pay rise for consultants while hse slash nchds income and training by 25% min

RANIA

http://www.irishtimes.com/newspaper/ireland/2009/0224/1224241710998.html

Prime Mover

Convenient the way that was released to coincide with the main story that the HSE has a 1.1 billion shortfall.

JuliusCaesar

Prime Mover wrote: »

Convenient the way that was released

maybe so, but a lot of HSE staff ticked off with this, as nobody else getting rises/increments/promotions and vacancies not being filled.........

RobFowl

Especially if you're a GP and have just been hit with an 8% plus cut in funding when the emphasis is supposed to be shifting the majority of care into the community.

donaghs

Reminds me again of Nye Bevan's negotating tactic, stuffing "their mouths with gold".
http://www.bbc.co.uk/archive/nhs/5159.shtml?all=2&id=5159

With so many people facing the sack or pay cuts, it looks much better now.

drzhivago

RobFowl wrote: »

Especially if you're a GP and have just been hit with an 8% plus cut in funding when the emphasis is supposed to be shifting the majority of care into the community.

I suppose Rob this is the swings and roundabouts
Sitting on the verge of a consultant job I obviously welcome the rise but for a new entrant it is not a rise the terms of the job are diferent now, they negotiated for an increase in the schediuling commitments where you can be scheduled any period between 8am and 8pm and also increased the working hours as well.

Not particularly relevant to me (value my free time) but they have also negotiated away rights to private practice.

This is a difficult one for most to understand but is a historic position, our heatlh service started out with junior doctors as the only medical employees in hospitals. Consultants were termed visiting specialists in those days and you were given visiting/admitting priviliges to hospitals where you could admit private patients charging fees and the pay back to the public service was that they treated public patients at no charge to hospital, because this could happen at any time during the week and there was no scheduled commitments it made planning health services difficult. It was only in the early 80's that the bulk of consultants became salaried for the first time.

I am not sure which model of healthcare is best for the country but I think that there is certainly value in fee for service models like US where consultant earnings is based on workload, there the insurance company is the payor, here it could be the HSE or DOHC. The model we have doesnt work right now for all groups so we should be looking at alternatives

I undertsand the shift to the community care but from HSE perspective they did a deal wit GP re medical cards for Over 70's and got stung on costs I suppose they are looking at paybacks and where they can make savings

I dont think the consultants will get out of this scott free by any means, they will after all pay the levy and I would not be surprised to see an actual pay cut for all HSE EMPLOYEES. They are €1.2 Billion in Debt(overdrawn, behind on funds not sure what the correct term is), sounds like funny money when you say it fast. i am reminded of dr evil and his 1 million dollars

Prime Mover

donaghs wrote: »

Reminds me again of Nye Bevan's negotating tactic, stuffing "their mouths with gold".
http://www.bbc.co.uk/archive/nhs/5159.shtml?all=2&id=5159

With so many people facing the sack or pay cuts, it looks much better now.

Of course it sounds like a lot to someone who has just gotten laid off. Why do you think they released that story on the day that the HSE announced a huge deficit? Link the deficit to the consultants of course.

Now I know this will cause you to splutter your tea all over your computer and your copy of The Communist Manifesto, but 240k is not exactly "gold" in a western economy considering their skills and the length of time they spent in training.

Government ministers get paid as much and they're not exactly running the place smoothly, Brendan Drumm's spin doctors get paid more than real doctors http://irishexaminer.com/ireland/idojcwmhcw/
bankers get paid millions for running the economy into the ground and Robbie Keane gets paid a consultants salary every two weeks or so and he is hardly footballer of the year.

Quit the begrudgery.

donaghs

Prime Mover wrote: »

Of course it sounds like a lot to someone who has just gotten laid off. Why do you think they released that story on the day that the HSE announced a huge deficit? Link the deficit to the consultants of course.

Now I know this will cause you to splutter your tea all over your computer and your copy of The Communist Manifesto, but 240k is not exactly "gold" in a western economy considering their skills and the length of time they spent in training.

Government ministers get paid as much and they're not exactly running the place smoothly, Brendan Drumm's spin doctors get paid more than real doctors http://irishexaminer.com/ireland/idojcwmhcw/
bankers get paid millions for running the economy into the ground and Robbie Keane gets paid a consultants salary every two weeks or so and he is hardly footballer of the year.

Quit the begrudgery.

I haven't be made redundant yet, so far so good.

I don't blame the consultants for the HSE deficit. The main worry I have about the HSE is that they could be doing a better job, and a lot of anecdotal evidence (some of it first-hand) about admin staff who literally have nothing to do. They seem to have owned up to this recently with a voluntary redundancy scheme: http://www.irishtimes.com/newspaper/ireland/2008/0709/1215537641899.html. A bit late for that now.

It's an old debate, but worth engaging if something is going to use a ridiculous example of a professional footballer. Perhaps it shows how out of touch you are. Robbie Keane is not paid from our taxes. And that's should be the end of that. If you aspire to his lifestyle your parents should have sent you to football trials as a youngster.

I think 240K as a public sector employee is "gold". It's just under Brian Cowen's salary, but still more than Gordon Brown or Sarkozy. I think it's about the same as a government minister salary - so on a level pegging with the people who are actually running the country. They're not doing a good job? Then vote them out.

Drumm's spindoctors aren't Public Sector employees. A scandal, but a different debate.

Not really begrudgery, just pointing out that taxes have to pay the salaries of public sector employees. And €240K is looking good!

sportswear

its a massive kick in the balls for them to be honest.

cutting private patients in publin hospitals, working on weekends, shift work.


i doubt they are delighted.

Prime Mover

Donaghs you seem to have this idea that once something is paid for out of tax revenue it is automatically bad value. You would end up paying a lot more if doctors were outside the public system. For example, Irish neurosurgeon will get 240k on this new contract. A US neurosurgeon gets paid 2 million dollars.

I don't understand your point about the spin doctors. It is still tax payers money they are being paid with. How is it a different debate that a PR consultant gets paid more from the public purse than a neurosurgeon?

2Scoops

Prime Mover wrote: »

A US neurosurgeon gets paid 2 million dollars.

LOL. Don't get me wrong, I broadly agree with your position, but this figure is not typical. I'm not sure any neurosurgeon can possible make that money from neurosurgery alone.

My 2 cents: I'm generally ok with consultants' salaries but the NCHDs clearly need the support more than they do, right now. And the 'skills and training' of doctors are overstated. Training as a research scientist was longer and more difficult than training to be a doctor.

Prime Mover

Ha, yes sorry that should have been 1 million, I didn't re-read the post

You think the skills are overstated? I think that opening up someones skull or heart is pretty impressive.

You are right about the support for NCHDs. Sometimes it seems like the consultants forget they were once NCHDs and are not vocal enough in their support for them.

Vorsprung

2Scoops wrote: »

And the 'skills and training' of doctors are overstated. Training as a research scientist was longer and more difficult than training to be a doctor.

I know nothing about research scientist training, but I imagine that if you **** up, people's quality of life/lives aren't at stake.

994

bigjimthefirst wrote: »

I know nothing about research scientist training, but I imagine that if you **** up, people's quality of life/lives aren't at stake.

*cough* thalidomide *cough*

And many other things.

2Scoops

bigjimthefirst wrote: »

I know nothing about research scientist training, but I imagine that if you **** up, people's quality of life/lives aren't at stake.

In clinical research, you'd be absolutely wrong. As I trained as both a medic and scientist, I can confidently say there are an equal number of opportunities to affect peoples' life/quality of life. I can also say the decisions I had to make as a doctor were mostly formulaic.

Vorsprung

I stand corrected so. In hindsight I made the point a bit abrasively, I'm gonna plead for post-call forgiveness! The points above are well made, but in relation to Thalidomide - there are SO many more controls, regulations etc nowadays, and the chances of that happening again are minute. Would you disagree?

2Scoops

Prime Mover wrote: »

You think the skills are overstated? I think that opening up someones skull or heart is pretty impressive.

With the appropriate training, doctors perform these surgical procedures routinely, so I can't imagine that they're that complicated. I was in Cuba for a while and they used to do heart and liver transplants all day and it wasn't a big deal. On the flip side of the coin, I would expect a doctor to struggle with designing a house, for example.

2Scoops

bigjimthefirst wrote: »

I stand corrected so. In hindsight I made the point a bit abrasively, I'm gonna plead for post-call forgiveness! The points above are well made, but in relation to Thalidomide - there are SO many more controls, regulations etc nowadays, and the chances of that happening again are minute. Would you disagree?

Not sure if this is directed at me or 994, but no harm, no foul here anyway. :pac: I think the chances of a thalidomide-like disaster happening again are slim, primarily because of the science-based restrictions and testing that have been instituted in the meantime.

2Scoops

Interestingly, here's what the free-market economy in the US is offering to doctors of various specialties:



Future Salary and Medical Student Specialty Choice
William Hueston
JAMA. 2009;301(8):826.

tallaght01

2scoops, there's no point in comparing your research stuff with training to be a doc. The argument here is about consultants, and not just "doctors" generically.

The decisions you make as a consultant are the ones other people can't make, and you're often asked to make them simply because they're not formulaic.

My neonatal consultants make some pretty hardcore decisions most days, and they're very iften called in because no-one else can intubate a baby, or get a central line in. Or they're asked to make end of life recommendations.

I simply don't think most research scientists have that kind of effect/responsibility. You may have found research harder than clinical medicine, but that doesn't mean it's so.

The money given to consultants was agreed ages ago (about a year ago I think). The payrise is a trade-off. The consultants do more out of hours stuff, and work weekends. They also give up their rights to private practice. To do this, and devote their time fully to the public service, they get some extra money as an incentive. But it would be less than they would have earned in private work in most cases.

2Scoops

tallaght01 wrote: »

2scoops, there's no point in comparing your research stuff with training to be a doc. The argument here is about consultants, and not just "doctors" generically.

The decisions you make as a consultant are the ones other people can't make, and you're often asked to make them simply because they're not formulaic.

My neonatal consultants make some pretty hardcore decisions most days, and they're very iften called in because no-one else can intubate a baby, or get a central line in. Or they're asked to make end of life recommendations.

I agree for the most part. In fairness, I could similarly compare study directors (often MD PhD research scientists who must make equally important patient decisions, depending on the nature of the trial) to consultants. I think that's a fairer, albeit not completely fair, comparison. I'm not even sure how it went off on this tangent - not my intention, and I'll shut up now!

tallaght01 wrote: »

You may have found research harder than clinical medicine, but that doesn't mean it's so.

The opposite is also true, of course. On a personal note, I like to think I found medicine easier, rather than research harder!

tallaght01

2Scoops wrote: »

I agree for the most part. In fairness, I could similarly compare study directors (often MD PhD research scientists who must make equally important patient decisions, depending on the nature of the trial) to consultants. I think that's a fairer, albeit not completely fair, comparison. I'm not even sure how it went off on this tangent - not my intention, and I'll shut up now!

I'd always hope pharma company directors got paid big bucks!!!! This was my get-out option if I can't take medicine any more by this time next year :P

tallaght01

2Scoops wrote: »

Interestingly, here's what the free-market economy in the US is offering to doctors of various specialties:



Future Salary and Medical Student Specialty Choice
William Hueston
JAMA. 2009;301(8):826.

That graph is very interesting. It's a good example of the flaws in the american system in terms of what they "value". They value billable units. You can bill per hip or knee or cruciate ligament, or per CT or MRI.

But the outcomes in paeds, psych and internal medicine are much harder to measure on a bill, so their docs are worth less.

It's always seemed to me that your income in the states is inversely proportional to the vulnerability of your patient population. So, the result is that they get less docs applying for jobs in paeds, psych and geriatrics.

2Scoops

The letter that this graph was included in was (kind of) making the point that the greater the number of places available in a particular specialty, the less the mean salary - another 'danger' of the free market system.

SomeDose

tallaght01 wrote: »

That graph is very interesting. It's a good example of the flaws in the american system in terms of what they "value". They value billable units. You can bill per hip or knee or cruciate ligament, or per CT or MRI.

But the outcomes in paeds, psych and internal medicine are much harder to measure on a bill, so their docs are worth less.

It's always seemed to me that your income in the states is inversely proportional to the vulnerability of your patient population. So, the result is that they get less docs applying for jobs in paeds, psych and geriatrics.

Interesting indeed. Anaesthetists (4th in the list) seem to buck the trend though, don't they? By definition, these are the docs whose patient population is the most vulnerable. Apart from surgical patients, the vast majority of ITU/HDU patients will be under the care of an anaesthetist. So I guess their earning power in the US is so high due to being tied in with various surgical specialities.

tallaght01

2Scoops wrote: »

The letter that this graph was included in was (kind of) making the point that the greater the number of places available in a particular specialty, the less the mean salary - another 'danger' of the free market system.

Yea, we see the same here in Oz. The ortho training programme is highly restricted. They all drive porsches and other suck funkmobiles.In fact, a neonatologist told me a few months ago that there was some resistance to increasing the number of training places, as it would eat into their private practice if there were more consultants trained.
There's huge private practice uptake in Oz, so there's a lot of reasons to enter the more restricted specialties.

SomeDose wrote: »

Interesting indeed. Anaesthetists (4th in the list) seem to buck the trend though, don't they? By definition, these are the docs whose patient population is the most vulnerable. Apart from surgical patients, the vast majority of ITU/HDU patients will be under the care of an anaesthetist. So I guess their earning power in the US is so high due to being tied in with various surgical specialities.

When I say vulnerable, I'm not talking about their medical conditions. It's a social reference.
Anaesthetists earn good money in private, as it's easy to bill for their services. Their services come in easily definable units.

RobFowl

tallaght01 wrote: »

The money given to GPs was agreed ages ago (about a year ago I think). The payrise is a trade-off. .

Sorry to disagree the over 70's money talked about was agreed in 1999 and was withdrawn from Jan 2009 (Capitation reduced fron 700 per person to 298 per person over 70), the 8% decrease is on top of that as well.

tallaght01

RobFowl wrote: »

Sorry to disagree the over 70's money talked about was agreed in 1999 and was withdrawn from Jan 2009 (Capitation reduced fron 700 per person to 298 per person over 70), the 8% decrease is on top of that as well.

Sorry dude, I wrote "GPs" when I meant to write "consultants".

RobFowl

tallaght01 wrote: »

Sorry dude, I wrote "GPs" when I meant to write "consultants".

No probs
Feeling a bit hard done by at the moment.
Public health docs are even worse off though !!!
I,m just getting the impression that the most vulnerable ie most junior docs are getting shafted completely, the GP's who see 90-95% of patient contacts are being shafted because the DOH hates us and the public have little sympathy for us because we have to take money off them most of the time rather than get paid though insurance schemes or by salary and consultants are getting a huge rise. (I know their private practice is limited etc).

NickCarraway

This pay rise is just the delayed implementation of the consultants contract, negotiated last year. I don't begrudge them their money.

But is there anyway they could just say "Look we'll hold off on the increase until the economy looks a bit better and when attempts to slash the HSE pay bill aren't currently being made".
Its not as if the consultants are going to starve, they are still well paid.

drzhivago

2Scoops wrote: »

Interestingly, here's what the free-market economy in the US is offering to doctors of various specialties:



Future Salary and Medical Student Specialty Choice
William Hueston
JAMA. 2009;301(8):826.

Interesting graph
The specialties with the highest amount reflect some where its difficult to recruit into

With respect to the low salaries they are in some specialties which have huge numbers of docs, I think they may also get reimbursed for procedures but i stand to be corrected on that one

Interesting sums