Ireland has the highest number of medical graduates per population among OECD countries, but half of the students come from other countries. The number of international students is not subject to the numerus clausus policy that limits the entry of Irish students into medical education, and the medical schools have become increasingly dependent on the tuition fees international students pay. However, the large student numbers are not matched by opportunities to complete an internship and postgraduate training. To the contrary, the number of internship places for international medical students has fallen as national authorities reserve a greater proportion for the growing number of Irish medical graduates to ensure a good return on the public investment in their education. Thus, most international students try to complete their medical education and enter postgraduate training outside Ireland. Also, many Irish medical graduates and (newly trained) doctors seek training and job opportunities abroad. Hence, while Ireland provides initial medical education to a large number of students, since many leave the country after graduation, it nonetheless relies heavily on international recruitment of doctors to fill its domestic needs. More coherent education, training, and employment policies are needed to address this paradox.