Working as a Doctor in Ireland: Medical Council and PRES Guide 2026

Ireland is a compact system with a single national regulator, the Medical Council of Ireland, and a single main public employer, the Health Service Executive (HSE). For doctors who qualified outside the EU and EEA, registration usually involves either the Pre-Registration Examination System (PRES) or an exemption from it.

Key facts

The Irish healthcare system

Ireland has a mixed public and private system. The HSE runs public hospitals and community services, while voluntary hospitals and private hospitals provide additional care. General practice is mostly private, with state-funded schemes covering parts of the population. Most non-consultant hospital doctor (NCHD) posts, including posts filled by international doctors, are in HSE and voluntary hospitals.

Authorities

• Medical Council of Ireland keeps the register, runs PRES and sets registration rules. See /councils/medical-council-of-ireland/.
• Health Service Executive (HSE) employs most hospital doctors and runs the National Doctors Training and Planning unit.
• Postgraduate training bodies (for example the Royal College of Physicians of Ireland, Royal College of Surgeons in Ireland, Irish College of General Practitioners) deliver specialist training.

Registration divisions

The register has several divisions:

• General Division for doctors practising in non-training posts.
• Specialist Division for doctors with a recognised specialist qualification.
• Trainee Specialist Division for doctors in recognised training posts.
• Supervised Division for doctors in specific supervised posts.

Which division you join depends on your qualifications, exams and the post you are offered. EU and EEA graduates are generally recognised automatically; doctors from outside the EU and EEA follow the Council's routes for non-EU graduates.

Recognition and PRES

The PRES has two levels:

• Level 2 is a written multiple-choice examination of medical knowledge.
• Level 3 is a clinical skills assessment, including a data interpretation component and an OSCE.

Candidates are normally allowed three attempts per level, and a Level 2 pass is valid for two years. Applicants who hold certain qualifications or have passed certain other exams are exempt. In 2026 the Council consulted publicly on extending exemptions; until changes take effect, rely on the exemption list on the Council's website.

Exam process step by step

1. Check whether you are exempt from PRES on the Medical Council website.
2. Apply to the Medical Council for assessment of your qualification and eligibility.
3. Sit PRES Level 2 if required. Book the session the Council specifies and pay the fee.
4. Sit PRES Level 3 within the validity of your Level 2 pass.
5. Apply for registration in the appropriate division and provide your English evidence.
6. Secure a post and complete the employment, Garda vetting and immigration steps.

Costs

The Medical Council sets fees for PRES, assessment and registration, and they change periodically; the current schedule is on medicalcouncil.ie. Budget for English tests, document verification, immigration and annual retention fees.

Timeline

Language requirements

The Medical Council requires evidence of English language competence for doctors whose primary medical degree was not taught in English or who come from non-English-speaking countries. Accepted tests and scores are listed on the Council's website. Check them before booking, because test results usually have a limited validity period.

Specialist training

Specialist training in Ireland is run by the postgraduate training bodies recognised by the Medical Council, typically structured as basic specialist training followed by higher specialist training. Entry is competitive. Experienced specialists trained abroad can apply for the Specialist Division if their qualifications meet the Council's criteria. The HSE also runs international clinical fellowship programs with partner colleges; their terms vary.

Working conditions

Hospital doctors below consultant level are employed as NCHDs under a national contract; consultant contracts are separate. Pay scales are set by the HSE and revised regularly. Working hours are capped under EU working time rules.

Document checklist

Prepare these before applying to the Medical Council:

• Primary medical qualification certificate and transcript.
• Internship certificate or evidence of equivalent clinical training.
• Certificates of good standing from every regulator where you have been registered.
• English language evidence meeting the Council's requirements.
• PRES results, or evidence of an exemption.
• Passport and identity documents.

Use consistent spellings of your name across all documents.

Preparation strategy for PRES

PRES Level 2 is a written multiple-choice exam of medical knowledge; Level 3 combines a data interpretation component and an OSCE. A plan that works for both:

1. Use broad clinical question banks covering medicine, surgery, paediatrics, obstetrics and gynaecology, psychiatry and general practice.
2. Learn the Irish and European practice context, including ethics and the Council's guide to professional conduct.
3. Practise timed MCQ sets and review every explanation.
4. Train OSCE stations aloud for Level 3: history, examination, explanation and communication.

Because each level normally allows three attempts, book only when your practice scores are stable.

Comparing Ireland with the UK route

Many doctors consider Ireland and the UK together because both are English-speaking and share similar hospital structures.

Read our UK guide for the GMC route. If you hold a PLAB pass, check the Council's current exemption rules, because recognition of other exams can change.

Finding a post

Most international doctors start as NCHDs in HSE or voluntary hospitals. Posts are advertised by individual hospitals and the HSE. When comparing offers, check whether the post is recognised for training, who supervises you and which registration division the post requires. A post in the Trainee Specialist Division requires a recognised training post.

Immigration basics

Doctors from outside the EU and EEA usually need an employment permit and a visa. Employment permits are issued by the Department of Enterprise, Tourism and Employment and visas by the Department of Justice. Check both departments' websites for current rules, and confirm with your employer which permit applies to your post.

Typical mistakes

• Not checking exemptions first. You may not need PRES at all.
• Letting a Level 2 pass expire before Level 3.
• Using outdated fee figures; fees change periodically.
• Assuming registration equals a job. Recruitment is separate.
• Missing the right division, which can limit the posts you can take.

Next steps

1. Read the Medical Council's registration pages and exemption list.
2. Plan your English test.
3. Train your clinical knowledge with exam-style questions in the MediFlow app.
4. Compare with the UK, since many doctors weigh PLAB and Ireland together, and with Australia.