Sir, – The proposal that the State would fund graduate-entry medical fees in exchange for mandatory years of service reveals, yet again, a profound misunderstanding of why so many Irish-trained doctors leave in the first place.The assumption appears to be that emigration is primarily a financial calculation, and that doctors can be retained through contractual obligation or quasi-conscription. This approach merely rehashes the failed thinking of the past: “the floggings will continue until morale improves”.Doctors do not leave Ireland simply because another country pays more. They leave because they are exhausted by toxic leadership, unsafe staffing levels, chronic understaffing, poor training structures and a working culture that too often treats goodwill as an inexhaustible resource.Successive governments have responded to this reality not by addressing the underlying conditions, but by attempting to make leaving harder. Yet, professionals with internationally-recognised qualifications will always vote with their feet. If doctors are treated better abroad – professionally, financially and personally – many will continue to go abroad.Retention cannot be achieved through coercion. It must be earned.If the Government genuinely wishes to keep Irish-trained doctors in Ireland, it should focus less on binding them to the system and more on building a health service in which they would actually choose to stay.Yours, etc, DR RORY STEWART,Creeslough,Donegal.