title: Predictors of career progression and obstacles and opportunities for non-EU hospital doctors to undertake postgraduate training in Ireland.
abstract: The World Health Organization's Global Code on the International Recruitment of Health Personnel urges Member States to observe fair recruitment practices and ensure equality of treatment of migrant and domestically-trained health personnel. However, international medical graduates (IMGs) have experienced difficulties in accessing postgraduate training and in progressing their careers in several destination countries. Ireland is highly dependent on IMGs, but also employs non-European Union (EU) doctors who qualified as doctors in Ireland. However, little is known regarding the career progression of these doctors. In this context, the present study assesses the determinants of career progression of non-EU doctors with particular focus on whether barriers to progression exist for those graduating outside Ireland compared to those who have graduated within.
  
  
  
  The study utilises quantitative data from an online survey of non-EU doctors registered with the Medical Council of Ireland undertaken as part of the Doctor Migration Project (2011-2013). Non-EU doctors registered with the Medical Council of Ireland were asked to complete an online survey about their recruitment, training and career experiences in Ireland. Analysis was conducted on the responses of 231 non-EU hospital doctors whose first post in Ireland was not permanent. Career progression was analysed by means of binary logistic regression analysis.
  
  
  
  While some of the IMGs had succeeded in accessing specialist training, many experienced slow or stagnant career progression when compared with Irish-trained non-EU doctors. Key predictors of career progression for non-EU doctors working in Ireland showed that doctors who qualified outside of Ireland were less likely than Irish-trained non-EU doctors to experience career progression. Length of stay as a qualified doctor in Ireland was strongly associated with career progression. Those working in anaesthesia were significantly more likely to experience career progression than those in other specialities.
  
  
  
  The present study highlights differences in terms of achieving career progression and training for Irish-trained non-EU doctors, compared to those trained elsewhere. However, the findings herein warrant further attention from a workforce planning and policy development perspective regarding Ireland's obligations under the Global Code of hiring, promoting and remunerating migrant health personnel on the basis of equality of treatment with the domestically-trained health workforce.
authors.affiliation: Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, College Green, Dublin 2, Ireland. tyrrelel@tcd.ie.
authors.forename: Ella
authors.initials: E
authors.lastname: Tyrrell
authors.affiliation: Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, College Green, Dublin 2, Ireland.
authors.forename: Conor
authors.initials: C
authors.lastname: Keegan
authors.affiliation: Department of Epidemiology and Public Health Medicine, Royal College of Surgeons, Dublin, Ireland.
authors.forename: Niamh
authors.initials: N
authors.lastname: Humphries
authors.affiliation: Department of Epidemiology and Public Health Medicine, Royal College of Surgeons, Dublin, Ireland.
authors.forename: Sara
authors.initials: S
authors.lastname: McAleese
authors.affiliation: Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, College Green, Dublin 2, Ireland.
authors.forename: Steve
authors.initials: S
authors.lastname: Thomas
authors.affiliation: Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, College Green, Dublin 2, Ireland.
authors.forename: Charles
authors.initials: C
authors.lastname: Normand
authors.affiliation: Department of Epidemiology and Public Health Medicine, Royal College of Surgeons, Dublin, Ireland.
authors.forename: Ruairí
authors.initials: R
authors.lastname: Brugha
mesh_terms: D002321:Career Choice; D002322:Career Mobility; D004501:Education, Medical; D054242:Emigrants and Immigrants; D004641:Emigration and Immigration; D004651:Employment; D005062:European Union; D005550:Foreign Medical Graduates; D006761:Hospitals; D006801:Humans; D007391:International Cooperation; D007494:Ireland; D016015:Logistic Models; D008505:Medical Staff, Hospital; D010560:Personnel Selection; D010820:Physicians; D012935:Social Justice; D013038:Specialization; D011795:Surveys and Questionnaires; D014944:World Health Organization
keywords: Career progression; International medical graduates; Postgraduate training; Recruitment; WHO Global Code