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Thursday 21 September 2023 Dublin: 12°C
# retention crisis
'Since I got the letter, it's just silence': Citizenship delays now a 'disincentive' for doctors to stay in Ireland
One doctor described the stress of applying for citizenship and work permits, and the toll it has taken on his personal life.

DOCTORS ARE WARNING that long delays in processing citizenship applications are acting as a disincentive for foreign-trained doctors to continue working in Ireland.

The HSE is in the midst of a recruitment and retention crisis as it struggles to fill hundreds of empty consultant posts within the public healthcare system, particularly in areas such as paediatrics and psychiatry. 

Organisations including the Irish Medical Organisation (IMO) and Irish Hospital Consultants Association (IHCA) have put pressure on the Irish government in recent years to tackle the shortage of doctors, which they say would also positively impact on waiting list numbers and alleviate the trolley crisis. 

However, doctors from outside of Europe, living in Ireland for more than five years, and who have applied for citizenship, are reporting years-long delays in having their applications processed.

“We should be making Ireland a place where the best and brightest want to work, where we welcome folks who are highly skilled, and professionals who we need to help our health service,” Paul Maier, Industrial Relations Officer with the IMO said. 

“And if we’re talking about this being an incentive to stay or an incentive to leave, I do know these immigration hurdles have been a disincentive to stay in Ireland.”

Maier explained that many doctors apply to work on precarious six-month long contracts and in order to accept a subsequent contract, they most reapply for a work permit through the Irish Naturalisation and Immigration Service (INIS) which involves an administrative fee. 

A grant of citizenship for eligible doctors who have been here over five years would eliminate that burden but extensive processing times are preventing that from happening for many. 

The Department of Justice has been under fire for the lengthy processing times over a number years now, but in response to a query from, it pointed to the Jones High Court ruling in May 2019 and the subsequent appealing of that ruling as the reason for the current processing delays of all applications. 

The Department put a halt to all applications being processed and suspended citizenship ceremonies for six months following the original High Court ruling. 

It states that processing times normally take around six months but in an interview with in October, solicitor Carol Sinnott said: “We have clients waiting for two-and-a-half years for a decision on their cases, which is horrendous and nothing to do with the Jones case”.

That particular case concerned Australian Roderick Jones who took a High Court challenge following a refusal on his application of citizenship – refused on the grounds that he had left the State for a period of time. 

The High Court ruling which accepted that he was not eligible due to his leaving the State was appealed, and the ruling overturned in November but as a result processing delays have been exacerbated. 

“Those who don’t yet qualify for citizenship or permanent residency, there is a requirement to apply for a work permit for only the duration of the contract for doctors employed, which is typically six months in duration, or on a rare occasion, a year,” Maier said of the process doctors must go through. 

“”[Then] you have to go through an entire process which includes a fee, and processing times during which you can’t leave the State or visit family… if it is delayed, it prevents doctors who are otherwise qualified and ready for work.”


Farhan Sikander is a doctor who has been living in Ireland for six years now and applied for citizenship in January 2019. 

Some 14 months later, the Pakistan-born emergency doctor is still waiting for an update on his application, continuing to repeatedly apply for a renewed work permit, and unable to travel outside of Ireland.

“I don’t have any kind of bad things against me. I have paid my taxes, always through the PAYE in the HSE, I went through the INIS website and it said it would take six months. I submitted my documents, my birth certificate, P60, payslips, Revenue cert. for the last five years, everything is done,” he said. 

“I submitted my documents on 29 January last year and I thought my application was straight forward but in June I got a letter saying it was in the second stage and since then, it’s just silence.”

Sikander said he is aware of other doctors in a similar situation with one Nigerian doctor waiting more than 18 months now without any update on his application status. 

“I’ve spoken to one or two other guys, fellow doctors, one Nigerian and one Pakistani and they all said it takes about three years in their experience but they [INIS] never mentioned that to me. 

“And then I look at forums online and people are saying if you are from an EU country you can apply for a passport and get it within four months so I think they’ve been singling us out.”

The 39-year-old added that family members of his, doctors who are working in the UK report a much quicker process for doctors to obtain work permits and permanent residence because of a tiered entry system for skilled doctors with offers of employment. 

He described the extensive amount of paperwork required to legally work in Ireland as a burden that has taken a hard toll on his personal life, along with the added distress of not being able to leave Ireland to visit his family. 

“There was a job opening in Ireland so I came here trusting my gut but then I loved Ireland after getting some experience here. I was offered a job in the UK with a permanent visa status but I have met my girlfriend here and we live together.” 

“I think I want to stay in Ireland because I love living here in this country and with this culture,” he added. 


The IMO is not alone in raising concerns for the future recruitment and retention of doctors in Ireland. 

Donal O’Hanlon, president of the Irish Hospital Consultants Association, also raised concerns over the delay in processing citizenship applications. 

“The IHCA has concerns that recruitment and retention of highly-skilled medical staff would be made much more difficult due to delays in processing citizenship applications and runs the risk of losing these professionals from our system,” he said. 

The Department of Justice said it cannot comment on individual cases but pointed to the Jones High Court Case as the cause for a delay in processing the 20,672 cases in the system at the end of 2019.

The High Court case lead to a ruling that applicants must have 12 months uninterrupted residence in Ireland prior to their application and lead to citizenship ceremonies being suspended.

But this was successfully appealed in November and citizenship ceremonies resumed in December 2019, with the second citizenship ceremony since the appeal held last Monday.

“A number of further ceremonies will be held later in 2020 and  it is hoped that these ceremonies will allow for in excess of 6,000 applicants to be conferred with Irish citizenship,” a spokesperson said. 

Asked if the Department of Health was concerned that delays could lead to the loss of doctors from the system, a spokesperson told they could not comment on the issue. 

When the same question was put to the HSE, a spokesperson said: “Citizenship is a matter for the Department of Justice and Equality. However, the HSE acknowledges there can be challenges but is guided by the Department of Business, Enterprise and Innovation around areas of immigration.”


Paul Maier of the IMO also said there are issues around doctors from some countries outside of Europe who are restricted from engaging in further specialised training in specific areas of medicine. 

“This also relates to another issue around a number of doctors working within the country who, because they didn’t complete an internship in one of a number of listed or approved locations or countries, are ineligible to participate in basic or higher specialist training within Ireland,” he said. 

“They train to become a consultant within that jurisdiction and instead are required to serve in NCHD (non-consultant hospital doctor) posts. 

“Part of that issue is the opportunity to train or participate in training, to specialise in an area of medicine. If someone wants to dedicate commitment to the Irish health service and are trying to be specialist in an area, we should encourage that and at the very least give every person duly qualified the opportunity to compete for training and position.” 

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