Work permits and Stamp 4 for doctors
The two-year multi-site General Employment Permit covers NCHD rotations between public hospitals. Doctors on this permit can apply for Stamp 4 after 21 months of eligible employment. This guide explains the permit conditions, salary thresholds and immigration permissions involved.
Checked on 22 August 2026 against the Department of Enterprise, Tourism and Employment and Immigration Service Delivery.
Public hospital posts
Two-year multi-site General Employment Permit
Every General Employment Permit for an NCHD in a public hospital or public health facility is issued on a two-year multi-site basis, whatever the length of the initial contract.
NCHD posts rotate on six-month contracts. Without this, a doctor would need a fresh permit at every changeover.
The Department of Enterprise, Trade and Employment with the Department of Health, for applications made after 6 December 2021.
What it covers
A later contract with a different public hospital or public health facility is covered by the same permit. No new application.
Limitations
It only covers public hospitals and public health facilities. Taking a post in a private hospital or private practice needs a new General Employment Permit, or a Critical Skills Employment Permit.
Separate rules for internship
The twelve-month internship is excluded from the two-year multi-site basis.
Check eligibility separately before applying for an intern post. Intern eligibility.
Stamp 1H
The immigration permission that goes with the two-year multi-site permit. It lets you work as an NCHD in any public hospital or health facility for the two years the permit runs.
Notify the Department before moving
Your employer has to tell the Department of Enterprise, Tourism and Employment about any change of location or contract before the change happens, not after.
You still hold a six-month contract with the first hospital, and that contract is still what you produce at registration and renewal. Moving hospital at the end of it is allowed within the HSE group, and the Department monitors the contracts.
Stamp 1H counts as reckonable residence for naturalisation.
Applying for Stamp 4
Stamp 4 permits you to live and work in Ireland without an employment permit, subject to its conditions. The qualifying employment period depends on the route below.
| Category | Months | What it is |
|---|---|---|
| Critical Skills Employment Permit | 21 | The standard fast track, open to any occupation on the Critical Skills list. |
| Hosting Agreement as a Researcher | 21 | Listed alongside the other two, and not a route doctors normally use. |
| Multi-Site General Employment Permit as a Non-Consultant Hospital Doctor | 21 | NCHDs on a multi-site General Employment Permit have a separate 21-month route to Stamp 4. |
| General Employment Permits | 57 | Where a doctor ends up if the permit is not the multi-site NCHD version, for example in a private hospital. |
| Intra-Company Transfer Employments | 57 | Included for completeness; not a route into clinical posts. |
Combining periods of employment
Time on a plain General Employment Permit or an intra-company transfer does not count towards the 21 months. Immigration Service Delivery says the two groups are not interchangeable, so a spell in a private hospital on an ordinary permit does not shorten the wait.
The count runs from commencement of employment in the State, which Immigration Service Delivery determines from an Employment Detail Summary on revenue.ie/myaccount. If you started on some other permission and moved to Stamp 1 later, it runs from the validity dates of the permit the Stamp 1 was registered under.
Stamp 4 granted on the 21-month basis is renewable every two years. On the 57-month basis it is renewable annually.
Immigration Service Delivery, Stamp 4 upgrades, page last updated 25 February 2026.
Compare permit types
Medical practitioners sit at SOC 2211 on the Critical Skills Occupations List (SI 213 of 2026, effective 13 May 2026). Being on the list is what makes the Critical Skills permit available to doctors at the lower threshold, and what removes the labour market needs test from a General Employment Permit.
| Permit | Salary floor | Recent graduate | Labour market test | Family |
|---|---|---|---|---|
| Critical Skills Employment PermitA job offer of at least two years. Nine months with the original employer before you can move. | €40,904 | €36,848 | Not required. | Immediate family reunification through Immigration Service Delivery, and permits for spouses and partners currently issue free of charge. |
| General Employment PermitTwo years initially, renewable for up to three more. For NCHDs in public hospitals, on a multi-site basis. | €36,605 | €34,009 | Required in most cases. Not required for occupations on the Critical Skills list, or where the job pays over €68,911. | Spouses, dependants and partners are not eligible for a Dependant Employment Permit and must apply for their own. |
Critical Skills applications cost €1,000. Ninety per cent refunded if the application is unsuccessful. Recent graduate means within twelve months of qualifying.
At least half the workforce must be EEA nationals, waived for startups inside two years supported by Enterprise Ireland or IDA Ireland.
Long-term residence becomes possible after sixty months of residency permission.
Salary thresholds from 1 March 2026
| Permit | Was | Now |
|---|---|---|
| General Employment Permit | €34,000 | €36,605 |
| Critical Skills Employment Permit | €38,000 | €40,904 |
Both first applications and renewals submitted on or after that date have to meet the new figures.
The Department published a roadmap of phased increases running to 2030. From 2027 the thresholds are reviewed annually and indexed: if CSO average weekly earnings rise, the thresholds rise by at least as much.
Coming to sit the PRES does not let you stay to work
Permission to enter Ireland for the PRES does not cover staying to work after the exam. Arrange the employment permit and visa required for your return.
- Doctors are permitted to enter the State to sit the PRES examination, and must leave on completion of it.
- Passing does not change that. You may only re-enter with an employment permit already issued, and the appropriate visa where one applies.
- A doctor who fails and wants to repeat has to apply to do so from outside the State.
- A doctor who stays on illegally is not eligible to apply for an employment permit at all.
Coming for an interview is a separate thing again. The Highly Skilled Job Interview Authorisation exists for an employer who wants to interview a doctor living outside the State before making an offer.
What the exam itself involves, and when it runs, is on the registration page.
Permits for locum work
A locum on a contract with a hospital or health facility, paid directly by it, needs an employment permit like anyone else.
A locum engaged and paid by an agency instead applies under the Atypical Working Scheme, before seeking entry to the State.
The scheme grants Stamp 1 for six consecutive months. At the end of it you either leave, or take up employment with a hospital having obtained an employment permit before the permission expires.
A locum who leaves can come back in the same agency capacity only after six months out of the State, on a fresh Atypical Working Scheme application. Coming back sooner requires an offer of employment and a permit.
For rates and indemnity, see getting a job after the intern year.
General permit conditions
- No doctor may take up employment in any capacity until registered with the Medical Council of Ireland.
- No doctor may take up employment in any capacity until registered with immigration and holding a valid Certificate of Registration.
- Employment permits are employer and job specific. You may only work for the employer, and in the job title, named on the permit.
- Stamp 1 is granted on the basis that you stay in the type of posting you held at registration, for the length of the permission. No other employment may be taken on during it.
- A doctor on Stamp 1 may not set up a business, medical practice or GP practice without separate business permission.
Apply for the employment permit at least four weeks before your immigration permission expires. The permission granted then runs for the same length as the permit, so six months or a year depending on the contract named on it.
Immigration permission is not granted for an observership, in a public or a private hospital. It is settled policy, not a case-by-case decision.
Earlier rules and exemptions
Arrangements for non-EEA doctors working in the State commencing 1 January 2014, with the employment permit requirement from 1 March 2014. The notice replaced arrangements published on 27 December 2013.
A doctor who has always been required to hold an employment permit must continue to do so. That covers everyone working in a private hospital or private health facility, and some categories in public ones.
Moving the other way needs a new permit too: a doctor holding a permit for a private hospital who wants a public post must apply for a new one before starting.
None of it applies to doctors already holding Stamp 4, who may renew for two years at a time provided they keep practising.
Medical Council registration
A permit lets you work. It does not put you on the register, and no Irish hospital can employ you as a doctor until the Medical Council has.
Medical Council registration →Common questions
Do NCHDs need a new work permit at every rotation?
No. Since 6 December 2021 every General Employment Permit for an NCHD in a public hospital or public health facility is issued on a two-year multi-site basis, whatever the initial contract says. A later contract with a different public hospital is covered by the same permit. The twelve-month internship is excluded from that arrangement.
What is Stamp 1H?
The immigration permission that goes with the two-year multi-site permit. It lets you work as an NCHD in any public hospital or health facility for the two years the permit runs. Your employer must notify the Department of Enterprise, Tourism and Employment of any change of location or contract before it happens. Stamp 1H is reckonable residence for naturalisation.
When can a doctor apply for Stamp 4 in Ireland?
After 21 months from commencement of employment in the State on a multi-site General Employment Permit as a Non-Consultant Hospital Doctor. Critical Skills Employment Permit holders and researchers on a Hosting Agreement reach it at the same 21 months. Every other General Employment Permit, and intra-company transfers, take 57 months. Time in the 57-month categories does not count towards the 21, because Immigration Service Delivery treats the two groups as not interchangeable.
Can you stay in Ireland after sitting the PRES exam?
No. Doctors are permitted to enter the State to sit the PRES and must leave on completion of it. Passing does not change that: you may only re-enter with an employment permit already issued and the appropriate visa. A doctor who fails and wants to resit must apply from outside the State, and a doctor who stays on illegally is not eligible to apply for an employment permit at all.
What is the salary threshold for a doctor's employment permit?
From 1 March 2026 the General Employment Permit threshold is €36,605 and the Critical Skills Employment Permit threshold is €40,904, up from €34,000 and €38,000. Recent graduates get lower figures: €34,009 on the General permit and €36,848 on Critical Skills. Both first applications and renewals submitted on or after that date must meet the new levels.
Are doctors on the Critical Skills Occupations List in Ireland?
Yes. Medical practitioners sit at SOC 2211 on the Critical Skills Occupations List, effective 13 May 2026 under SI 213 of 2026. That is what makes the Critical Skills permit available at the lower salary threshold and removes the labour market needs test from a General Employment Permit.
What could not be verified
- The HSE's own circular, HSE guidance on employment permits for NCHDs, which sits behind the maintenance notice covering its staff pages since roughly 28 January 2026.
- How intern recruitment treats applicants who would need a permit. The HSE intern unit's eligibility page is behind the same notice.
- The full roadmap table of threshold increases to 2030. The Department publishes the outcome as a PDF that could not be read; the 2026 figures here come from its own permit pages.
- Processing times for any permit type.
- Whether the internship exception to the multi-site arrangement has changed since December 2021.
Permit rules and salary thresholds can change. Tell me if a figure here has moved.