HSE breaking contractual agreements with NCHDs. AGAIN!

Jane5

I received this attachment from medical HR regarding our "training supports", **snigger**

Note this part:

Contribution towards approved examinations

The HSE will continue to make a contribution towards the cost of specific
examinations as established by the Postgraduate Medical and Dental Board (PgMDB).
The list of examinations developed by the PgMDB has now been reviewed by the HSE with a view to ensuring that it supports relevant examinations. The list of examinations approved by the HSE is set out in Appendix Two.

The sum of the contribution to be made available by the HSE to support NCHDs will continue to be €450 per examination as specifically identified in Appendix Two.
In cases where the cost of the exam is less than €450, then the amount contributed will be the same as the cost of the examination.

This contribution should only be made available by employers upon the applicant NCHD successfully passing the relevant examination and providing to the employer the necessary documentation to confirm same.
No contribution will be made in scenarios whereby the exam is not specifically identified in Appendix 2 or where the applicant has failed the exam.

This is a blatant serious breach of the agreed terms and conditions of the new NCHD contract as negotiated on our behalf by the IMO. Has anyone contacted them about this? I am no longer a member, as I have been disgusted for years with their poor efforts to secure any type of decent working conditions for the NCHD cohort of their membership.

The HSE can't keep riding us bareback like the spineless fools that we are. Is it time for another High Court challenge????

:mad::mad::mad::mad::mad:

resus

IMO didn't negotiate anything re: training
Nil negotiated, Nil breached

Time to stop wasting our time with IMO and start flexing our individual muscle. Hospitals desperate for NCHDs, so put in your notice over this, if this in an issue YOU feel strongly about, and move to a hospital which honours terms and conditions YOU have agreed with them.

It is amazing how many "alternative" contracts are out there now, largely owing to our skills now being in hot demand.

... market forces etc.

take everything

resus wrote: »

IMO didn't negotiate anything re: training
Nil negotiated, Nil breached

Time to stop wasting our time with IMO and start flexing our individual muscle. Hospitals desperate for NCHDs, so put in your notice over this, if this in an issue YOU feel strongly about, and move to a hospital which honours terms and conditions YOU have agreed with them.

It is amazing how many "alternative" contracts are out there now, largely owing to our skills now being in hot demand.

... market forces etc.

This is what i was thinking.
Many hospitals are crying out for SHOs at the moment- surely it gives doctors some leverage.

Jane5

I like your idea of negotiating things for ourselves instead of relying on our "union". However, they actually did negotiate terms and conditions vis a vis exams and training financial supports, and it did not include a "pay only if you pass" scenario. The deal was to pay, full stop. The HSE are breaking this agreement.

resus

Fine, like I said, YOU feel they are not honouring the Terms and Conditions of YOUR contract, give them notice and leave. EVERY single Personnel Department across the country are looking for NCHDS. Tell them you'll take the job on the condition that you get these entitlements paid and you want it in writing before you start...

docbroc

For the record I would like to quote something I posted over a month ago that was replied to by a high ranking member of the IMO:
Quote:
Originally Posted by docbroc

In terms of exam and training fees. Our Medical Admin has a big mouth. She has just gotten back from their latest coven with news. From the 1st of July the plan is - your exam is only covered first time and only covered if you pass. UK exams will not be covered. Preparatory courses of any kind will not be covered. This is what happens when you entrust education to the HSE.

That is rubbish. She's talking out her backside[IMO NCHD High Ranker]

resus

Backside or no backside, the circles of "letters" and "complaints raised" and "threats leading no place" and then "issue forgotten about" or my personal favourite, "it's being dealt with on a national level!" will continue unless we take things in our own hands.

Bullying is rife under Medical Unionism I'm afraid. The "Best" deal for all, sod the individual is the basic rule.

The true power is that we are in hot demand. We need to use this card...

beeno67

resus wrote: »

Backside or no backside, the circles of "letters" and "complaints raised" and "threats leading no place" and then "issue forgotten about" or my personal favourite, "it's being dealt with on a national level!" will continue unless we take things in our own hands.

Bullying is rife under Medical Unionism I'm afraid. The "Best" deal for all, sod the individual is the basic rule.

The true power is that we are in hot demand. We need to use this card...

Sorry if a stupid question. It is a long time since I worked in hospitals, but, if NCHD jobs are decreasing and medical graduates are increasing, why are NCHDs in demand?

RobFowl

beeno67 wrote: »

Sorry if a stupid question. It is a long time since I worked in hospitals, but, if NCHD jobs are decreasing and medical graduates are increasing, why are NCHDs in demand?

Because a huge amount of NCHD jobs are no longer approved training position and as a result are of no use whatsoever to any doctor who is in training (ie almost every single one).

opinion guy

Training grants ??!!??!?!!?!?!?

Screw that. NCHD's are still-working 50, 60, 70, 80 hour shifts with no break.

1POD

I've just been doing some quick calculations here.

I pay €65 a month by direct debit to the IMO, which, as I look at yet another overdrawn bank statement, I am really struggling to justify.

I regret this situation as I fundamentally believe in the principle of having a strong union in order to represent its members. I have been a member of the IMO since I graduated several years ago and I normally don't have a lot of time for people who join for a month or two during a rough period and then cancel their membership as soon as the storm settles. At the beginning of last year when all the cuts were first mooted I whipped up lots of support and signed up many new members in my own hospital, naively spouting the IMO line of needing close to full membership in order to represent us effectively. A fair point, I thought.

18 months later what has been achieved?

A look at the IMO website reveals that the last update relating to NCHD's was 7 months ago and indicated that the High Court case against the the HSE has been settled. Apart from a few wishy washy emails from the IMO in the interim stating that X has come their attention and they are continuing to state their position and are negotiating with the HSE and will let us know in due course when it is sorted out. I have seen no proactive efforts by the IMO to protect the welfare of doctors and patients by insisting that education and training is essential for all doctors.

The HSE has been allowed to pretend that it is making a significant contribution to training costs of NCHDs while in reality, the funding that once existed towards the cost of books, courses and exams has been effectively removed. A payment is being made directly to the respective colleges towards training an elite subgroup in numbered training posts without any requirement for the colleges to clarify exactly what they will provide in return for this payment and whether or not that payment will cover the huge fees (compared with UK courses) currently being charged by the colleges for courses and exams. Where were the IMO when this cosy arrangement was being sewn up? And in a turkeys-voting-for-Christmas type manouevere, it has now been decreed that courses in the U.K. will no longer be funded, despite the fact that they are frequently the only option for many doctors due the the limited number of courses provided by the colleges here. ( It must also be noted that the U.K. courses are quite often of a significantly higher standard than those provided in Ireland and attendance there should be encouraged). In the past 2 months I have paid (in addition to mandatory medical council, college and professional association membership fees )over €6000 in course fees, exam fees, flights and (budget) accomodation: training which was not available in Ireland, necessary for my job and for which I can't even claim tax relief at present, never mind receive funding towards it.

The HSE has somehow decided that it will pay up to €450 towards one of ACLS, ATLS and APLS courses (total cost of each being approx €500, €750 and €800 in addition to travel and accommodation expenses) and that it will only pay college exam fees on passing exams: most of which have a notoriously low pass rate. I'm straining hard to hear the IMO objecting to this.

Contrary to public perception, there has been no improvement in my working hours since the alleged introduction of the EWTD. In actual fact, because of the unbelievably shortsighted measure of introducing numbered training posts without sorting out all the other problems, a number of posts in our department, like many others have been left unfilled, due to the difficulty in recruiting NCHDS, forcing the remainder of us to work extra call to cover these vacancies. In addition, I have yet to hear the IMO highlight all the extra work undertaken by NCHDs outside their "rostered" hours in terms of audit and morbidity and mortality meeting preparation which is essential if a hospital is to function safely.

What is most regrettable the current situation is the general perception that the situation is so complicated that it can't be sorted out and the general air of despondency and frustration among NCHDs. Such a pity when there are well functioning models in the southern hemisphere.

So back to the calculations: apparently there are roughly 3600 NCHDs in the country. If even 1000 NCHDS paid, as I do, €65 per month into a fund: that would create a pot of €780,000 to employ a few properly qualified and dedicated souls whose full time job it would be to represent the views and interests of NCHDs at national level. Quite frankly, I am tired of being preached at that my union is only as strong as its members and that I need to get involved: I work between 60 and 100 hours every week, I have exams to study for and I have a family to look after. I have solidly paid my membership fees, attended every hospital meeting, returned every IMO survey and driven several hours to regional meetings on a number of occasions and I have no inclination to spend any more time on even more meetings that are achieving little.

I think its time we had a dedicated union to represent the hospital doctors.

Is anybody interested?

resus

Absolutely Interested 1POD
Problem being is, are there enough of us who would bother their arse doing it...?

I am increasingly believing the days of the traditional Unions are numbered. I for one am getting 10x further negotiating my own T&C. It is amazing how quickly T&C are honoured and back pay is paid properly when you hand in your 2 week statutory notice!

Power of the individual/professional is strangely on the increase!

Would setting up another "union" be the answer? or a collaborative employment of a lawyer and an accountant (the latter being the most nb) to accurately quantify how they are screwing us and then defend it.

ie. accept the crap thrown at us, but robustly ensure every hour worked is paid for?

jmn89

Wow, so even after medical school the faceless monsters don't stop screwing you wherever they can... I'll be an NCHD in one year's time - can't wait!

Jane5

1POD,

I would be very interested. I have often thought about starting up a union, and even looked into a few of the requirements before, how many members you need, etc. I have an interest in employment law as a family member is a solicitor who specialises in this area.

PM me if you're serious, I know a couple others who might be interested too.

What would we call the new union? Need a catchy name!

docbroc

Been there done this. From what I remember the existence of the IMO throws a major spanner in the works.You probably couldnt get your union declared a legal entity with rights to negotiate/take industrial action as long as the IMO is around. Your options would be to form a representative group ie IHCA or to join a more competent large union the HSE is afraid of ie SIPTU. If we had been members of SIPTU this last few years believe me we would be exponentially better off now.

docbroc

Jane5 wrote: »

1POD,

I would be very interested. I have often thought about starting up a union, and even looked into a few of the requirements before, how many members you need, etc. I have an interest in employment law as a family member is a solicitor who specialises in this area.

PM me if you're serious, I know a couple others who might be interested too.

What would we call the new union? Need a catchy name!

How about the DFWU - the Dont Fcuk With US union.

resus

Union per say is not necessarily the answer, given the huge cost involved.

Our rights are negotiated already, just not being actively enforced. Which is the IMOs downfall.

What is needed is a cooperative/collective and incredibly SIMPLE means of ensuring our contracts are enforced.

Doctors per say are too damn busy to accurately collate their hours worked against what we're actually paid. LArgely because our contracts are so complex. So RECORDS enforceable in court exist, but just not collated in a usable manner. We ALL know we are underpaid, just can't prove it !!! We all know our rotas are illegal, just too scared to step out of line for fear of not getting the next job. Which is incomprehensible to any outsider, but it's true.

THIS is where we must start ie. HISTORY
then get accurate audit of problem ie. EXAMINATION
then get a real fickle, young, dynamic lawyer on it ie. INVESTIGATION

Doubt it will EVER need to go to court.

Pastafarian

resus wrote: »

Absolutely Interested 1POD
Problem being is, are there enough of us who would bother their arse doing it...?

I am increasingly believing the days of the traditional Unions are numbered. I for one am getting 10x further negotiating my own T&C. It is amazing how quickly T&C are honoured and back pay is paid properly when you hand in your 2 week statutory notice!

Power of the individual/professional is strangely on the increase!

Would setting up another "union" be the answer? or a collaborative employment of a lawyer and an accountant (the latter being the most nb) to accurately quantify how they are screwing us and then defend it.

ie. accept the crap thrown at us, but robustly ensure every hour worked is paid for?

See I think the bolded part above is the key.

I think setting up another union is redundant and unobtainable, althou some sort of NCHD association is perhaps merited. Quite aside from that there is a clause in the new NCHD contract that I'm think rather sneakily means that only the IMO can renegotiate the contract (but don't take my word for that). Task num1 would be to compile a list of contract abiding jobs. They are out there - its just where ? Also this varies with specialty - for example A&E are EWTD compliant generally everywhere - others not so. But some are.

Imagine what would happen if every NCHD could look up a list of jobs that are compliant with the contract and the EWTD. Imagine - it comes around to job time and you can look up the list and see that surgical sho's, regs in St HolierThanJesusHimself's will get their training grant but are rostered to work a whole weekend. etc. OR hospital Y only has 5 people covering Ortho call so you will work 1 in 5.

Individual docs would then be empowered to make informed choices about where they work. Lets start using market forces to our advantage now that we are in heavy demand. As an individual I have already planned out my letter stating that if they don't comply to EWTD, I'm leaving to somewhere that does.

Such an association could also make policy statements. For example Minister for Health cuts support to home carers by x%. Or hospital x has to close its a&e as there are 500 people on trollies. IMO and IHCA to their combined shame never say anything about these things (whether this is due to the gagging clause written into new contracts or union policy I'm not sure). INO on the other hand is always right up there in Six-One rightfully saying how terrible it is.

tallaght01

Look at what Remedy did in the UK.

The BMA were equally as shyte as the IMO, so a group of NCHDs formed "Remedy".

They still don't have negotiating rights, but they're growing, they're very popular, and they make the NCHDs feel like someone is fighting. They even brought some of the bigwigs to the high court a few months ago.

http://www.remedyuk.org/

Jane5

That sounds like a great start, Pastafarian! It would be easy enough to have a website, hosted by one of us, where docs could send in their scanned contracts, or fwd us copies of letters/emails from HR/Med Recruitment, as well as posting up details of who pays overtime legally, who refuses to pay for exams, etc.

As it is your good idea, would you be interested in starting that up? I'd be happy to help anyway I could, or to start it off if you were too busy to? It's easy enough to collect NCHD contact details, I could get at least 100-200 right off the bat, as well as Facebook, and could send a group mail to let them know that this is up and running, and that it is a collaborative thing.

Nice idea! And a good bit easier than starting a union, I have to say, and no cost.
Thanks for that! makes me very positive when people come up with great suggestions for these neverending problems NCHDs seem to continually face.

resus

Good by me too. Very +ve move. Facebook makes us easily identifiable, which is a problem if you make -ve remarks, but not a bother if you are positive about things.

So here is a thought. How about highlighting +ve jobs we know about in a structured format, I think there is a website in UK which started doing this, I'll try to hunt it out.

Nobody can slam you for saying, "Bantry General has a reputation for great Medical SHO teaching and experience there is regarded highly." But they could slam you for saying .... has a reputation for not paying overtime correctly."

SleepDoc

Exam fee 700 euro

Refunded by HSE 450

Journals, courses 2000 approx.

Refunded by HSE = 0

This is another pay cut in all but name.

I've cut back on useless, frivolous expenditure such as IMO membership.

Jane5

resus wrote: »

Good by me too. Very +ve move. Facebook makes us easily identifiable, which is a problem if you make -ve remarks, but not a bother if you are positive about things.

So here is a thought. How about highlighting +ve jobs we know about in a structured format, I think there is a website in UK which started doing this, I'll try to hunt it out.

Nobody can slam you for saying, "Bantry General has a reputation for great Medical SHO teaching and experience there is regarded highly." But they could slam you for saying .... has a reputation for not paying overtime correctly."

Well, I'm not talking about being Pollyanna about it either. While knowing the positive stuff is nice, and positive comments would be useful, I do mean primarily naming and shaming. It can be done anonymously, or can set up a members only login so members can view the latest contractual violations. A list of which hospitals are not paying exam fees, which are not paying overtime, and keep it constantly updated.
It's completely useless to set up a website saying positive stuff only. The things you need to know are:

Will you be trained and receive training support?
Will you be paid for hours worked?
Will you be worked illegally or will the EWTD be applied?
What is your rota like?
Is your hospital complying with contractual annual/study/conference leave requirements?

If you cannot find these things out from the website, it is useless.

resus

Fair enough, let's find out if such a website would be legal


if not, we get it hosted in Tonga !

Pastafarian

Wow glad someone liked one of my ideas for once! :P

But thinking about it a little more i too would be concerned about the legalities of it. I don't think you could say on a publicly accesible site that hosptial x forces srugical regs to work fri thru mon for example. It might cause a fuss ....thou then again maybe this is one way to effect change.
Sorry Jane I wouldn't have time to start that up as i already have some extracurriculars on my plate.


To be honest the more i think about it the more likely I am to walk. Just this week gone by whilst I am dangerously busy and getting harassed by nurses about basic stuff (for I am both sho and intern at the moment), whilst said nurse is getting during 9 to 5 working hours one to one teaching from a specialist nurse trainer a person about management of stiuation X using drugs a,b,c - stuff that i don't even know and would love to have some explain to me (hey and I'll settle for 1 to 10 teaching no need for one to one). Anyhow - I just thought.....NO. F**k this. Here I am trying to balance getting aggressively harassed over iv lines on the one hand - something my nursing colleague is well able to do whilst instead she sits there getting tutored - and on the otherhand trying to arrange vitally important treatment for patient 1 - the diverging needs of full filling two jobs at once literally requiring me to be in two places at once (or maybe three).....I just thought - nothing is worth this ****. I am not putting up with this level of stress on a daily basis. This crap WILL put me in an early grave. Oh and I'm not even gettting paid for all of it.

F-U-C-K T-H-A-T.
So i'm out. Its just a question of when and what next.

Nchd2010

I know this may not sit well with some here, but it does have to be mentioned that our remuneration both as NCHDs and subsequently if and when we become independent practitioners or consultants is significantly higher than in many other EU countries. Whilst training here is appalling in most specialties, making a personal contribution to further education is not unreasonable, and not out of line with many other professions.

I accept that working hours are onerous, and flouting of relevant legislation is widespread, however, as a 3rd year graduate, I am earning far in excess of most, if not all of my school classmates.

Also, someone earlier mentioned the notion of joining up with SIPTU. Surely ethically and morally we couldn't condone this..the public sector unions in this country are like the HSE, greedy, bloated and inefficient. SIPTU were and are quite willing to protect the "rights" of many workers in unskilled positions, with lifelong job security and favourable pension arrangements, such as hospital porters, who are earning far in excess of highly trained professionals (NCHDs) and causing a significant drain on HSE finances.

ORLY?

Nchd2010 wrote: »

as a 3rd year graduate, I am earning far in excess of most, if not all of my school classmates.

Per hour?

Nchd2010 wrote: »

Also, someone earlier mentioned the notion of joining up with SIPTU. Surely ethically and morally we couldn't condone this..the public sector unions in this country are like the HSE, greedy, bloated and inefficient. SIPTU were and are quite willing to protect the "rights" of many workers in unskilled positions, with lifelong job security and favourable pension arrangements, such as hospital porters, who are earning far in excess of highly trained professionals (NCHDs) and causing a significant drain on HSE finances.

Agree with this.

Jane5

It is most certainly legal to state things like "hospital X makes SHOs work 60 hour straight shifts and is contravening EU law". Libel is a damaging lie, however, if it is the truth, then even if it is damaging, you can legally say it and not be sued.

Isn't it causing a fuss sort of the point here? You know, so we'll stop being treated like crap?

If we don't stop being so spineless, then we deserve everything we get.

And nurses in this country need to bloody well buck up and do what any student nurse in say, Kazakhstan, does as part of their normal job. Delaying provision of medical care to patients by tying up doctors with simple jobs that they can do and just refuse to, is a national disgrace, and tbh, should result in disciplinary action. The knock on effects of these ridiculous practices, such as FIRST DOSES, is enormous.

Pastafarian

Nchd2010 wrote: »

I know this may not sit well with some here, but it does have to be mentioned that our remuneration both as NCHDs and subsequently if and when we become independent practitioners or consultants is significantly higher than in many other EU countries. Whilst training here is appalling in most specialties, making a personal contribution to further education is not unreasonable, and not out of line with many other professions.

I accept that working hours are onerous, and flouting of relevant legislation is widespread, however, as a 3rd year graduate, I am earning far in excess of most, if not all of my school classmates.

Ok you are earning more because of the disgraceful conditions you are expected to put up with day to day which, doubtless, your school classmates do not and would not put up with. Its compensation. Or worse a bribe to get us to stay in the job and not walk away. I would happily work for less if they didn't work me illegal hours and actually trained me. Indeed the entire idea of overtime rates is to a) compensate the worker for excess hour and more importantly b) discourage the employer from overworking its employees. Personally speaking I would gladly sacrifice some income for actual training and legal working conditions - I know many others feel the same.

Also, someone earlier mentioned the notion of joining up with SIPTU. Surely ethically and morally we couldn't condone this..the public sector unions in this country are like the HSE, greedy, bloated and inefficient. SIPTU were and are quite willing to protect the "rights" of many workers in unskilled positions, with lifelong job security and favourable pension arrangements, such as hospital porters, who are earning far in excess of highly trained professionals (NCHDs) and causing a significant drain on HSE finances.

I largely agree with this. Joining siptu not a great idea. I think speaking with our feet is a better option.

Jane5 wrote: »

It is most certainly legal to state things like "hospital X makes SHOs work 60 hour straight shifts and is contravening EU law". Libel is a damaging lie, however, if it is the truth, then even if it is damaging, you can legally say it and not be sued.

Indeed. A fair point. I guess its about being able to prove things. I also feel thou - HSE is a large beast - if you piss it off it might stomp on you. I think it would not be wise to publish such info unless doing it anonymously. I guess the options are anonymous website or finding an interested journalist somewhere. Indeed consultants may not like it either - since some of them are also strongly opposed to the EWTD. I had a conversation with one recently on this that was both very revealing and shocking as regards their attitude on this, but I'd best keep that to myself.

Isn't it causing a fuss sort of the point here? You know, so we'll stop being treated like crap?

If we don't stop being so spineless, then we deserve everything we get.

hmmm fair point.

And nurses in this country need to bloody well buck up and do what any student nurse in say, Kazakhstan, does as part of their normal job. Delaying provision of medical care to patients by tying up doctors with simple jobs that they can do and just refuse to, is a national disgrace, and tbh, should result in disciplinary action. The knock on effects of these ridiculous practices, such as FIRST DOSES, is enormous.

To be fair to the nurses - many of them are also frustrated by this type of thing as they have to wait for a doctor to get **** done. They are not allowed to do many things they are well able to do on account of their own union rules and nursing admin. This is stuff the IMO should have been fighting against for along time, but its yet another thing they ignore.

Jane5

About the HSE being a large beast and stomping on you:

Was thinking about that today, and a couple of things occurred to me.

1)If the conditions and training are so bad that one was going to leave anyway-then who cares how pissed off they are?

2) The HSE knows damn well if they ruin any doctors career over speaking out about anything, that that doctor, knowing full well they no longer have anything to lose, would become such a massive thorn in their side that attempting to remove it would cause torrential haemorrhage. Including going public about the career ruination, with naming and shaming of ALL parties involved, and legal action and litigation for loss of earnings as well as for breach of contract and illegal working conditions. I don't think the HSE are that stupid. They don't like fixing problems, to be sure, but damage control and PR are their major areas.

Nchd2010

Pastafarian wrote: »

Ok you are earning more because of the disgraceful conditions you are expected to put up with day to day which, doubtless, your school classmates do not and would not put up with. Its compensation. Or worse a bribe to get us to stay in the job and not walk away. I would happily work for less if they didn't work me illegal hours and actually trained me.

I agree to an extent, but I think many medics seem to think we have the hardest job in the world. We don't. It pisses me of tremendously to think of the money overpaid porters, "medical manpower "managers"" and various HSE types bring home, and no doubt they do have an easier time than us. However, there's almost half a million unemployed and the country is bankrupt. Many of my medical school classmates drive new or nearly new BMWs, Mercs, S2000s etc. None of my school classmates do (then again I wasn't privately educated). Our job as doctors, even in the bleakest moments enables us to provide solace and comfort to the sick and afflicted which is a tremendous privilege in itself.

With regards to improving the situation, I'm not sure what can be done. I'm no apologist for the IMO, but I really don't think that those who give of their time freely to act as hospital reps etc are part of a HSE conspiracy or indeed are blind to such a conspiracy going on over their heads.

Just a few thoughts:
1 Why is it that the cleaning staff are private employees, are the porters, similarly unskilled manual workers are in the employ of the HSE in safe jobs on ridiculous money, with pensions and generous sick leave allowances

2 Why do radiographers get paid an overtime rate AND a service rate on call eg in at least 2 teaching hospitals, I know for a fact that radiographers were paid €200 for performing CT scans on call. With further generous allowances for more advanced CTs (ie giving a bit of contrast). Why does no-one in the media care about this. In fairness, setting up a scan isn't really all that onerous or skilled a task

3 RemedyUK seem to be a very forward thinking and sensible group...but what have they really achieved? Can we as doctors get more involved, speak out on healthcare inequities, and adequately perform our role as advocates for a better society, either within the IMO or some other grouping. And can we do this without endless reference to pay and money (conditions and training are fair game though)

4 Am I an idiot for wanting to train, work and care for the people of Ireland given the sorry state of our "health" service? Why amn't I in Oz?