Background: Medicine is a high-status, high-skill occupation which has traditionally provided access to good quality jobs and relatively high salaries. In Ireland, historic underfunding combined with austerity-related cutbacks have negatively impacted job quality to the extent that hospital medical jobs have begun to resemble extreme jobs. Extreme jobs combine components of a good quality job – high pay, high job control, challenging demands, with those of a low-quality job – long working hours, heavy workloads. Deteriorating job quality and the normalisation of extreme working is driving doctor emigration from Ireland, and deterring return. Methods: Semi-structured qualitative interviews were conducted with 40 Irish emigrant doctors in Australia who had emigrated from Ireland post-2008. Interviews were held in July-August 2018. Results: Respondents described hospital workplaces in Ireland that were understaffed, overstretched and within which extreme working had become normalised, particularly in relation to long working hours, fast working pace, doing more with less and fighting a climate of negativity. Drawing on Hirschman’s work on exit, voice and loyalty (1970), the authors consider doctor emigration-as-exit and present respondent experiences of voice prior to emigration. Only 14/40 respondent emigrant doctors intend to return to work in Ireland. Discussion: The deterioration in medical job quality and the normalisation of extreme working is driving doctor emigration from Ireland, and deterring return. Irish trained hospital doctors emigrate to access good quality jobs in Australia and are increasingly likely to remain abroad once they have secured them. Health systems and employers must mitigate the emergence of extreme work in healthcare to improve doctor retention. Employee voice (about working conditions, about patient safety, etc.) should be encouraged and should be used to inform health system improvement.