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Mohsin Kamal
consultants shortage

'I'm at the bottom of the list': Non-EU doctors in Ireland still face barriers in accessing specialist training

The Irish Medical Council said that it hoped recent changes in law would prompt more doctors to stay in Ireland to pursue specialist training here.

THE DIFFICULTIES FACED by non-EU doctors in applying for further training to become consultants in Ireland has been highlighted by a paediatric doctor.

Mohsin Kamal came to Ireland in March 2016. After working in Kilkenny, Letterkenny and Cork hospitals, he’s now an infectious disease registrar (a mid-ranking hospital doctor) at Crumlin Children’s Hospital in Dublin.

He aims to be a fully-trained consultant, and to carry out research into infectious diseases, but he is now unsure if Ireland is the place to do it. 

Kamal has said that the process for non-EU doctors to apply for training to become consultants is difficult, with extra qualifications needed to apply, and a preference for EU doctors above others when applications are being assessed. 

A recent Bill, the Regulated Professions (Health and Social Care) Amendment Bill 2020, now signed into law as an Act, aims to give greater access to non-EU doctors to train here.

Previously, the Irish Medical Council only recognised internships from eight countries as being equivalent to an Irish/EU internship – these are Australia, New Zealand, South Africa, Pakistan, Sudan, Malaysia, Malta and the UK.

This meant that many non-EU doctors needed to prove that their internship was the equivalent of an Irish internship with a Certificate of Experience in order to be eligible for Trainee Specialist registration, which prevented many from advancing their careers, with many leaving the country.

Now, the Irish Medical Council says doctors with non-EU internships “who are appropriately qualified and have established eligibility for General Registration”, but without initial Irish basic medical training, will be eligible to apply for Specialist Training.

But Kamal says that this won’t affect the vast majority of non-EU doctors here, and there are still other hurdles for non-EU doctors in attempting to apply for specialist training in Ireland – such as access to a PRES 2 exam not being available in Ireland, and EU doctors being prioritised for Specialist Training.

Everyone thinks it’s a big congratulations thing and it’s a big achievement for us. But in reality, it’s nothing beneficial for [most non-EU doctors.] I was eligible when I came to Ireland, but I cannot get to train here because of the [other] rules.

Kamal says he wants to stay in Ireland, but he has to make a decision for his career.

The process for applying for Specialist Training

An estimated 43% of Ireland’s doctors have graduated outside of Ireland, according to an Irish Medical Council report.

The Irish Medical Council also says that in 2018, doctors from countries outside of the EU cumulatively contributed more new entrants to the Irish register of medical practitioners than Ireland did.

Doctors Irish Medical Council Irish Medical Council

In Ireland there are two training schemes: the Basic Specialist Training (BST) which is two years long, and Higher Specialist Training (HST) which is five years long. 

In order to be eligible for BST, a doctor in Ireland needs to do an internship for one year (the Bill mentioned above deals with this), and they need to register for the Irish Medical Council. After this, EU graduates can apply directly for training.

Non-EU doctors have a few extra steps before registering. They need to do Pre-Registration Examination System (PRES) exams: PRES 1, PRES 2, and PRES 3. 

The Irish Medical Council said that all non-EU qualified doctors are required to pass or be exempt from the PRES, and the recent changes in law don’t change this requirement.

There is no facility to allow doctors to sit the PRES 2 exam in Ireland according to Kamal, so many will do the UK (PLAB) or US (USMLE) equivalent.

In response to questions from, the Irish Medical Council said that they were phasing out the PRES 2 exam “in favour of recognising a number of international tests of clinical knowledge” and that this “made PRES easier for applicants to apply for registration”.

“…Between the four overseas exams, there are now hundreds of test centres around the world in which the computer-based exam can be undertaken,” it said of PRES 2.

A PRES 3 exam, a clinical skills exam based on the main clinical disciplines of obstetrics and gynaecology, paediatrics, psychiatry, surgery, and general practice, can be done in Ireland – but is currently on hold due to the Covid-19 pandemic. 

Once these tests are passed, they can apply for Specialist Training programmes – but will only be considered for a post after any EU candidate who applies. This has been cited before as a strain on non-EU doctors who wish to further their training as consultants. 

Kamal said:

If there are 29 positions and 30 applicants, if one of them is from Pakistan and the rest of the 29 candidates are from Ireland and the Europe, and the fully-qualified doctor from Pakistan gave a great interview and his CV was brilliant… he will not be given the opportunity to get training.

An Irish Medical Council report cited a non-EU doctor, who said that “it’s incredibly hard for non-EU doctors who graduated from Irish medical college… to get onto HST because of ‘EU first’ rule and policy.”

RCPI RCPI / October 2019 RCPI / October 2019 / October 2019

Responses from the Irish Medical Council and the IMO 

In a statement, a spokesperson for the Irish Medical Organisation (IMO) said that the Regulated Professions (Health and Social Care) Amendment Bill 2019 was “a first step in ensuring that all doctors, regardless of their country of medical education, will have the opportunity to compete for a training scheme position in Ireland”.

“Meaningful access to training scheme positions for non-EU international doctors is only possible with a significant expansion of training scheme positions.

In our most recent presentation before the Oireachtas Health Committee regarding medical workforce planning, the IMO spoke about the need to increase our consultant, GP, public health and overall medical workforce.

The IMO told that Oireachtas hearing that there are around 500 vacant consultant posts, which is contributing to growing hospital waiting lists, now at over 840,000 people.

To future-proof our service, one of the things that we need to do is to train more of those doctors who are already working in, and familiar with, the health service in this country.

“We do not believe the Act will create increased difficulty for those who would otherwise be able to register with the Irish Medical Council on the basis of their recognised internship qualification.

“Regarding the PRES examination, we do understand that due to Covid-19, parts of this exam have been more difficult to achieve. This is unrelated to the Act.”

The Irish Medical Council gave the following statement to a similar number of issues raised:

“One of main barriers to accessing postgraduate training for non-EU qualified doctors, has been the requirement to have been granted the equivalent of a Certificate of Experience, ie, the doctor’s internship needs to be considered the equivalent of an Irish internship, in order to be eligible for Trainee Specialist registration, which is a requisite for entry into a training programme.”

The Medical Council said that it has “long sought amendments” to the Medical Practitioners Act 2007, and that the Act amends the five health professional regulatory Acts, including the Medical Practitioners Act. 

A key amendment contained in this Act is the removal of the requirement to have the equivalence of a certificate of experience for registration in the Trainee Specialist Division (TSD), opening access to doctors who are appropriately qualified and have established eligibility for General Registration, but without initial Irish basic medical training.

“This means all non-EU qualified doctors will have access to the TSD once they establish eligibility for general registration.”

In relation to English language requirements, nothing will change. Non-EU qualified doctors who are not EU citizens will still be asked to provide evidence of communication skills in the exact same way as is currently in place.

The Medical Council said that it’s hoped that with better access to progress their education and training, less doctors will leave the country because of this.

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