Áine Kenny: Non-EU doctors struggling to access consultant training

Áine Kenny: Non-EU doctors struggling to access consultant training

Non-EU doctors are struggling to access training schemes and it will result in them leaving Ireland, a Crumlin Children's Hospital registrar has said.

Non-EU doctors are being prevented from joining Irish training schemes to become consultants, it has been claimed.

Mohsin Kamal, originally from Pakistan, came to Ireland in 2016 and says he has not been given the opportunity to progress his career. This is his third year as a registrar in Crumlin Children's Hospital and he wants to become a consultant in paediatrics.

In order to become a consultant in Ireland, doctors must have completed an intern year, two years of basic specialist training, and then 4-6 years of higher specialist training.

However, non-EU doctors are struggling to access these training schemes.

The training schemes are run by different medical colleges and are overseen by the Irish Medical Council.

"My undergraduate degree and my internship outside of Ireland is recognised to do the job which the training scheme doctors are doing, but it isn't recognised to get onto a training scheme to become a consultant," says Dr Kamal.

Some non-EU doctors end up doing two years or more of rotations, equivalent to the basic specialist training, but they are not exempt from this level when applying for the training schemes.

Dr Kamal would like to see a streamlined parallel pathway to basic specialist training for non-EU doctors and he says the current application process feels discriminatory. 

He claims the selection criteria for doctors applying to the training schemes is preferential based on nationality, with non-EU nationals who graduated outside the EU bottom of the list.

Dr Mohsin Kamal, who works at Crumlin Children's Hospital, says there is no training opportunities for non-EU doctors in Ireland.
Dr Mohsin Kamal, who works at Crumlin Children's Hospital, says there is no training opportunities for non-EU doctors in Ireland.

Non-national doctors must also pass three Pre-Registration Examination System (PRES) exams in order to apply to a training scheme.

"I am exempt from PRES 1 due to my internship back home. There are two other parts, PRES 2 and 3, which existed in 2016. Many of my [non-EU] friends passed those three exams, but could never get accepted into paediatric basic specialist training," says Dr Kamal.

"They kept applying and eventually they got accepted into the basic specialist training (a level below their current post), when they had the experience for the higher training because they had been working in the system for so long."

Dr Kamal says there used to be a backdoor route for non-EU doctors hoping to become paediatric consultants.

If doctors completed either the UK Royal College of Paediatrics and Child Health or Royal College of Physicians in Ireland membership exam, did rotations equivalent to the basic specialist training, and their consultant gave them a reference, they could be exempted from the basic specialist training and be accepted straight into higher specialist training to become a consultant.

Dr Kamal tried to take this route a year ago, but when he applied, the college said they did not grant these types of exemptions anymore. This was despite the fact he had proof other non-EU doctors had been accepted in this way.

A further complication is that the PRES 2 exam has been discontinued, meaning non-EU doctors hoping to train as a consultant in Ireland must go to either the UK to sit their equivalent, the PLAB, or to the USA to take the USMLE. Only then can the PRES 3 exam be taken.

After this is completed, the doctor may be required to retake the IELTS English exam, despite having already passed it to register with the Irish Medical Council and working in the system ever since.

"They block us from every route," says Dr Kamal.

Dr Kamal believes these policies actively encourage non-EU doctors living in Ireland to join the NHS.

"If I have two year's experience in Ireland, my membership exam, and a letter from my consultant saying they are happy with my English, on that basis, the UK is exempting me from all their PLAB exams and the English language exam, and they give me a direct induction in their higher specialist training scheme.

"But Ireland does not recognise the experience that I gained here, I have to sit the UK PLAB exam, retake the IELTS English exam and complete basic specialist training for two years, just to apply for higher specialist training in Ireland."

Dr Kamal says even if he does all this and applies to the higher training, he will be chosen last over EU doctors. "It makes no sense. They don't want us to stay, they just want to train their own doctors."

However, Dr Kamal says even the on-scheme Irish doctors are "treated badly" and they are all under serious pressure due to staff shortages.

He doesn't understand why there aren't more training positions available in general, as there is competition even among the Irish graduates.

"One in five consultant positions are not filled. We are not creating enough consultants. They are not even giving the opportunities to the Irish doctors, we are the non-EU doctors [who are bottom of the list]."

While there is a pay difference between the specialist registrars who are on-scheme and the registrars who are not on-scheme, Dr Kamal says he doesn't care about the money.

"I don't need a pay rise. I just need training. We are happy to work at the same wage, we just need opportunities."

Dr Mohsin Kamal is highlighting the inequalities that exist in the Irish doctor training schemes.
Dr Mohsin Kamal is highlighting the inequalities that exist in the Irish doctor training schemes.

He says non EU doctors may get training in specialities that have very low numbers of doctors applying, but only when the colleges fail to fill those posts with EU doctors.

Dr Kamal has been in Ireland for almost five years now, meaning he can apply for Irish citizenship soon. He thinks this may be the only option left for him. "Once I have Irish citizenship, I should be treated equally, but if they don’t give me the basic specialist training exemption then I have to leave this country to pursue my career elsewhere.

"Us non-EU doctors will be working at the registrar level for the rest of our life."

When asked about the training scheme criteria being ranked in order of nationality, the HSE said: "EU community preference is applied during the recruitment process for postgraduate training programmes.

"Available specialist training places are allocated by the training body in the first instance to those candidates who at the time of application are citizens of Ireland or nationals of another Member State of the European Union."

When asked about English language requirements, the HSE said: "When applying for Higher Specialist Training, non EU graduates are not required to repeat the IELTS exam obtained for registration purposes with the IMC. Rather they are asked, if necessary, for an IELTS certificate which is dated within two years.

"Candidates who have been working in the Irish system for a number of years with valid IELTS are not subject to these requirements."

The Irish Medical Council said for doctors to gain access to specialist training, they must be eligible for registration on the trainee specialist division of the register.

"The requirements are set out in the Medical Practitioners Act 2007. An amendment to legislation, long sought by the Medical Council, to allow non-EU graduates apply to access specialist training, is contained in the Regulated Professions (Health and Social Care) (Amendment) Bill 2019.

"This amendment to the Act will remove the requirement to hold the equivalent of a certificate of experience for entry in the Trainee Specialist Division. This removes the barrier for non-EU doctors to access specialist training.

"Access to registration in the Trainee Specialist Division will enable doctors to apply for entry to formal post graduate training programmes."

This legislation was listed as a priority in the last Dáil term but it did not complete all stages through the Oireachtas before the general election in February.

The Medical Council added that it is hopeful that the legislation would be reintroduced and passed soon.

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