By Dr Zainab Afzal, Senior House Officer, Department of Anaesthesia, St. Vincent’s University Hospital, Dublin
In July of last year, I moved to Ireland as part of the CPSP-HSE scholarship programme (an initiative between the College of Physicians and Surgeons Pakistan and the HSE). Starting work as a Senior House Officer in the Department of Anaesthesia at St Vincent’s University Hospital was a turning point in my professional life, and also a major adjustment.
Looking back on this past year, I want to share a few things that I wish I had known earlier. If you’re an international medical graduate (IMG) planning to work in Ireland, these lessons could help make your transition significantly smoother.
A different kind of healthcare system
From day one, I was struck by the structure and professionalism of the Irish healthcare system. Everything here is supervised, protocol-driven, and patient-centred. For many of us, this can be a cultural shift, especially if we come from systems where supervision, documentation, and formal protocols are less structured.
Here’s what stood out to me:
- Consultants are approachable and supportive, and you’ll often have direct communication with them.
- Documentation is critical, not just for good practice, but for legal protection. Make it a habit from day one.
- Guidelines and protocols are strictly followed, and you’ll be expected to align with them.
- Workplace culture values safety, respect, and accountability, and you’ll find people are generally very patient and humble.
Key lessons for new IMGs
1. Documentation saves careers
In our home countries, we may not document every interaction, but in Ireland, failing to document your practice can get you into serious trouble. Always document clearly, thoroughly, and in a timely manner.
2. Double-check your pay scale
Don't assume your salary is correct. Based on prior experience, many IMGs, and even Irish trainees, discover later that they were placed on the wrong scale. Speak to HR early and clarify your entitlements.
3. Navigating housing and relocation.
Ireland’s housing crisis is real. Finding suitable accommodation can be challenging and scams are common. Stick to trusted sources like:
- Daft.ie
- Facebook groups such as Doctor Daft and Doctor Res
- Your hospital’s HR department or roster coordinator. Sometimes outgoing staff vacate hospital accommodation.
Culture shock is real - but so is support
When I first arrived, I found the Irish accent difficult, especially during fast-paced clinical conversations. I felt homesick, isolated, and unsure of myself. At times, I truly believed I didn’t belong here, and that’s something really challenging to cope with. But one positive interaction with a senior consultant changed that. Sometimes, that’s all it takes to restore your confidence.
If you’re struggling, ask for help. You’ll be surprised how supportive the faculty and colleagues are. And remember, things do get easier. You’ll adapt to the pace, the accent, and the expectations of the system.
A resource-rich training environment
Ireland offers tools and experiences that may be new to many IMGs. In Anaesthesia, for instance, I used advanced monitoring equipment for the first time. A year later, I’m confident in its use. Trust me, you’ll have all the help you need to get used to the things here. Be curious, show initiative, and make the most of every opportunity.
Protect your reputation - and yourself
Ireland has a small medical community. Your reputation travels fast. Always be honest, respectful, and professional. But professionalism isn’t enough. Even with the best intentions, misunderstandings or oversights, especially in documentation or communication, can lead to serious consequences, including legal claims or Medical Council investigations.
That’s why having independent indemnity cover from day one is non-negotiable.
Why Medical Protection indemnity is essential for IMGs
In Pakistan, and many other countries, doctors rarely face legal action, and indemnity isn’t something we think about. But in Ireland, the legal environment is very different.
As a hospital doctor working within the HSE, you will be protected against the financial consequences of clinical negligence claims by the Clinical Indemnity Scheme (CIS).
However, an IMG, you’re new to the system. Even minor misunderstandings, documentation gaps, or communication issues can lead to big consequences, including legal action or Medical Council investigations, which can be emotionally and financially devastating. Why take the risk when you can have peace of mind?
The CIS does not extend to assistance for:
- internal complaints and disciplinaries related to your clinical practice
- inquests
- Medical Council investigations
- criminal allegations arising from the provision of clinical care.
This is where Medical Protection can help. As a Medical Protection member you would however be entitled to request assistance in these circumstances.
What Medical Protection offers you
Medical Protection provides comprehensive, tailored protection for doctors at all levels. Their support starts before a complaint arises, and continues through to legal advice and representation.
Find out more about Medical Protection membership
Final thought: Don’t wait until it’s too late
Something you’ve always done in your home country might not be acceptable here, and you may not even realise it until you’re accused of misconduct. Why take that chance?
Medical Protection exists to support you, not just when something goes wrong, but to help you avoid problems in the first place. Protecting yourself from the start is one of the best decisions you’ll make as you begin your journey in Ireland.
This past year has brought tremendous growth, both professionally and personally. If you’re just starting out, know this:
You belong here.
You’re not alone.
And with the right support, like Medical Protection, you’ll thrive.
Trust me, I’ve been there.
Wishing you the very best on your journey.
Dr. Zainab