Consultants v Harney

Vorsprung

Was reading more on this today, thought it deserved a new thread:

Today's Irish Times wrote:

Recruitment drive will fail, say consultants

Eithne Donnellan and Ronan McGreevy

Attempts by Minister for Health Mary Harney to recruit new consultants to the health service on terms that have not been agreed with the consultants' representative bodies will fail, the Irish Hospital Consultants' Association (IHCA) said yesterday.

The IHCA and the Irish Medical Organisation have informed medical bodies representing doctors in other countries that the contracts on offer for the new posts have a number of shortcomings and they should advise their members not to apply for them.

They say the new consultants will be "gagged" and will not have the right to speak out if services are not up to scratch.

Former IHCA president Dr Josh Keaveney yesterday described the salary on offer for the new jobs - which would be up to €205,000 per year - as "Mickey Mouse". He said people in the US were making $500,000 (€368,000) a year.

However, Finbarr Fitzpatrick, secretary general of the IHCA, said the main issue was not money. He said this issue received little attention at the consultant contract negotiations, which have now broken down.

Some 50 of the new consultant posts, which the unions plan to boycott, are due to be advertised tomorrow by the HSE.

Mr Fitzpatrick advised potential candidates to "take the long view which is that sooner or later, and it may well be later, there will be an agreed contract hammered out which will be to their advantage".

The IHCA will hold an extraordinary general meeting next Sunday at which it will make a formal decision to boycott the recruitment process. They are also likely to stop doing administrative and managerial tasks in hospitals from Sunday in protest at the posts being advertised without agreement.

IHCA president Dr Mary McCaffrey claimed many of the posts about to be advertised have not been adequately resourced and that if anyone applied for them they may end up frustrated, unable to do their jobs as a result of lack of resources. Junior doctors in a number of specialities, including surgery, orthopaedics and anaesthetics, have already made it clear they will not apply for the new posts.

The talks' chairman, Mark Connaughton SC, said in a letter to unions and health service employers yesterday that he was "taken aback" at the IHCA's withdrawal from the talks on Monday. However, he said he recognised the consultant organisations' objections to the Minister's decision to proceed with the advertisement of the new posts.

But he said there had been many weeks of discussion with substantial consensus on a variety of issues and that "it would be a great pity if the parties did not continue to attempt to build on that consensus".

"It appears however that I may have little further to contribute to the process . . . it may be that discussions will resume on a different basis and in another forum," he continued.

Ms Harney said last night the money on offer to new consultants was not "Mickey Mouse".

"We are offering to pay consultants €205,000 plus a 20 per cent bonus . . . for anybody to describe this is as 'Mickey Mouse' is incredible," she said.

She said if the consultants' bodies tried to veto consultants coming in from abroad that would "damage patients and subvert the will of the Government".

She added that there was no question of gagging new consultants and said she had brought in provisions to protect whistleblowers in the health service.

Linkage

So what do people think?

It's a hell of a lot of money tbh! Stupid comment by the guy who said "What kind of a house can you buy with 205k". But I think the Government are playing this better than the nurses situation.

Firstly, the consultants haven't been offered a lot of what Harney is saying in public, at least not in face to face talks anyway, for example at their last meeting, the contract would have made them do on-call for free.

Secondly, the father of a friend of mine is a consultant. He was saying that if he took up the new contract that was offered to them, he'd effectively be making 20% less for more hours.

Now I don't want to sound like I'm the consultants side just cos I'm a med student! I think that's a lot of money, and if I was offered that amount of money in 15 years I think I'd be happy that my future was pretty secure (if it wasn't already).

2Scoops

Well, it's patently obvious that the actual job is not worth €205k - I don't think anyone would argue with that (maybe I'm wrong).

So, in my mind at least, the real issue is that the same amount of money could be earned with less work, or that the same amount of work could earn twice as much money. So, it's no longer about the actual value of the service but a matter of principle (not to mention the principal) and social comparison. That at least can be understood, if not condoned.

Heinrich

It seems crazy to think that nobody raises as much as an eyebrow at the indecent "salaries" of footballers, musicians et al. My money certainly goes on the useful professions!

InFront

True, but how can anyone describe €205,000 earnings as Micky Mouse?

Okay, it's going to leave them at an overall disadvantage from where they were before, and any sudden and an overall drop in earnings like that just because of a failed health system and a failed health minister should be listened to fairly. They do have a point in that sense.
But people like Mr Keaveney aren't going to win much popularity referring to €205k as if it's peanuts. He should be outlining the shortcomings of this contract (especially in relation to silencing health workers), and telling the public how it puts them at a disadvantage, not him. I think it's the Consultants who are handling this badly.
My Dad works in the health service, he's not a Consultant, and tbh it seems like there are a lot of NCHDs from the new pool dubious about the new contracts too, it isn't just consultants who aren't particularly happy. But in some ways they are their own worst enemies.

2Scoops

Heinrich wrote:

It seems crazy to think that nobody raises as much as an eyebrow at the indecent "salaries" of footballers, musicians et al. My money certainly goes on the useful professions!

In the world of sport and entertainment, the salary is merely a reflection of the money supporting it. If people stop watching a football team or stop listening to a particular band, their income will decrease dramatically. It's not about value for money, it's about how much money are people willing to give. As scandalous as it is etc. etc., you can choose not to contribute.

The difference here is we are talking about state salaries. You are paying for the consultants whether you like it or not. The onus is on the state to get value for money. The issue is what constitutes 'value for money?' Can you put a price on the life-saving work of a good medic? Or do you simply compare it to what other countries pay them?

I don't have a huge problem with the money demands themselves, although some of the comments are ridiculous and it's being handled badly by a few 'arrogant docs' *ahem*:).

Politicians wages on the other hand are a national disgrace - not only do they provide an uninformed substandard service, they are renumerated far in excess of other countries' politicians.

tallaght01

I don't have much to add to this thread. People have a bee in their bonnets about people who are financially well off. That will never change. What will also never change is the fact that when you want to take money off a group of people and increase their workload, they will fight it. Regardless of whether they earn 1 euro or 100 euro per hour. Every one of you would do the same. If I ever face the situation, I shall do it too.

I would like to ask the panel what they think a consultant should be paid. Let's take my consultant tonight, right now, for example. She's in the UK,as am I, but the system is similiar, so the comparison would stand. It's 21:45hrs. Shes been in since 8am. She has had a 30 minute lunch. She bears responsibility for all 30 babies in our premature baby unit. 7 of them are intensive care babies, the other 23 range from being on the verge of needing intensive care, to being pretty stable. She will go home at about midnight,but there is a woman in labour who's baby is likely to be very seriously unwell when he/she is born, so the boss has about a 50% chance of being called in tonight.

To bear that responsibility, I think she deserves a lot more money than she gets (she gets about the sterling equivalent of 100k euro per year). I think you could multiply her money several times and it wouldn't be unfair. It's a large burden to carry. There's not many people in the country who carry such a burden in their day to day life.

Someone above questioned whether we should pay people based on what a similiar professional earns overseas, or what the job is actually worth. So I'd be interested in opinions on a monetary value. I'd particularly be interested to hear fom those who have ever had somebody die on them because they made a mistake in work. It would be interesting to hear what people would expect to be paid for that kind of stress.It wold also be interesting to hear what professions people re comparing the consulants to when they come up with this value.

I agree that the PR side of things has been handled badly. However, I would also pose the question........ and here's where I'm gonna get flamed, but what the hell....as to why should consultants care about the PR side of things or what the public think of them, when the public never cared about them for years. When those same consultanats were juniors working like dogs for minimum wage under horrendous conditions, the public didn't care. When those conultants saw their marriages break down because they were serving the public, the public didn't care. The public only care when it suits them. Opinions?

I know people will get annoyed by that questions. I know they'll say "we paid for you to go trhough college" etc etc. I would argue, though, that society gets far more out of consultants than consultants get out of society.

As for all the comments about wanky consultants etc. I don't think that's worth commenting on. It's the usual ill informed generalisations, from poeple who might work in the same hospital as an arrogant consultant or once saw a consultant they thought was arrogant. I work, for eg, with a lot of speech+language therapists, but most certainly wouldn't have the gall to publicly say they're all arrogant or overpaid or whatever, because while I can claim to know a few of them, I can't claim to know hat their day to day life is like.
Wow, and I started off claiming I hadn't got much to say on this thread!

InFront

tallaght01 wrote:

Wow, and I started off claiming I hadn't got much to say on this thread!

Haha that was my first reaction:D

I would like to ask the panel what they think a consultant should be paid.

I agree with you that €200k is deserved, but if I were pressed, I'd probably say about €100k (yes I did magically arrive at that figure) for a very hard working nurse, and of course that's ridiculously unfeasible, I'm a softie.
Anyway, for me the only problem is that "Micky Mouse salary" comment the guy made.

why should consultants care about the PR side of things or what the public think of them, when the public never cared about them for years.

That's true, but ultimately it's public opinion that matters with regard to whether the Government think they're going to get stung on election day. It's in the IHCA's interest to put themselves in good standing with Joe Public and make him think that the patient is losing out here.

2Scoops

Tallaght01,

A consistent theme to your posts is the hardship faced by doctors, including yourself apparently, who live for their work to the detriment of their personal lives. Now you're saying that the level of responsibility, the long hours and lack of a social life is worth financial renumeration.

Frankly, it smacks of self-imposed martyrdom. Look at me, look at all the things I have to do, look at how much I've suffered and I never complain once! All I want is more money. Well, first of all, I've news for you and all who share your opinion: you don't have to do it if you don't want to. With your qualifications you could get a far cushier number and live in relative luxury. I don't honestly believe the weight of responsibility on medics is as imposing as you imply, certainly as it will be shared by most of the staff in the same ward. If it's the case that you enjoy your work, then stop constantly cribbing about it!

Would it surprise you to learn that more lives depend on my work than that of any single doctor? Albeit in a manner similar to the role of the economist you mentioned in a previous thread and a bit removed from the actual dying part . Would it also surprise you to learn I work longer (and harder) than any of the 'mad hours' you have mentioned (7.30am - 12 midnight minimum, 7 days a week with approx 2-3 all-nighters per month)? That my training has been longer than or equal to that of any medical consultant? That I haven't been out in a social context since Christmas?

And what do I get paid? Let's just say it's substantially less than 100k. And do you know what? The sky hasn't fallen. I still come to work every day because I love it and I don't want to do anything else. Because I enjoy making a difference on a global level and the monetary value of my work is unimportant once I have a living wage.

So, to answer your question on the monetary value of a consultant's salary: a living wage. No more, no less. If they can get more, go ahead, the more power to them, I won't begrudge them. Just don't think your work is so freaking special as to actually deserve almost 10 times the pay of everyone else:rolleyes:

InFront

2Scoops wrote:

So, to answer your question on the monetary value of a consultant's salary: a living wage. No more, no less.

You cannot be serious? What are you talking, €30 - €40k? You can hardly get nurses to work for that, add in the added responsibility, a major academic effort and personal commitment and you really think you'd get people entering medicine? You'd get a brain drain to foreign countries, and nobody coming here, and (I believe) major drops in entry requirements to medical schools. You'd also have a lot of pissed off workers unwilling to make any personal effort if the only thanks is the same wages as your secretary, but longer hours.

You really don't think any of that will effect patient care or the quality of care provided?

tallaght01

2Scoops wrote:

Tallaght01,

A consistent theme to your posts is the hardship faced by doctors, including yourself apparently, who live for their work to the detriment of their personal lives. Now you're saying that the level of responsibility, the long hours and lack of a social life is worth financial renumeration.

Frankly, it smacks of self-imposed martyrdom. Look at me, look at all the things I have to do, look at how much I've suffered and I never complain once! All I want is more money. Well, first of all, I've news for you and all who share your opinion: you don't have to do it if you don't want to. With your qualifications you could get a far cushier number and live in relative luxury. I don't honestly believe the weight of responsibility on medics is as imposing as you imply, certainly as it will be shared by most of the staff in the same ward. If it's the case that you enjoy your work, then stop constantly cribbing about it!

Would it surprise you to learn that more lives depend on my work than that of any single doctor? Albeit in a manner similar to the role of the economist you mentioned in a previous thread and a bit removed from the actual dying part . Would it also surprise you to learn I work longer (and harder) than any of the 'mad hours' you have mentioned (7.30am - 12 midnight minimum, 7 days a week with approx 2-3 all-nighters per month)? That my training has been longer than or equal to that of any medical consultant? That I haven't been out in a social context since Christmas?

And what do I get paid? Let's just say it's substantially less than 100k. And do you know what? The sky hasn't fallen. I still come to work every day because I love it and I don't want to do anything else. Because I enjoy making a difference on a global level and the monetary value of my work is unimportant once I have a living wage.

So, to answer your question on the monetary value of a consultant's salary: a living wage. No more, no less. If they can get more, go ahead, the more power to them, I won't begrudge them. Just don't think your work is so freaking special as to actually deserve almost 10 times the pay of everyone else:rolleyes:

Of course this is why i try, withouth success to stay away from these threads. Some people are angry. There's lots of social and psychological reasons why people begrudge others financial or social success. That's fine. I understand it. If we're being honest, I've shared that feeling. Most of us have, as youngsters, looked at kids with things our familes could never afford. And we resnted them for it, even on a personal level. It's a human reaction, and it's probably fair enough.

There's a recurrent theme in my posts about the rough life docs lead. You'll find they're all (I hope!) in response to the recurring threads on this board about how docs are arrogant/overpaid/lazy/conspirators with big pharma etc. The most recent of these pointless posts was started by yourself, 2scoops. Surely, we have a right to reply in the same emotive and non-substantive way in which these threads are begun. No?

I don't regard myself as a martyr, and I don't go on about my "mad hours" in real life. I rarely talk about work to even my family, as I don't wish to moan. They know I work in a baby unit. When I com home ina bad mood, they know something bad has happened in there. I don't talk about it, and they don't ask. None of my closest friends could even tell you the names of any of my colleagues. But then again, they don't keep telling me I'm overpaid/arrogant/babykiller etc etc.

I don't know what you do for a living. I don't care. If you really work the hours you say you do,and (this is the important bit) you have the responsibility or human life in your hands on a minute by minute basis, then I agree you shold be paid a shed load of money.

If, on the other hand, you really believe that the responsibility for a patient death is spread evenly around the consultants in the department where the death occured, you are wrong. If you have cocked up, and the result is a disabled or brain damaged child, the parents get angry at the person who cocked up, not the department.

For the record, I don't want more money. I have a reasonably nice flat in a nice area. I, like most of the population, don't have any money left at the end of the month, but I get by.

Also, the old "if you don't like you job, leave it" attitude is one that's fuelled by whatever it is making you generally angry at doctors. It's the same argument thats hauled out on the after hours forum about the nurses. We obviously couldn't all pack u and walk away coz our conditions are crap.If we did, poeple would still call us moneygrabers! BUT....if it makes you feel better, I'm off to Australia in september for a few years, because their conditions are better.

I think your last post has just exposed the fact that you're angry. I don't know what you're angry about. I know it's not simply the fact that I'm saying my boss isn't an overworked sponger. I know it's not the fact that I whine about my job. I don't know what it is, but may i suggest that you start to listen to your own advice...insofar as maybe it's your poor conditions and low pay that are making you angry. maybe it's you who should change jobs. Regardless of what it is, I hope you get it sorted. I'm gonna walk away from this thread,though, as it's going off topic.

I'll still be reading, though, if somebody has a constructive answer to my quetions. InFront, I agree with you that I'd be happy paying nurses 100k per annum. In a previous thread, though, I said nurses should be paid enough to own a nice house in a nice area, and have a nice holiday ever year (ie the minimum a well educated professional would expect), but I was called an arrogant doctor because of it. of course i was.

2Scoops

InFront wrote:

You cannot be serious? What are you talking, €30 - €40k? You can hardly get nurses to work for that, add in the added responsibility, a major academic effort and personal commitment and you really think you'd get people entering medicine? You'd get a brain drain to foreign countries, and nobody coming here, and (I believe) major drops in entry requirements to medical schools. You'd also have a lot of pissed off workers unwilling to make any personal effort if the only thanks is the same wages as your secretary, but longer hours.

You really don't think any of that will effect patient care or the quality of care provided?

The question was (paraphrazing): "what is the monetary value of a job as a consultant?" NOT: "How much would you have to pay someone to be a doctor?" The two are quite different. Can't I be an idealist?:)

2Scoops

tallaght01 wrote:

Of course this is why i try, withouth success to stay away from these threads. Some people are angry. There's lots of social and psychological reasons why people begrudge others financial or social success. That's fine. I understand it. If we're being honest, I've shared that feeling. Most of us have, as youngsters, looked at kids with things our familes could never afford. And we resnted them for it, even on a personal level. It's a human reaction, and it's probably fair enough.

There's a recurrent theme in my posts about the rough life docs lead. You'll find they're all (I hope!) in response to the recurring threads on this board about how docs are arrogant/overpaid/lazy/conspirators with big pharma etc. The most recent of these pointless posts was started by yourself, 2scoops. Surely, we have a right to reply in the same emotive and non-substantive way in which these threads are begun. No?

I don't regard myself as a martyr, and I don't go on about my "mad hours" in real life. I rarely talk about work to even my family, as I don't wish to moan. They know I work in a baby unit. When I com home ina bad mood, they know something bad has happened in there. I don't talk about it, and they don't ask. None of my closest friends could even tell you the names of any of my colleagues. But then again, they don't keep telling me I'm overpaid/arrogant/babykiller etc etc.

I don't know what you do for a living. I don't care. If you really work the hours you say you do,and (this is the important bit) you have the responsibility or human life in your hands on a minute by minute basis, then I agree you shold be paid a shed load of money.

If, on the other hand, you really believe that the responsibility for a patient death is spread evenly around the consultants in the department where the death occured, you are wrong. If you have cocked up, and the result is a disabled or brain damaged child, the parents get angry at the person who cocked up, not the department.

For the record, I don't want more money. I have a reasonably nice flat in a nice area. I, like most of the population, don't have any money left at the end of the month, but I get by.

Also, the old "if you don't like you job, leave it" attitude is one that's fuelled by whatever it is making you generally angry at doctors. It's the same argument thats hauled out on the after hours forum about the nurses. We obviously couldn't all pack u and walk away coz our conditions are crap.If we did, poeple would still call us moneygrabers! BUT....if it makes you feel better, I'm off to Australia in september for a few years, because their conditions are better.

I think your last post has just exposed the fact that you're angry. I don't know what you're angry about. I know it's not simply the fact that I'm saying my boss isn't an overworked sponger. I know it's not the fact that I whine about my job. I don't know what it is, but may i suggest that you start to listen to your own advice...insofar as maybe it's your poor conditions and low pay that are making you angry. maybe it's you who should change jobs. Regardless of what it is, I hope you get it sorted. I'm gonna walk away from this thread,though, as it's going off topic.

I'll still be reading, though, if somebody has a constructive answer to my quetions. InFront, I agree with you that I'd be happy paying nurses 100k per annum. In a previous thread, though, I said nurses should be paid enough to own a nice house in a nice area, and have a nice holiday ever year (ie the minimum a well educated professional would expect), but I was called an arrogant doctor because of it. of course i was.

Well sorry if my previous post sounded emotive.

For record, I'm not unhappy with my my position. I live and breathe my work and don't want to leave it. The money issue honestly doesn't bother me as I can afford everything I want and I live in a very nice place.

If I am angry [which I don't consider myself to be] it's at the (perceived) inflated self-importance of anyone who believe their work is somehow worth more money than people of perceived lower status. In fact, part of my argument is that the value of the 205k itself isn't even the issue.

Of course, going along with InFront's sentiments, it's equally ridiculous to pay nurses (or teachers or Gardai) inflated salaries of 100k or similar - the economy would collapse. The only reason 30-40k (a living wage in InFront's opinion:)) seems like such an insult and a deterrent to becoming a doctor in the fact that people judge themselves based on what other people make and the perceived status of their job. That's human nature, but just don't think it should be confused with how much a job is worth, objectively speaking.

And, finally, my arrogant docs thread was not saying all doctors are arrogant. I thought I was quite clear on that point. The fact of the matter is the label has stuck, whether it's justified or not. That is what I was seeking reasoned debate on, not a free for all on the hard station of doctor:).

InFront

Can't I be an idealist?

Ah well, if you're really speaking in terms of idealism there'd be no hospitals, patients, illness nor consultants (well maybe pediatricians for their great ties!) I think the need to pay consultants good money relates to attracting the right people into the position and, as is only fair, rewarding them for a pretty significant effort in that position.

2Scoops

InFront wrote:

I think the need to pay consultants good money relates to attracting the right people into the position and, as is only fair, rewarding them for a pretty significant effort in that position.

Then the 'right people' are motivated by money and status.:cool:

tallaght01

2Scoops wrote:

If I am angry [which I don't consider myself to be] it's at the (perceived) inflated self-importance of anyone who believe their work is somehow worth more money than people of perceived lower status. In fact, part of my argument is that the value of the 205k itself isn't even the issue.
.

Just to address this point. I think what you meant to say is that some pepople believe that their work is somehow worth more money than people who don't have the same pressures and direct responsibilty as they do? Presumably the "perceived lower status thing" was another anti-doctor jibe?

I don't think it's unreasonable for my boss, who is directly responsible for the lives of the 30 premature babies in our unit, to be paid more than our paperboy.
I think that's a simple point, and I don't think it should make you angry :P

InFront

Then the 'right people' are motivated by money and status

To a certain extent, possibly. But if I arrive in A&E after a crash, unconscious with thoracoabdominal bleeding and two collapsed lungs, I don't want Mother Teresa there waiting for me, I want a motivated, very bright, hardworking and competent Doctor, probably quite competitive, and quite confident. I don't want one who will be jetting off to do a shift in McDonald's in twenty minutes.

I'd like to think he knows exactly what he needs to do, and he's the best guy for the job, whatever his motivation to be there is. "Right" in that sense, is not kindhearted or a good listener, it's a high performer.

2Scoops

tallaght01 wrote:

Just to address this point. I think what you meant to say is that some pepople believe that their work is somehow worth more money than people who don't have the same pressures and direct responsibilty as they do? Presumably the "perceived lower status thing" was another anti-doctor jibe?

I don't think it's unreasonable for my boss, who is directly responsible for the lives of the 30 premature babies in our unit, to be paid more than our paperboy.
I think that's a simple point, and I don't think it should make you angry :P

Spare me your amateur psychology - now that does make me angry:D

I think you're reading too deeply into my posts - no specifically anti-doctor jibes were intended; it was a general comment.

2Scoops

InFront wrote:

To a certain extent, possibly. But if I arrive in A&E after a crash, unconscious with thoracoabdominal bleeding and two collapsed lungs, I don't want Mother Teresa there waiting for me, I want a motivated, very bright, hardworking and competent Doctor, probably quite competitive, and quite confident. I don't want one who will be jetting off to do a shift in McDonald's in twenty minutes.

I'd like to think he knows exactly what he needs to do, and he's the best guy for the job, whatever his motivation to be there is. "Right" in that sense, is not kindhearted or a good listener, it's a high performer.

And, strictly speaking, none of that requires a set salary of any kind, only passion for the job.

Edit: Oh, and intelligence, of course.

tallaght01

good sir, I shall spare you my amateur psychology, when you stop airing the issues with the medical profession that plague your inner self on a public forum.

For the record, none of the above makes me angry

2Scoops

tallaght01 wrote:

good sir, I shall spare you my amateur psychology, when you stop airing the issues with the medical profession that plague your inner self on a public forum.

For the record, none of the above makes me angry

Looks like you're more interested in getting the boot in than making good on your promise to leave this thread alone:)

Edit: or reading my posts properly, apparently :rolleyes:

ergo

The first point I want to make and is slightly off topic but related to this thread is regarding the nurses' demands,

my initial reaction was "more money for less work - forget about it!" but now I'm thinking we need to do all we can to try and attract and keep the best people in nursing, if it wasn't for the Philipino's and Indian nurses the hospitals would all be closed and we need to train and keep our own irish-trained nurses to ensure the future of our Health service, no matter the cost (and stop exploiting the Philippines and India for their well trained nurses)


secondly, regarding the consultants, yes , it's very bad PR some of the stuff that's in the press the last day or 2, eg "what sort of house would you buy with €200,000 " (per year..:rolleyes: )

but, again , we need to do all we can to keep our own highly trained consultants in our own system. The one argument about the potential earnings in the US had been mentioned. What won't be mentioned is the obscene amounts earned privately in this country in some specialties eg interventional Cardiology, Orthopaedics (we're talking €500,000 to €1,000,000 per year here (the above number in exceptional circumstances but it is a fact).

The thing to rememeber too is that all the current consultants can do and say what they want because they will never have to take up these new contracts and very few will. They can stick with their current contract forever. It's all going to be very messy and difficult however it's worked out, let me raise one scenario:

currently there are 2 consultants covering a service in a Dublin teaching hospital, when a 3rd is eventually hired on a public only contract he will be effectively running his end of the service for whatever sum they eventually come up with while the other 2 consultants spend half their time in the private hospital with their private patients earning (estimated) €500,000 per year

how is the new consultant going to feel? it's going to be a difficult transition period but it has to be done because the current contract is just ridiculous really and has been exploited by a small (but I don't know how small) minority of consultants as alluded to above

and to address the "how much is a consultant worth" issue, well it is a difficult one, rising through the ranks to get to a position where a consultant post is offered is not an easy thing by any stretch of the imagination, the competition is fierce with glass ceilings at many stages and many tough exams (eg exams which 80% of people who take them fail ie 80% of qualified doctors (who may have never failed an exam in their lives) who sit these specialist exams fail them at any one time...! Not to mention once getting past this exam stage and onto SpR schemes then having to prove themselves at meetings/presentations etc and following this, after finishing an SpR scheme when maybe only there will be a job for 1 in 4, truly the difficulties don't end once the CAO points are in the bag and it's not just a matter of putting in long hours during your best years to get there

as I said it's going to be a difficult transition but it has to be done and there'll be complaints no matter what sum they come up with, I think they'll just have to go with it sooner or later

nesf

How much is a consultant worth? Um, how long is a piece of string?

Saintly

tallaght01 wrote:

I don't have much to add to this thread. People have a bee in their bonnets about people who are financially well off. That will never change. What will also never change is the fact that when you want to take money off a group of people and increase their workload, they will fight it. Regardless of whether they earn 1 euro or 100 euro per hour. Every one of you would do the same. If I ever face the situation, I shall do it too.

Bar the bee in the bonnet comment, I absolutely agree with you.

tallaght01 wrote:

I would like to ask the panel what they think a consultant should be paid. Let's take my consultant tonight, right now, for example. She's in the UK,as am I, but the system is similiar, so the comparison would stand. It's 21:45hrs. Shes been in since 8am. She has had a 30 minute lunch. She bears responsibility for all 30 babies in our premature baby unit. 7 of them are intensive care babies, the other 23 range from being on the verge of needing intensive care, to being pretty stable. She will go home at about midnight,but there is a woman in labour who's baby is likely to be very seriously unwell when he/she is born, so the boss has about a 50% chance of being called in tonight. Someone above questioned whether we should pay people based on what a similiar professional earns overseas, or what the job is actually worth. So I'd be interested in opinions on a monetary value. I'd particularly be interested to hear fom those who have ever had somebody die on them because they made a mistake in work. It would be interesting to hear what people would expect to be paid for that kind of stress.It wold also be interesting to hear what professions people re comparing the consulants to when they come up with this value.

There are many people who work ridiculously long hours in their chosen careers, all with their own 'kind of stress’ to manage. Stress and demanding hours are certainly NOT exclusive to medicine. I have friends who work in high support child care units (where they are regularly assaulted) who work from 3pm on a Friday to 8am on Monday, sleeping in the unit for 7 hours per night, (on call during the night for any disturbances which in my day were unfortunately frequent), not getting a single tea or lunch break in the entire weekend and back to work on Tuesday evening. I worked there myself through university (as did many a med and nursing student!) so I can vouch for the difficult work conditions –caring for troubled, violent kids, with little personal space or rest. Wages averaged 54,000K.

I know people in the private sector - in private consultancy, in portfolio management, working seven day weeks to keep some project afloat - literally knowing that if they fail, their job is on the line, without the protections and perks of public employment. How's that for stress? How about soldiers serving in conflict situations? I know people in child protection social work who begin work at 8am and often get home at 11pm or midnight or later - they are not paid overtime rates, they are not financially renumerated for their time after 5pm and instead accumulate a huge amount of leave that they never take due to chronic staff shortages. These social workers are making key decisions about the safety of a child in their own family - when they make mistakes, a child can be left in a situation where they face further sexual, physical abuse, neglect or potential death. They make these life-changing decisions in a vacuum of support and resources - how do you financially compensate for that kind of stress?!

My point is that you don't. You financially compensate people for their skill base, their experience, knowledge and hours spent at work. People experience stress in many different ways. I have worked in a hospital for five years (as a medical social worker - call me the bleeding heart liberal of the forum!) and I have seen a wide range of reactions from docs when a patient dies due to a medical error. Some are more accepting of it than others. Some have deep feelings of regret, but have learned from experience that mistakes happen, they learn from the incident and move on. Ultimately, we all accept a job knowing the conditions and stressors attached. We are all entitled to seek to improve those conditions, however the grounds for improvement should be based on actual quantifiable factors such as skills, experience, hours of work, responsibilities etc as opposed to factors such as stress and commitment - both of which may vary hugely from one person to the next.

tallaght01 wrote:

why should consultants care about the PR side of things or what the public think of them, when the public never cared about them for years. When those same consultanats were juniors working like dogs for minimum wage under horrendous conditions, the public didn't care. When those conultants saw their marriages break down because they were serving the public, the public didn't care. The public only care when it suits them. Opinions?

You are hardly suggesting that public service is a key reason for marriage breakdown among consultants?! How exactly should the public demonstrate their care and consideration in such situations? Send flowers?! (Am actually teasing here, I sense this was the more emotive part of your post). Ultimately, the public fund a significant portion of each consultant's wage. You are right - the consultants are not obliged to care about public opinion, however whether the consultants agree or not - public opinion counts.

tallaght01 wrote:

I know people will get annoyed by that questions. I know they'll say "we paid for you to go trhough college" etc etc. I would argue, though, that society gets far more out of consultants than consultants get out of society.

Given the high demand for entry to medicine and the high competition for consultant posts, it appears that many people strive to become a consultant - they presumably get a lot out of their work. Obviously society needs consultants - but you can apply your argument to just about every core work group - paramedics, nurses, gardai, teachers, road construction workers, architects, judges, economists, social policy analyists. Health provision encompasses far more than the head honcho of the treating team.

tallaght01 wrote:

As for all the comments about wanky consultants etc. I don't think that's worth commenting on. It's the usual ill informed generalisations, from poeple who might work in the same hospital as an arrogant consultant or once saw a consultant they thought was arrogant. I work, for eg, with a lot of speech+language therapists, but most certainly wouldn't have the gall to publicly say they're all arrogant or overpaid or whatever, because while I can claim to know a few of them, I can't claim to know hat their day to day life is like.

Also agree. Having working with many consultants, I have yet to meet one that was 'wanky'. I have had some difficulties working with consultants in relation to their inability to recognise the impact of socio-economic conditions on their public patients. That said, with repeated lectures - they usually surrender (to escape my monologues no doubt!). Tallaght01, I generally enjoy reading your posts -in this thread, however I think you've let emotion and defensiveness get the better of you. Slapping the label ‘angry’ on people who just happen to disagree with you defeats the purpose of discussion. BTW Having worked in Australian hospitals for the last 9 months, I heartily agree that the conditions are far better over here. Less stress, more sun, plus go work in the outback – lots of fun.

Saintly.

tallaght01

saintly wrote:

There are many people who work ridiculously long hours in their chosen careers, all with their own 'kind of stress’ to manage. Stress and demanding hours are certainly NOT exclusive to medicine. I have friends who work in high support child care units (where they are regularly assaulted) who work from 3pm on a Friday to 8am on Monday, sleeping in the unit for 7 hours per night, (on call during the night for any disturbances which in my day were unfortunately frequent), not getting a single tea or lunch break in the entire weekend and back to work on Tuesday evening. I worked there myself through university (as did many a med and nursing student!) so I can vouch for the difficult work conditions –caring for troubled, violent kids, with little personal space or rest. Wages averaged 54,000K.

I know people in the private sector - in private consultancy, in portfolio management, working seven day weeks to keep some project afloat - literally knowing that if they fail, their job is on the line, without the protections and perks of public employment. How's that for stress? How about soldiers serving in conflict situations? I know people in child protection social work who begin work at 8am and often get home at 11pm or midnight or later - they are not paid overtime rates, they are not financially renumerated for their time after 5pm and instead accumulate a huge amount of leave that they never take due to chronic staff shortages. These social workers are making key decisions about the safety of a child in their own family - when they make mistakes, a child can be left in a situation where they face further sexual, physical abuse, neglect or potential death. They make these life-changing decisions in a vacuum of support and resources

My thughts on this issue either keep getting taken out of context, or else the responses are not fully thought out.

What I am saying is this:

1) Consultants work really hard. They have more responsibility than most in their jobs. Therefore, they do not deserve a worsening of their conditions.

2) Consultants work really hard. That doesn't mean that I don't think others work hard. I am also aware that others have a high level of responsibility in their job. I may not believe that being responsible for a childrens' home for a weekend is as much of a responsibility as being in charge of a cardiac ICU for a weekend, but that doesn't mean I don't accept that they have a hard job. In summary....

Do I think consultants work hard? Yes I do.

Do i think others work hard? Yes I do.

Do I think our social workers and soldiers should get paid a hell of a lot more money? Yes I do.

Do I think that consultants pay should be reduced because these other people are paid less? No I don't.

For the record, I would pay a soldier who is in active combat more money than I would pay a consultant. However, I'm not sure that's really the point here.

saintly wrote:

how do you financially compensate for that kind of stress?!

My point is that you don't. You financially compensate people for their skill base, their experience, knowledge and hours spent at work. People experience stress in many different ways. I have worked in a hospital for five years (as a medical social worker - call me the bleeding heart liberal of the forum!) and I have seen a wide range of reactions from docs when a patient dies due to a medical error. Some are more accepting of it than others. Some have deep feelings of regret, but have learned from experience that mistakes happen, they learn from the incident and move on. Ultimately, we all accept a job knowing the conditions and stressors attached. We are all entitled to seek to improve those conditions, however the grounds for improvement should be based on actual quantifiable factors such as skills, experience, hours of work, responsibilities etc as opposed to factors such as stress and commitment - both of which may vary hugely from one person to the next.

I don't think we only compensate people for their skills, knowledge, experience, and hours worked. I think responsibility comes into it too. I always believed that this was why people higher up the ladder were paid more, despite similiar experience and qualifications. I think the responsibility and the stress that goes with it are big factors in why the consultants are paid so well.

You also talk about what "The grounds fo improvement" should be. Whilst I disagree fundamentally with the statement you made, I think it's irrelevant, as the consultants don't want an improvement in their conditions. They are, as I understand it, fighting against worsened conditions. Therefore, perhaps the inverse to what you said should apply. Perhaps we wll indeed attract less well qualified doctors with less experience.

saintly wrote:

You are hardly suggesting that public service is a key reason for marriage breakdown among consultants?! How exactly should the public demonstrate their care and consideration in such situations? Send flowers?! (Am actually teasing here, I sense this was the more emotive part of your post). Ultimately, the public fund a significant portion of each consultant's wage. You are right - the consultants are not obliged to care about public opinion, however whether the consultants agree or not - public opinion counts.

wasn't putting the point about not caring what the public thought of consultants forward as my personal opinion. It's an opinion bandied about by many of us when we're on an exhausting run of shifts. It's something we all have a laugh about in the doctors mess after a 36hour shift when we read about our conditions becoming an issue when we make it to consultant level. It's usually just said in that kinda half-joking but half-serious way. I don't htink any of us want you to send us flowers, but it is funny how our conditions are only an election issue at the wealthier end of the spectrum.

There is no way of avoiding the fact that docs have a higher rate of alcoholism, substance misuse and suicide than comaparable professions. And that's because of a public sector job. Experience has thought me that people react badly to that type of comment. That's fine. It won't change anything at this end anyway. Europe has stepped in to save our asses on the hours issue.

saintly wrote:

Given the high demand for entry to medicine and the high competition for consultant posts, it appears that many people strive to become a consultant - they presumably get a lot out of their work. Obviously society needs consultants - but you can apply your argument to just about every core work group - paramedics, nurses, gardai, teachers, road construction workers, architects, judges, economists, social policy analyists. Health provision encompasses far more than the head honcho of the treating team.

Again the fact that the same point could be aplied to other professions doesn't invalidate the point. However, I stand by my assertion that, over the career span of a doctor, the public gets more out of them hour for hour than they put into them, so why would they want to cut their pay? That's the real question I was posing. I'm not so sure that's the case with some other professions, but it's hard to quantify in terms of what you would measure, so it's probably a moot point.

saintly wrote:

Tallaght01, I generally enjoy reading your posts -in this thread, however I think you've let emotion and defensiveness get the better of you. Slapping the label ‘angry’ on people who just happen to disagree with you defeats the purpose of discussion.

Saintly.

Do I have emotions? and am I defensive when I'm told that I'm overpaid, lazy, arrogant or whatever? The answer to both is yes. Did these feelings "get the better of me" (ie do I take back any of the points I've made in the cold light of day?). The answer is no.

I do think 2scoops was angry. His language suggested it. Maybe I'm wrong. Who cares.

You'll notice I didn't decribe anyone else who disagreed with me as angry.

Anyway, like I said above, anger is a human emotion, and he's entitled to be angry. I have no problem with it.

Anyway, I'm off tot he shops to buy port and rum and pheasant so my maid can prepare tonights' meal

Kind regards.

Jimoslimos

An issue I find interesting (which doesn't seem to have been addressed here) is the allowance for consultants to treat both public and private patients. I can understand their gripe about less pay for more hours but IMO they should be made to choose whether they want to treat public or private patients (not both). I don't buy the excuse that what they do in their free time (treat private patients) is their business (its my business - my tax money is paying your wages) plus whenever money is involved there is always a conflict of interest.

nesf

tallaght01 wrote:

Do I think our social workers and soldiers should get paid a hell of a lot more money? Yes I do.

Do I think that consultants pay should be reduced because these other people are paid less? No I don't.

Ok, in simple economic terms what do you mean by this? Soldiers are already fairly well paid versus their equivalent in the private sector, or at least that's what my friends in the army tell me (and these are privates and corporals here). Consultants have a very nice closed shop if you want to get down to it and aren't paid at market rates really, by what measure are you saying that they should be paid more?


I'm not really trying to attack you here or anything, more trying to understand the logic behind the above. Personally I considered being a soldier because the pay was good, ditto with teacher, garda etc. They aren't severely underpaid by any stretch of the imagination tbh.

tallaght01

Actually, that's a good point jimoslims, and one which I have to say I don't understand well. In the UK, our consultants work a set amount of hours per week. What they do in their free time is of course their own business, regardless of whether the taxpayer pays their wages.

Now, in Ireland, my understanding of the issue is that consultants can treat private patients on public hospital property. My understanding of this arrangement was that it came about so the govt wouldn't have to pay them as muh as they otherwise owuld have.

So, basically, in lieue of extra pay, the consultants are allowed treat private patients on the premises. This means that the govt save money, and it gives docs the opportunity to earn extra cash if they like.

In the current negotiations, the govt are saying the consultants an etra 50k per annum or so, but they can't do private work.

This current arrangement seems reasonable to me. But, I'm not sure if I've understood it properly. Does anybody know the details of this part of the contract as it currently stands?

I'm not asking for a load of the usual "the consultants only care about their private patients" generalisations. I'm just looking for the contractual details.

I'd be very grateful if anybody could post them or summarise them.

nesf

tallaght01 wrote:

This current arrangement seems reasonable to me. But, I'm not sure if I've understood it properly. Does anybody know the details of this part of the contract as it currently stands?

I can only give you anecdotal stuff about this but I've found (and logically it would follow) that it's hugely dependent on the area in question. For some 50K a year might be reasonable accurate, for others it might be a large cut in salary depending on the work involved.

tallaght01

nesf wrote:

Ok, in simple economic terms what do you mean by this? Soldiers are already fairly well paid versus their equivalent in the private sector, or at least that's what my friends in the army tell me (and these are privates and corporals here). Consultants have a very nice closed shop if you want to get down to it and aren't paid at market rates really, by what measure are you saying that they should be paid more?


I'm not really trying to attack you here or anything, more trying to understand the logic behind the above. Personally I considered being a soldier because the pay was good, ditto with teacher, garda etc. They aren't severely underpaid by any stretch of the imagination tbh.

Consultants are paid at less than market rates presumably, if you compare what they would get for a consultation in a BUPA hospital versus what they would get in a state hospital.

If you want to compare what our soldiers get, compared to what they would get "in the private sector", then I guess you'd have to compare them to mercenaries or whatever you'd call them. I know a guy who goes to iraq regularly as a private soldier, who gets a shed load more than anybody I know in the PDF in ireland.

I also think that if social workers are working until midnight but not being paid for it, then they should be paid for it.


That's about as simple as I can make it. That is my, possibly flawed, logic.

tallaght01

nesf wrote:

I can only give you anecdotal stuff about this but I've found (and logically it would follow) that it's hugely dependent on the area in question. For some 50K a year might be reasonable accurate, for others it might be a large cut in salary depending on the work involved.

I agree. In my specialty (neonatal intensive care) there's no private work, as the state is good at providing neonatal services. No govt has the balls to take money away from that area, coz the press would put pics of tiny babies in incubators on their front pages. Therfore, neonatologists would be delighted witht he new contract.

Orthopaedic surgeons, despite the rumours that they aren't even medically qualified :P can earn a shed load more than 50k per annum doing private ops. Same goes for anaesthetists and cardiologists, to name but a few.

nesf

tallaght01 wrote:

If you want to compare what our soldiers get, compared to what they would get "in the private sector", then I guess you'd have to compare them to mercenaries or whatever you'd call them. I know a guy who goes to iraq regularly as a private soldier, who gets a shed load more than anybody I know in the PDF in ireland.

Hmm, see I'm not convinced that you need to compare exact like with like. Considering you only need a leaving cert to enter the ranks etc, it doesn't pay badly since you can start at an early enough age and the pay for duties, and duty abroad is good even from the start. Plus job security etc.

Also, the problem with mercenaries being compared to defence forces doesn't really work when you compare expected duties tbh.

InFront

Jimoslimos wrote:

An issue I find interesting (which doesn't seem to have been addressed here) is the allowance for consultants to treat both public and private patients. I can understand their gripe about less pay for more hours but IMO they should be made to choose whether they want to treat public or private patients (not both).

What do your local county councillors work at?

tallaght01

nesf wrote:

Hmm, see I'm not convinced that you need to compare exact like with like. Considering you only need a leaving cert to enter the ranks etc, it doesn't pay badly since you can start at an early enough age and the pay for duties, and duty abroad is good even from the start. Plus job security etc.

Also, the problem with mercenaries being compared to defence forces doesn't really work when you compare expected duties tbh.

Well, who can I compare them to? How are they paid in relation to the gardai or fire service? (both physical jobs, with a fitness test, an aptitude test, and a requirement for the leaving cert)

I do, however, think the soldiers issue misses the point. The guys back home I know in the PDF don't appear to get paid a load of cash, but I could be wrong. I have no idea what a soldier earns. I do know, though, that I can't think of any money that can adequately compensate a person for being in a warzone!

The reason the soldiers issue came up is the following:

there is a recurring theme in arguments of this nature about how consultants should take their worsened conditions because other people have stressful jobs but don't get paid as much. Soldiers were one of the examples given to me. I assumed the poster therefore knew that soldiers were poorly paid, so i said they should be paid more. The point I'm making is that consultants shouldn't have to take a pay cut just because other public sector workers get shafted.

Also, the context was soldiers in combat, as I remember it. I don't know what they get paid when they're in a combat zone, but I'm pretty sure I wouldn't do it for the money they're on!

chump

I think some people are forgetting just how difficult it is to become a consultant. It's not like just after their 8 odd years training they can immediately become a consultant. It's a very cherished position, they must be the best in their specialty. I believe the government have used the publics streak of jealousy to act as leverage in this debate. Shure Joe Public isn't going to applaud the Consultants for eeking out what they believe their worth - the public will moan and say 'bejaysus, that's a fierce salary, what about the poor nurses yada yada yada' - it's a load of horse****.

First of all - it is extremely difficult to even get training to become a doctor, then doing the study and exams is even more difficult, then doing the intern years is even more demanding, then at the same time they have to do more exams and show further motivation, then they have to decide on where/what they want to specialise in, Q more study and exams and courses and workload, they demonstrate exceptional performance and then maybe some day they can be entertained for a consultants post, and earn WOW 200k odd.

Poopoo, big swinging mickey, they're at the top of an extremely difficult profession and deserve to be rewarded. The same can be said of ANY profession, in fact any career path - you reach the stop you should be rewarded for it.

The question then is, what is adequate compensation. [hah, and that's the discussion!!!]

Saintly

tallaght01 wrote:

My thughts on this issue either keep getting taken out of context, or else the responses are not fully thought out.

Or someone simply disagrees with some (not all) of your comments...

tallaght01 wrote:

What I am saying is this:

1) Consultants work really hard. They have more responsibility than most in their jobs. Therefore, they do not deserve a worsening of their conditions.

If you reread my original post, I completely agree with you. No consultant on a current contract should (or will) have to take a paycut. However, the government is entitled (as the employer) to consider who they need to employ in the future. At present, the employer wishes to employ consultants who are solely dedicated to public patients. The government is entitled to consider new contracts for this new consultant position.

tallaght01 wrote:

2) Consultants work really hard. That doesn't mean that I don't think others work hard. I am also aware that others have a high level of responsibility in their job. I may not believe that being responsible for a childrens' home for a weekend is as much of a responsibility as being in charge of a cardiac ICU for a weekend, but that doesn't mean I don't accept that they have a hard job.

Again we are almost in agreement - though remember, the vast majority of Irish consultants choose to see private patients to supplement their income. That work is not obligatory so they have can hardly complain about long hours when they actively seek additional work. In an earlier post, you described your (UK) consultant's daily routine and made the point that

tallaght01 wrote:

It would be interesting to hear what people would expect to be paid for that kind of stress.

My point is that if you start using stress as a basis for financial packages - people in every professional group will jump up and down to tell you their woes - the child worker, the fireman walking into a fire, consultant making critical decisions, traffic wardens being regularly abused by the public. People experience stress completely differently, some thrive in crisis, others run from it. I don't think stress should factor as a part of contract agreements - it's far too vague and impossible to measure.

tallaght01 wrote:

Do I think our social workers and soldiers should get paid a hell of a lot more money? Yes I do. Do I think that consultants pay should be reduced because these other people are paid less? No I don't.

Again as in my original post, I absolutely agree with you. I do believe however, that the Dept of Health is entitled to formulate public only consultant contracts if that is what the health care system needs.

tallaght01 wrote:

I don't think we only compensate people for their skills, knowledge, experience, and hours worked. I think responsibility comes into it too. I always believed that this was why people higher up the ladder were paid more, despite similiar experience and qualifications. I think the responsibility and the stress that goes with it are big factors in why the consultants are paid so well.

True, I left out responsibility - unlike stress, responsibility is an excellent indicator of how much someone should be paid.

tallaght01 wrote:

You also talk about what "The grounds fo improvement" should be. Whilst I disagree fundamentally with the statement you made, I think it's irrelevant, as the consultants don't want an improvement in their conditions. They are, as I understand it, fighting against worsened conditions. Therefore, perhaps the inverse to what you said should apply. Perhaps we wll indeed attract less well qualified doctors with less experience.

I absolutely disagree with this. I refuse to believe that the present arrangement with Irish consultants is a) best for patients and the health service and b) that changes will attract less qualified doctors with less experience. Other countries employ public only consultants effectively, why on earth can't we? The current consultants will not, as I understand, be affected by the proposed changes. The new contracts are for a new type of consultant that the employer perceives to be necessary to meet the needs of public patients.

The government is obliged (in theory) to ensure that public patients receive the best deal possible. Everyone who works in the Irish health care system is painfully aware of the need for change. I have mates who are NHCDs who resisted the European working directive when it was introduced (not that it made a blind bit of difference, it had yet to be implemented when I left last Sept). Anyhow, my mates argued that if the directive was introduced, their access to their consultants would dramatically decrease as their shifts changed (i.e. a week of nights or late afternoon shifts, no consultant in sight) . The argument at that stage was that dedicated shift friendly consultants would be far more productive with regard to NHCD learning. Right or wrong, those were their sentiments at the time.

tallaght01 wrote:

wasn't putting the point about not caring what the public thought of consultants forward as my personal opinion. It's an opinion bandied about by many of us when we're on an exhausting run of shifts. It's something we all have a laugh about in the doctors mess after a 36hour shift when we read about our conditions becoming an issue when we make it to consultant level. It's usually just said in that kinda half-joking but half-serious way. I don't htink any of us want you to send us flowers, but it is funny how our conditions are only an election issue at the wealthier end of the spectrum.

To be fair, I think there is a huge sympathy in Ireland for junior docs - they filmed a six episode documentary on interns last year, that sparked public debate about the hours, lifestyle etc. Public interest in the consultant contracts however is not simply about money - its about health care provision, its about public patients, about waiting lists, about effective health care management. There are wider issues at play here. I have friends in medicine who would disagree about your perception of public opinion (at least in Ireland).

tallaght01 wrote:

There is no way of avoiding the fact that docs have a higher rate of alcoholism, substance misuse and suicide than comaparable professions. And that's because of a public sector job.

Have a huge interest in suicide research and prevention - would be interested in the career rates, I remember that old myth about dentists was blown out of the water - from memory, I think it is docs, lawyers, pharmacists etc that show high rates - in the US. Not sure if any research re same has been done in Ireland. I think there are more complex reasons than employment for suicide, but I definitely agree that the pressures of medicine may be a contributing factor. Access to means, probability of success are just two of the factors also linked to suicide rates -unfortunately doctors score highly here.

Back to the discussion -ultimately, we are talking about change. Consultants should and I am sure, will fight for the best conditions for these new public consultants - but they cannot expect the government to entirely subsidise the loss of earnings from private practice (which was always voluntary and the discretion of the consultant) to a public only consultant.

Saintly

Saintly

tallaght01 wrote:

there is a recurring theme in arguments of this nature about how consultants should take their worsened conditions because other people have stressful jobs but don't get paid as much. Soldiers were one of the examples given to me. I assumed the poster therefore knew that soldiers were poorly paid, so i said they should be paid more. The point I'm making is that consultants shouldn't have to take a pay cut just because other public sector workers get shafted.

Grr Aargh! Will you please read my post! I never once said that consultants should take their worsened conditions because other people have stressful jobs but don't get paid as much and just to clarify, I absolutely, categorically don't think that. My point (again!) is that once you start using stress as a means of calculating pay (as you asked with regard to your consultant), everyone will jump on the big salary/salary hike bandwagon. I have absolutely no idea what a soldier in a warzone is paid! However, imo many public sector workers are very well paid, me included (having a nice cushy 9-4.30 hospital social work job).

Saintly

donaghs

€205000 is an amazing Public Sector salary. As with the rest of us, you can try and earn more in the private sector or abroad if you're not happy.

A 39-hour week is not long by todays standards. A lot of people in the private sector do 40 or more and don't think anything strange about it. And overtime is a rare concept in the private sector nowadays.

In relation to professional footballers, they are not hired and payed for by the state (i.e. us, the taxpayers). Someone said consultants are at the top of their profession and deserve to get as much money as they can. Since we're paying for it they don't deserve a blank cheque, and we have agree some kind of "fair" amount.

Finally I have to get a dig in at PJ Breen. The average industrial wage is €32,000. Where does he think all those people are living? Maybe he's their landlord...

donaghs

One more thing. The IMO should agree to work to lift the cap on places for medical students (increase the numbers). By restricting places they guarantee their jobs and high salaries. The consultants are a sub-set of this problem within the medical profession.

Jimoslimos

InFront wrote:

What do your local county councillors work at?

Sweet f*** all:D

A bit OT but I see your point, it could be (very weakly) argued that a county councillor's wage isn't enough and so warrants working at another job - not that I'd agree. I don't think you'll find much people arguing that €205k isn't enough to scrape by!

tallaght01 I'm not 100% sure on what the current situation is with consultants treating private patients in Ireland at the moment and how much they would stand to lose if it was withdrawn - as nesf said it does depend on the speciality. From all accounts consultant psychiatrists do quite well and ergo also mentioned cardiology and orthopaedics, I suppose any other condition that rich old men tend to suffer from. tallaght01 - you chose the wrong area to get rich from;)

Vorsprung

donaghs wrote:

One more thing. The IMO should agree to work to lift the cap on places for medical students (increase the numbers). By restricting places they guarantee their jobs and high salaries. The consultants are a sub-set of this problem within the medical profession.

This is a Government funding problem, not an IMO problem.

donaghs wrote:

€205000 is an amazing Public Sector salary. As with the rest of us, you can try and earn more in the private sector or abroad if you're not happy.

If all the consultants went abroad in the morning we'd be kinda stuck, wouldn't we? And they can earn more in the private sector for sure, but then we wouldn't be changing anything. The problem with the Health Service is that patient care is consulant led rather than consultant provided (The Hanly Report's summary is worth a quick read), so to try to change things in line with the bigger picture of the European Working Time Directive, the HSE actually needs these people working solely for the public service

Traumadoc

Adding extra consultants wont change the system we have, they have been adding extra people for years in management and its still as bad as ever I cannot see the point in employing extra consultant surgeons for example if they are sitting around with no patients to operate on. We need more beds more operating spaces, to get the most of the consultants we have -


Many consultants are under employed because they cannot do work in the public system because there are no beds. Many are paid on the double operating on public patients in the private system (NTPF) I have strong objections to this.

The money is very good - but I do not trust the managers and so will not sign up to the new contract its not worth the extra 20k- (i do not see privates outside the public hospital)

InFront

I'm sure most people were expecting it anyway but just to keep things up to date:

http://www.rte.ie/news/2007/0422/harney.html

I would lean on the side of the consultants on this, but I think that vote is just the pinnacle of a disastrous PR week for them.

Saintly

Traumadoc wrote:

Many consultants are under employed because they cannot do work in the public system because there are no beds.

In addition to further bed investment, the health service needs to utilise the beds already in existence more effectively. The primary health care system in Ireland is virtually non existent. Patients occupy acute hospital beds LONG after their planned discharge date - due to a chronic shortage in home help, care attendants, meals and wheels, convalescence beds, rehab beds, nursing home placements etc. Services are patchy and vary hugely from one area to the next. The subvention schemes (home and nursing) are just the most ridiculous systems ever thought up. If hospital beds are ever to be freed from the notorious bed blocker, the primary health system will need a huge overhaul and investment.

Saintly.

Robbiethe3rd

The gorvernment will not provide more beds because more beds cost more money. What you call an invetment is actually a money pit for them.
If they opened more beds they would have to pay for more drugs, maybe more x-ray & surgery facilities so they have something to do with the patients occupyiny the beds and employ more nursing staff.
There is always an infinite demand on resources in hospitals, no matter what the overall state of the health service. Take the example of the NHS. It was though that when that began, as the years went on, less and less money would be needed as people would become healthier, the opposite happened. instead of dying of one illness, people died of another which needed to be treated also.

I would of course love to see more beds open but I dont think it will be a immediate priority of Mary Harney.

donaghs

Interesting looking back on the history of the NHS in relation to where we find ourselves now. Irish healthcare was always the poor cousin of the NHS, the private sector having to fill in for a meagre public sector. But we do appear to have aped their public/private split.

Aneurin Bevan forced through the NHS post-1945, forcing aside various interest groups like nurses and GPs, sometimes unfairly. But the one interest group he couldn't overcome was the consultants. Eventually he gave in and bought them off. In his own words, when asked how he won them over and ended their protests, he said he "stuffed their mouths with gold".

PoleStar

I may repeat a few things already said, but a few things need to be clarified.

1. No one in the IHCA said that 205k was a "mickey mouse" salary. What was said that Minister Harney was dealing with the issue in a mickey mouse fashion.


2. With regards to the value of jobs, most in a capitalist society will agree that those who have a more difficult job, with more responsibility and difficult training to get there should be paid more. So lets do one simple comparison as I have heard that good nurses should be paid 100k. A nurse does 4 years in college and while they may do post grad courses and gain extra experience and do have a responsible job etc, when they leave college they are essentially ready to go nurses. The average consultant will have spent 6 years in college, and usually anything from 10 to 15 years work as a postgraduate trainee before they are considered capable to deal with every eventuality. Durint this 15 year stint, they have actually probably done an average of70-80 hours a week, so taking a normal job, they have actually (including med school) been training for the job for 36 years. Thats quite an onerous training scheme i think. And contrary to what the HSE and the Minsiter would like to think, consultants work well in excess of the contractual requirements, putting in many weekends and nights per year.


3. Responsibility. No the responsibility and blame for patient care is not shared. Perhaps people dont know this but a consultant is someone who is personally responsible in name for the care of patients, and that includes being reponsible for decisions made by juniors under your supervision. So no, there is no one there to share the responsibility.


And what always amazes me is that while 10 years ago when junior doctors were not paid for the hours they worked which is 80 hours a week and we frequently saw in the media that omg its disgraceful that doctors work so much. Nowadays all we hears is that junior doctors get paid far too much. This is not actually the case, they just get paid for the hours they work. If a porter or nurse works 80 hours a week then they will be earning big salaries too.

While the media frequently portrays us docs as the evil of society, I always find it interesting when it is 2 am sunday morning, having been in work on site in the hospital since 9am saturday, and a patient asks casually "what time you off at doc" and you tell them the reality that you will leave the hospital at maybe 6pm on Monday, and work the rest of the week as normal, the shock on their faces and absolute disbelief is amusing.

This aint a "feel sorry for me coz I am a doctor" rant, it is merely a statement that while I love my job, I work hard and I expect to be well paid for it.



Feel free to discuss lol!


By the way for those of you who are discussing the contract, I urge you to look at publicjobs.ie where the shambolic contract is there for everyone to view.

tallaght01

Saintly wrote:

Or someone simply disagrees with some (not all) of your comments...


If you reread my original post, I completely agree with you. No consultant on a current contract should (or will) have to take a paycut. However, the government is entitled (as the employer) to consider who they need to employ in the future. At present, the employer wishes to employ consultants who are solely dedicated to public patients. The government is entitled to consider new contracts for this new consultant position.



Again we are almost in agreement - though remember, the vast majority of Irish consultants choose to see private patients to supplement their income. That work is not obligatory so they have can hardly complain about long hours when they actively seek additional work. In an earlier post, you described your (UK) consultant's daily routine and made the point that My point is that if you start using stress as a basis for financial packages - people in every professional group will jump up and down to tell you their woes - the child worker, the fireman walking into a fire, consultant making critical decisions, traffic wardens being regularly abused by the public. People experience stress completely differently, some thrive in crisis, others run from it. I don't think stress should factor as a part of contract agreements - it's far too vague and impossible to measure.



Again as in my original post, I absolutely agree with you. I do believe however, that the Dept of Health is entitled to formulate public only consultant contracts if that is what the health care system needs.



True, I left out responsibility - unlike stress, responsibility is an excellent indicator of how much someone should be paid.



I absolutely disagree with this. I refuse to believe that the present arrangement with Irish consultants is a) best for patients and the health service and b) that changes will attract less qualified doctors with less experience. Other countries employ public only consultants effectively, why on earth can't we? The current consultants will not, as I understand, be affected by the proposed changes. The new contracts are for a new type of consultant that the employer perceives to be necessary to meet the needs of public patients.

The government is obliged (in theory) to ensure that public patients receive the best deal possible. Everyone who works in the Irish health care system is painfully aware of the need for change. I have mates who are NHCDs who resisted the European working directive when it was introduced (not that it made a blind bit of difference, it had yet to be implemented when I left last Sept). Anyhow, my mates argued that if the directive was introduced, their access to their consultants would dramatically decrease as their shifts changed (i.e. a week of nights or late afternoon shifts, no consultant in sight) . The argument at that stage was that dedicated shift friendly consultants would be far more productive with regard to NHCD learning. Right or wrong, those were their sentiments at the time.



To be fair, I think there is a huge sympathy in Ireland for junior docs - they filmed a six episode documentary on interns last year, that sparked public debate about the hours, lifestyle etc. Public interest in the consultant contracts however is not simply about money - its about health care provision, its about public patients, about waiting lists, about effective health care management. There are wider issues at play here. I have friends in medicine who would disagree about your perception of public opinion (at least in Ireland).



Have a huge interest in suicide research and prevention - would be interested in the career rates, I remember that old myth about dentists was blown out of the water - from memory, I think it is docs, lawyers, pharmacists etc that show high rates - in the US. Not sure if any research re same has been done in Ireland. I think there are more complex reasons than employment for suicide, but I definitely agree that the pressures of medicine may be a contributing factor. Access to means, probability of success are just two of the factors also linked to suicide rates -unfortunately doctors score highly here.

Back to the discussion -ultimately, we are talking about change. Consultants should and I am sure, will fight for the best conditions for these new public consultants - but they cannot expect the government to entirely subsidise the loss of earnings from private practice (which was always voluntary and the discretion of the consultant) to a public only consultant.

Saintly

Well, after a month or so of being solidly on call I think my brain is too fried to understand the points being made in Saintly's post.
He mentions other professions who work in high responsibility jobs, but then implies I'm being unreasonable in claiming consultant's pay has nothing to do with what these people earn. In which case, I don't know what relevance the comparisons have.

He then makes the point that the government are "entitled" to negotiate a new contract with the consultants. I agree. Because it's true. This whole argument has arisen because they are entitled to renegotiate the contract. That's not the issue. The issue is whether it's fair. I think it's not because:

1) One group of consultants will have worse conditions than the other. The lower morale will not be good for patient care.

2) The new group of consultants won't have a secretary, any juniors, or any kind of team at all. (This is only the word on the medical grapevine here in the UK, can someone confirm if it's true?). If this is true, the new consultants will be as useful as a chocolate fireguard. Chocolate fireguards are not good for patient care.

3) The new consultants will have a "gagging clause". This is amazing. Words defy me. Is this even legal in the 21st century? This is not good for patient care


The point about having consultants dedicated to public patients only raises the interesting question of what will happen to the private patients. Private medicine takes a lot of the pressure off public waiting lists presumably?

IN terms of other countries employing public only consultants. Which countries are they? I have no idea, but would be interested in seeing what's happened there. How do you measure "effectively" in "Other countries employ public only consultants effectively, why on earth can't we?".

Can anybody also clarify the point about "The vast majority of irish consultants coose to see private patients". I listened to an IMO rep on the radio recently who said that the majority don't do private work. That's certainly the case here in the UK. Does anyone have the figures for Ireland?

"The new contracts are for a new type of consultant that the employer perceives to be necessary to meet the needs of public patients.
The government is obliged (in theory) to ensure that public patients receive the best deal possible."

The needs of the public are most certainly not served by the introduction of what is effectively a sub-consultant grade, for the reasons given above.

I also don't quite understand the point about the european working time directive. It's not been implemented in Ireland yet. It's been implemented in the UK though. It doesn't mean our consultants work shifts. They work the same hours they always have. I don't really get the point. But it could be just that I'm post-oncall.

I would disagree with your friends who say that there's a lot of sympathy for junior docs in Ireland. I know when I talk to people about the conditions, they are sympathetic, and make all the right noises. There were more noises after the junior docs show on RTE a while back. BUT, the point I was making was that there isn't anything like the media coverage, and public interest in the junior docs hours issue as there is in the consultant pay issue. In essence, what I'm saying is that:

a) junior docs working what is more or less slave labour-minimal interest

b) Those junior docs progress up the ladder and earn a decent living- public outrage.

Anyway, I really came on here to find out what the current situation is with the negotiations. I've been out of the loop lately. I know the new contracts were advertised. Have people applied for these posts? Have the IMO boycotted interviews? Who is doing the shortlisting? Will the current consultants co-operate with the new consultants?

Traumadoc

tallaght01 wrote:

2) The new group of consultants won't have a secretary, any juniors, or any kind of team at all. (This is only the word on the medical grapevine here in the UK, can someone confirm if it's true?). If this is true, the new consultants will be as useful as a chocolate fireguard. Chocolate fireguards are not good for patient care.

?

This is taken fromthe letter of approval for the posts it can be found on www.publicjobs.ie
Approval to this post is subject to the following conditions

• Total employment remaining within your approved ceiling.
• That normal recruitment procedures for the filling of consultant posts are applied.
• Funding will be from within your financial allocation and on the clear understanding that claims will be entertained at a later date for increased costs associated with this post or for overspends against your financial allocation.
▪ That there are no non-consultant hospital doctor posts attached and hence no further revenue implications.

nesf

tallaght01 wrote:

a) junior docs working what is more or less slave labour-minimal interest

b) Those junior docs progress up the ladder and earn a decent living- public outrage.

Anyway, I really came on here to find out what the current situation is with the negotiations. I've been out of the loop lately. I know the new contracts were advertised. Have people applied for these posts? Have the IMO boycotted interviews? Who is doing the shortlisting? Will the current consultants co-operate with the new consultants?

Afaik, and I've not really been following closely, the general feeling is that the old consultant contracts were too generous and that the new contracts should be closer to what is considered the "equilibrium wage" associated with the role. Harney on Q&A was talking about moving to a Scandinavian system where there isn't a consultant and then juniors and admin under them but a team of consultants with juniors and admin under the team rather than individual consultants. I've no idea of what exactly this entails or means but it is the gist of what she said.

tallaght01

nesf wrote:

Afaik, and I've not really been following closely, the general feeling is that the old consultant contracts were too generous and that the new contracts should be closer to what is considered the "equilibrium wage" associated with the role. Harney on Q&A was talking about moving to a Scandinavian system where there isn't a consultant and then juniors and admin under them but a team of consultants with juniors and admin under the team rather than individual consultants. I've no idea of what exactly this entails or means but it is the gist of what she said.

IN the UK, there are some units where there is a team of consultants, and a team of juniors under them. I have worked in 2 such units. It means poor supervision for the juniors, as you're constantly working with different consultants who don't really get to know you're strenghts and weaknesses, and therefore can't mentor you properly. This is ot good for patient care.

It also leads to disjointed care for the patients, as the junior looking after them over the weekend may be working with another team for the next 3 weeks, so the follow up is left to someone else who isn't familiar with the case. The overwhelming consensus (amongst those in the 2 hospitals where I worked anyway) was that the system is fundamentally flawed with no-one feeling they have "ownership" of a patient, and the responsibility that goes along with it. Although it does save money. I guess that's the main priority.

The argument about reaching an equilibrium of pay is, I believe, inaccurate. This is because the new consultants are being employed in a monopoly market, insofar as there's an employer's monopoly. If they have no option of doing private work, then we're in a "price-setting" situation. I believe that for some of the top brains in the country, and the training they have undergone, and the crazy hours of service they have given, coupled with the postgraduate exams they have passed and the 24 hour a day 7 days a week responsibility they are faced with, consultants are most defnitely not overpaid.

nesf

tallaght01 wrote:

IN the UK, there are some units where there is a team of consultants, and a team of juniors under them. I have worked in 2 such units. It means poor supervision for the juniors, as you're constantly working with different consultants who don't really get to know you're strenghts and weaknesses, and therefore can't mentor you properly. This is ot good for patient care.

It also leads to disjointed care for the patients, as the junior looking after them over the weekend may be working with another team for the next 3 weeks, so the follow up is left to someone else who isn't familiar with the case. The overwhelming consensus (amongst those in the 2 hospitals where I worked anyway) was that the system is fundamentally flawed with no-one feeling they have "ownership" of a patient, and the responsibility that goes along with it. Although it does save money. I guess that's the main priority.

I've no idea of how affective a system it is or how it works out on the ground. Could it be a different system in Scandinavian countries versus the UK though?

tallaght01 wrote:

The argument about reaching an equilibrium of pay is, I believe, inaccurate. This is because the new consultants are being employed in a monopoly market, insofar as there's an employer's monopoly. If they have no option of doing private work, then we're in a "price-setting" situation. I believe that for some of the top brains in the country, and the training they have undergone, and the crazy hours of service they have given, coupled with the postgraduate exams they have passed and the 24 hour a day 7 days a week responsibility they are faced with, consultants are most defnitely not overpaid.

Honestly, I don't know. Relative to the average wage the new consultant wage is very high, the old one when you add in private fees is far far higher. I don't disagree that consultants should be paid well, they should, but 205K in our economy is not small change. There is an international market for consultants, and yes they could receive much higher wages in other countries but (since this is the public-only wage afaik) I'd think that only comparisons with other countries for "public-only" consultancies versus private systems like the US. I'd also believe that compared to the other "top brains in our country" 205K isn't bad.

I didn't mean that 205K was too much for consultants to be paid btw, I was referring to the old contracts where private fees could (in some cases) make that a far higher number.