Ir Med J. 2014 Jan;107(1):28-9

Sir

Frohlich and Moriarty are to be congratulated for bringing to the fore the system of medical education in Ireland that creates specialists for export¹. Emigration is a personal and professional upheaval that is forced upon many doctors of all specialties, and undoubtedly it does result in economic waste. However the financial figures that Frohlich and Moriarty cite as the amount of economic waste may not be accurate. Firstly the authors state that the cost of educating a student in the UK from entry to medical school to completion of the intern year has been estimated as £334 000 (€391 726). However medical education in the UK is quite different to that in Ireland. Most medical schools in Ireland have a pre-medical year – this would result in higher costs in Ireland.

Student tuition fees in the UK are much higher than student service fees in Ireland – this pushes more of the cost of training onto the state in Ireland. There is also a very different undergraduate medical education system in the UK compared to Ireland and once so again costs will not be comparable. According to Frenk et al the cost of undergraduate education in most Western European countries is approximately €307 800 – this may be a better estimate of the cost in Ireland². However an estimate it undoubtedly is, and it leads us to a first conclusion: we simply don’t know how much we spend on undergraduate medical education. Secondly the authors estimate the cost of delivering postgraduate education from medical school to consultant level at €960 000. However there are difficulties with this figure. Even though postgraduate doctors are being educated they are also contributing to the health service, and so return on investment is being delivered by these doctors even if they do not practice as consultants in Ireland.

This is as it should be – indeed according to Janet Grant “the strength of medical education is its integration of service and training”³. The figure of €960 00 in any case is a worst case scenario – it assumes that emigrant doctors leave Ireland when they have completed their specialist training – in fact many of them do so part of the way through their training. This leads us to a second conclusion: spend on postgraduate medical education is complex – it is difficult to distil it to a single figure. The authors rightly cite the financial wastage that results from high emigration amongst our trained specialists. If the health service does not listen to clinical and educational arguments, then it might listen to economic ones. However we must be sure of our figures if we are to win these arguments.

K Walsh
BMJ Learning, BMA House, Tavistock Square, London WC1H 9JR
Email: [email protected]

References

1. Frohlich S, Moriarty J. Attitudes and Intentions of Current Anaesthetic Trainees. Ir Med J. March 2013. 106: 82-84

2. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, Fineberg H, Garcia P, Ke Y, Kelley P, Kistnasamy B, Meleis A, Naylor D, Pablos-Mendez A, Reddy S, Scrimshaw S, Sepulveda J, Serwadda D, Zurayk H. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010 Dec 4;376:1923-58.

3. Grant J. The Calman report and specialist training. Calman report builds on the status quo. BMJ 1993;306:1756