medical services and doctors in Ireland is not straightforward as there could be a future oversupply of doctors if emigration continues to rise and population size decreases.

A significant number of Irish doctors have traditionally moved to other English speaking countries for employment or training and emigration has been an unemployment safety valve for doctors. Similarly, many New Zealand medical graduates have traditionally moved (and still do) to Australia to train or work and many Canadian medical graduates cross the border to the US every year.

The implications of large increases in medical school intakes all over the developed English speaking world may mean that opportunities for cross-border movements of medical graduates for post-graduate training and work may diminish going forward as every country becomes self-sufficient. The unemployment safety valve of emigration could be sealed off for new medical graduates as a result. It is my opinion that there needs to be more debate around the future impact of the current expansion.