title: Ireland's medical brain drain: migration intentions of Irish medical students.
abstract: BACKGROUND
  To provide the optimum level of healthcare, it is important that the supply of well-trained doctors meets the demand. However, despite many initiatives, Ireland continues to have a shortfall of physicians, which has been projected to persist. Our study aimed to investigate the migration intentions of Irish medical students and identify the factors that influence their decisions in order to design appropriate interventions to sustain the supply of trained doctors in order to maintain a viable medical system.
  
  
  METHODS
  An online cross-sectional survey was undertaken of all Irish medical students studying in the Republic of Ireland. The survey included nominal, ordinal, and scale items to determine migration intentions, factors influencing their decisions, and understanding of the Irish healthcare system.
  
  
  RESULTS
  A total of 2 273 medical students responded (37% response rate), of whom 1 519 were classified as Irish medical students (having completed secondary school in Ireland). Of these, 88% indicated they were either definitely migrating or contemplating migrating following graduation or completion of the pre-registration intern year. Forty percent expressed an intention of returning to Ireland within 5 years. The factors most influencing their decision to leave were career opportunities (85%), working conditions (83%), and lifestyle (80%).
  
  
  CONCLUSIONS
  The migration intentions expressed in this study predict an immediate and severe threat to the sustainability of the Irish healthcare service. Urgent interventions such as providing information about career options and specialty training pathways are required. These must begin in the undergraduate phase and continue in postgraduate training and are needed to retain medical school graduates.
authors.affiliation: National University of Ireland, Galway, Ireland. p.gouda1@nuigalway.ie.
authors.forename: Pishoy
authors.initials: P
authors.lastname: Gouda
authors.affiliation: National University of Ireland, Galway, Ireland. k.kitt1@nuigalway.ie.
authors.forename: Kevin
authors.initials: K
authors.lastname: Kitt
authors.affiliation: Department of Public Health, Merlin Park Hospital, HSE West, Galway, Ireland. david.evans@hse.ie.
authors.forename: David S
authors.initials: DS
authors.lastname: Evans
authors.affiliation: Department of Public Health, Merlin Park Hospital, HSE West, Galway, Ireland. deirdre.goggin@hse.ie.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Goggin
authors.affiliation: University of Limerick, Limerick, Ireland. Deirdre.McGrath@ul.ie.
authors.forename: Deirdre
authors.initials: D
authors.lastname: McGrath
authors.affiliation: University College Dublin, Dublin, Ireland. jason.last@ucd.ie.
authors.forename: Jason
authors.initials: J
authors.lastname: Last
authors.affiliation: Trinity College Dublin, Dublin, Ireland. mhenness@tcd.ie.
authors.forename: Martina
authors.initials: M
authors.lastname: Hennessy
authors.affiliation: Royal College of Surgeons in Ireland, Dublin, Ireland. rarnett@rcsi.ie.
authors.forename: Richard
authors.initials: R
authors.lastname: Arnett
authors.affiliation: University College Cork, Cork, Ireland. siun.oflynn@ucc.ie.
authors.forename: Siun
authors.initials: S
authors.lastname: O'Flynn
authors.affiliation: National University of Ireland, Galway, Ireland. fidelma.dunne@nuigalway.ie.
authors.forename: Fidelma
authors.initials: F
authors.lastname: Dunne
authors.affiliation: National University of Ireland, Galway, Ireland. diarmuid.odonovan@nuigalway.ie.|Department of Public Health, Merlin Park Hospital, HSE West, Galway, Ireland. diarmuid.odonovan@nuigalway.ie.
authors.forename: Diarmuid
authors.initials: D
authors.lastname: O'Donovan
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002321:Career Choice; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D004504:Education, Medical, Undergraduate; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D033182:Intention; D007494:Ireland; D007588:Job Satisfaction; D008019:Life Style; D008297:Male; D010820:Physicians / Q000600:supply & distribution; D011365:Professional Practice Location; D012577:Schools, Medical; D013337:Students, Medical; D011795:Surveys and Questionnaires; D000078329:Workforce; D017132:Workplace; D055815:Young Adult