HSE breaking contractual agreements with NCHDs. AGAIN!

Nchd2010

Jane5 wrote: »

That is so pathetic.

Your stupid sh*t about how NCHDs should be expected to make financial contributions towards their training. Where to begin? Do you have any idea? Are you five years old or something?

In the US, residency lasts for 4 years. Then you are a consultant.
In the UK, structured training, on schemes that guarantee employment in a specific location for the duration of your training till consultancy are standard.

Right. I'm in a bit of a rush, so I've chosen to quickly take you to task on these little points.

Do you think all training should be free, in a country that is bankrupt, with insufficient funds to provide adequate care for patients, with healthcare inflation at record highs, and with a reasonably well paid NCHD workforce?

You do not become a consultant, or anything like it after 4 years in the US. You may become an attending which is a completely different post, and not as independent as an Irish consultant. After that you'll probably do at least one fellowship, and even then, getting a tenured appointment will not be easy. Have you looked at the hours of work for residents in the US? There's plenty in recent issues of the New England about it if you want to have a gander, but believe me, it's no better than here in most specialties. Their remuneration is also substantially less.

You called me pathetic, yet you seem to think that the UK is a land of milk and honey in terms of training. Have you heard of RemedyUK? They took the architects of MTAS to court to try to bring them before a fitness to practice committee under the GMC for the farce they had made of "training" in the UK. Seriously, are you not aware of this? It's been well reported in the BMJ. 12,000 people marched AGAINST the most recent reforms to training and "Modernising Medical Careers" in Glasgow and London. What a bunch of fools, sure "structured training, on schemes that guarantee employment in a specific location for the duration of your training till consultancy are standard". L..O..L

Jane5

Nchd2010 wrote: »

Right. I'm in a bit of a rush, so I've chosen to quickly take you to task on these little points.

Do you think all training should be free, in a country that is bankrupt, with insufficient funds to provide adequate care for patients, with healthcare inflation at record highs, and with a reasonably well paid NCHD workforce?

You do not become a consultant, or anything like it after 4 years in the US. You may become an attending which is a completely different post, and not as independent as an Irish consultant. After that you'll probably do at least one fellowship, and even then, getting a tenured appointment will not be easy. Have you looked at the hours of work for residents in the US? There's plenty in recent issues of the New England about it if you want to have a gander, but believe me, it's no better than here in most specialties. Their remuneration is also substantially less.

You called me pathetic, yet you seem to think that the UK is a land of milk and honey in terms of training. Have you heard of RemedyUK? They took the architects of MTAS to court to try to bring them before a fitness to practice committee under the GMC for the farce they had made of "training" in the UK. Seriously, are you not aware of this? It's been well reported in the BMJ. 12,000 people marched AGAINST the most recent reforms to training and "Modernising Medical Careers" in Glasgow and London. What a bunch of fools, sure "structured training, on schemes that guarantee employment in a specific location for the duration of your training till consultancy are standard". L..O..L

Yes, I think that if NCHDs are working in the public system exclusively, working illegal hours to prop up the system, for years and years and years on end due to a total lack of career structure in this country, that their training should be provided for free. Absolutely. End of.
Considering that maintaining valid ACLS/PALS/ATLS are now prequisites for hiring, and professional competence requiring paying for various courses and training is now mandatory. If you are required BY your job to have certain certificates in order to keep your job, then they need to pay for them
In Oz and NZ even their Medical Council registration is paid for by the hospitals, not to mind training expenses.

NCHDs didn't bankrupt the country, or the health service. Poor planning, inefficient work practices, and a slavish desire to maintain the status quo at all costs are wasting more money than paying for training, which actually saves money long term as doctors aren't making costly mistakes all the time. Yet as much as possible is being clawed out of NCHD salaries, because they have no union. Rather than tackle the inefficient practices and poor planning, it seems easier to just unilaterally decimate medical training.

I am more than aware of the situation in the UK. Yet, the situation in Ireland is so bad that many of my colleagues who left for the UK do tell us of the land of milk and honey that it is.
Training is better, and there are numerous structured training schemes in place, schemes in which one is assigned to a 'deanery' and can only be sent to hospitals within that deanery. Job security is much more, and there recently has been the advent of "run-through" training, essentially eliminating the morale destroying desperate search for a suitable and relevant job every couple of months.

Oh dear. So you're only an attending after four years in the US. So? Your entire residency is within the one area. No moving around every six months from one end of the country to the next. A guaranteed job with training for FOUR YEARS. Most Irish NCHDs would give their right arm for that.

So you read the New England regularly, are remarkably well informed as to the function of HIQA etc, remember well your undergraduate days when there were no free fees, and wish to maintain the clearly dysfunctional status quo at all costs, yet claim to be an NCHD? You must be a very very old one?? 'Cos you had said you were a third year medical graduate, yet free fees have been in place since 1996.

Jane5

Jane5 wrote: »

Ya know, NCHD2010, you seem remarkably invested in maintaining the corrupt status quo for someone who is so junior. I've literally never, ever heard an NCHD say the things you do.

Can I ask you a question? What are your thoughts on consultants who work in public hospitals treating private patients? You know, their NCHDs spend a huge proportion of their time treating their consultants private patients.

You know, I thought of something. If NCHDs were remunerated for the time they spend working looking after private patients from the insurance company or the consultant themselves, proportionately, they could well afford their training expenses, and would save the HSE a fortune.

What are your thoughts on that?

Hey, "NCHD". I know you're in a rush an' all, but you totally disregarded my question above. What do you think? Clearly you want us to pay for our own training. The above way would seem to be an excellent way of achieving that, as well as being fairer. So what do you think?

Nchd2010

My goodness. What a load of vitriol.

where to start...

1st...don't call me a liar. It's grossly unprofessional and childish. I graduated in 2007, and the years prior to this, every year at the SU elections, the good old socialists and the Campaign for Free Education would be almost demagogic (is that a word?) in frightening people into thinking fees would return. They also wanted to get rid of the registration fee as I recall. I never said free fees weren't in place when I was in college.

Your stupid sh*t about how NCHDs should be expected to make financial contributions towards their training. Where to begin? Do you have any idea? Are you five years old or something?

Easy now... I've explained before, this is standard in many other professions. And I'm more than willing to walk the walk myself, as I've described.

You symbolise all that is wrong with the health service, NCHD2010.

Of course I do. A dedicated doctor with two memberships and a masters, having graduated in 2007. A doctor who has repeatedly said that I'm dissatisfied with training here. A doctor who has encouraged colleagues to stand up and be counted and take some personal responsibility for training. You know...you're right.

fine while you are a wet behind the ears twenty something, with no mortgage, children or dependents

I'm by no means wet behind the ears. Trust me, i've plenty of life experience. And I know I'm a lucky man to be in the position I'm in. I'm hugely privileged.

Training is better, and there are numerous structured training schemes in place, schemes in which one is assigned to a 'deanery' and can only be sent to hospitals within that deanery. Job security is much more, and there recently has been the advent of "run-through" training, essentially eliminating the morale destroying desperate search for a suitable and relevant job every couple of months.

Just...no. No no no. This is just plain wrong. Look at what the colleges are saying in the UK. Talk to the trainees. Your friends may well be doing well but this is absolutely not the case for most in the UK...Look at all those left in limbo at the outset of MMC...Look at RemedyUK....Look at the doctors protesting on the streets. They're not all wrong are they? Are they?

wish to maintain the clearly dysfunctional status quo at all costs,

This is getting ridonculous. How can I say it any more clearly...I don't believe the training in this country is good enough. I think it can be improved. I think I used the word "appalling" in an earlier post. Why why why are you putting words into my mouth? (i'm answering most of your questions, I can't wait to read your answer to that one)

You know, I thought of something. If NCHDs were remunerated for the time they spend working looking after private patients from the insurance company or the consultant themselves, proportionately, they could well afford their training expenses, and would save the HSE a fortune

I don't really agree with this. At all. It enshrines a two tier health service. Healthcare should be free for all at the point of care, and should be equitable. I support a system based on social insurance for all, with equal access to care...something like what Dr James Reilly has proposed. So I can't agree with that. It's an interesting point though tbf tbh.

So you read the New England regularly, are remarkably well informed as to the function of HIQA etc

yep, and I really don't think that's inconsistent with being a 2007 graduate. Surely you read the New England?

From your earlier posts I gather you have a bee in your bonnet about peoples backgounds (middle class etc). While I appreciate that getting to where you are may have been difficult, so has it been for all of us.

I don't have a bee in my bonnet about my background. I'm proud of where I come from. I do have a problem with a lot of the attitudes of entitlement and justification which largely come from the middle classes in medicine.

Also, to those going into overdraft. How??? Seriously, you must be earning at least double the average industrial wage. This is incredibly bad financial management. Get yourself an accountant or something. Living a reasonable lifestyle, even paying for a lot of courses should not put you anywhere near overdraft. I mean there's millions of people on less money managing to get by without getting into debt.

I'm repeating myself over and over guys. Just open your mind a bit:)

SleepDoc

Nchd2010 wrote: »

I don't have a bee in my bonnet about my background. I'm proud of where I come from. I do have a problem with a lot of the attitudes of entitlement and justification which largely come from the middle classes in medicine.

Also, to those going into overdraft. How??? Seriously, you must be earning at least double the average industrial wage. This is incredibly bad financial management. Get yourself an accountant or something. Living a reasonable lifestyle, even paying for a lot of courses should not put you anywhere near overdraft. I mean there's millions of people on less money managing to get by without getting into debt.

I'm repeating myself over and over guys. Just open your mind a bit:)

No bee in the bonnet eh?

"honeyed path from private school with grinds to University in Trinners or D4"

"I wasn't privately educated"

"Coming from a working class background, unlike many of my colleagues, means that I know the value of money"

"..medicine is dominated by the middle classes with an unjustified sense of entitlement"

"....there is an unjustified sense of entitlement amongst what is largely a middle class profession"

"In the real world, where many doctors from privileged middle-class backgrounds have no experience of,"

Your generalisations about the backgrounds and finances of your colleagues betrays your lack of awareness and perhaps empathy.

And again, thanks for the financial advice.

Nchd2010

Jane5 wrote: »

many of my colleagues who left for the UK do tell us of the land of milk and honey that it is.
Training is better, and there are numerous structured training schemes in place, schemes in which one is assigned to a 'deanery' and can only be sent to hospitals within that deanery. Job security is much more, and there recently has been the advent of "run-through" training, essentially eliminating the morale destroying desperate search for a suitable and relevant job every couple of months.

I just had to go back and quote this. Maybe there are some that benefitted from the reorganisation of training in the UK. But I think it was a Lord Justice Goldring or something, in a summary of a case brought before him, that described the reforms as "disastrous". I suppose you also believe the NHS bull**** about 4 hour targets?

The NHS are just like the HSE. If you believe this nonsensical propaganda that training in the UK is of a high standard then you really need to do a bit of research. Google Remedy UK and have a goosey at their website...see what our fellow NCHDs in the UK think of the system.

Nchd2010

Your generalisations about the backgrounds and finances of your colleagues betrays your lack of awareness and perhaps empathy

Lack of awareness? Just look at the figures from the ESRI or the universities...most people in courses such as medicine and law come from professional background. An overwhelming majority in fact. FACT.

I don't see how I lack empathy either, I'm more than willing to spend my own money improving the quality of care to my patients, something which seems to be anathema to, well pretty much everyone else on here. Is saving the state money not showing empathy on a kind of a grand scale?

tallaght01

Pastafarian wrote: »

congrats on escaping the ghetto by the way

Nchd2010

I wasn't going to respond to that. Says more about the poster really tbf.

tallaght01

Nchd2010 wrote: »

A dedicated doctor with two memberships and a masters, having graduated in 2007.

See, I reckon this is the problem.

If you have two memberships as a second year SHO (let alone the masters) then you clearly don't value your social life as much as the rest of us :P

And for the rest of you, get yizzer arses to Oz or NZ.

It's not all great here, but it's pretty decent. I just agreed to cover a few weekend shifts in paeds A+E, and I've gotten 2 separate emails from HR thanking me profusely. They're also giving me extra money for it, which I didn't ask for.

Avoid the UK if you can. I worked there for a long time, and it's the pits. The whole "we'll keep you in the deanery" thing is fine. But there are huge downsides working that system. Not as many as working in Ireland though :P

Pastafarian

Nchd2010 wrote: »

Let me clarify. I think provision of training is poor in this country. However I have spent about €12,000 of my own cash doing a masters, and believe its only reasonable that we make some sort of financial contribution to our training. Lets be honest, the previous system was wide open to abuse, and if we’re not blind or stupid, all of us will be aware colleague nefariously claiming money from the grant.

You know I agree with you here that the old system was open to abuse. But I think we need to redefine something here. When I give out about no training I am not merely referring to grants and course. My post is supposed to be a training post - it should involve regular hours of training worked into my rota. The consultants have it written into my contract. This NEVER happens. My mate in US residency programs during his intern year got 90 mins a day of bleepless tutoiral training using sophisticated simulators etc. The log book I've been given to track my 'training' is not in any way shape or form training - its idle busywork in which I record my service job and illegal horus (actually I make a point of putting my illegal horus into it). When they get the in hosue training that they are supposed to be providing sorted out then i'll start worrying abuot courses.

For example in the law profession, barristers spend years devilling for little or no money, often subsisting on part time jobs unrelated to their career.

Way to pick the most backward professional training system in the country, You know devilling barristers also refer to their senior's as "Master". Furthermore, since you are apparently such a working class hero - surely you realise that the main effect of devillign is to keep people from working class backgrounds out of the profession and keep it amongst the well off. Yet this is the career you are proposing as a model to aspire to ?

Many other professionals spend significant sums on higher training and extra qualifications.

Yet most get their exams fees etc reimbursed by their employer. Even solicitors now get their Blackhall fees paid by their employers for the most part.

Those companies “throwing money” at poor pastafarian (i hope it wasn’t coins, that might have hurt) were almost certainly not on the brink of bankruptcy, attempting to provide an essential service to a growing population with little or no funds and extremely high rates of inflation.

The plant was shut down a year or two later. Primarily because of staff turnover because working conditions were poor and it pushed the cost of operating up constantly having to train new people. Bascially all their competitors were offering better packages - much as how all the
HSE's competitors offer better packages one way or another. They attempted to push me into a masters to keep me on. It actualyl forced my hand to quit because no way was I getting trapped there.

Also, in the private sector, performace and outcome is monitored. I’ve worked with many doctors who are substandard in the past year. One doctor I know was working in an emergency department, and managed to fail an ACLS course, which takes a lot tbf. Such inadequacy would simply not be tolerated in the private sector.

To be honest alot of this performance and outcome stuff in the private sector is bull. My experience is that those who played the game and said the right things at the right meetings were promoted - even if they were **** at their jobs. Promotion had little to do with actual quality of work.

3. I’m well aware that call is not an extension of the day job. However it simply does not make sense to have highly skilled and educated young people sitting around watching telly in the res. My point is that we should really be agitating for a genuine 24/7 health service, with most doctors working shifts.

I actually agree with you on the shift work. But few do agree so its higily unlikely to happen. It would also require many more doctors and they are cuerrntly reducing numbers. But this is off the point. In the current system it is dangerous and immoral to work doctors like slaves for multiples of the legal workign horus limit. Full stop. Period. End of.

4. I’ve never said anything justifies working dangerous hours and I don’t agree with it. I know how easy it is to nod off driving home, or driving to the other end of the country for lectures and I’ve been scared ****less sometimes.

The overwhelming theme of your posting so far has been 'come on guys quit whining its nto that bad'. You are defending the status quo and arguing with those of us who want change. Also everytime you work illegal horus you are lending you tacit approval to that system (as do we all....but thats gonna change soon enough)

5. “Not all who work these hours are young free and single. THere are more perspectives than your own.” Everyone has a choice. Everyday we make them. There is opportunity cost with every decision we make. We can’t have everything. I’d love to be a cardiothoracic surgeon, but I’ve shifted my focus to another area of medicine because the opportunity cost was too great.

I'm sorry this is jsut facile. People who are in the same finanical position to you have wives and kids to support. Have a littl think how comfortable you would be if you were in that situation.

6. “We don't have to get used to it - not at all.” We do. Our pay will be cut further. The economy is failing. What we can do is try to make things better within the medical community. Ask your consultant for a tutorial…don’t go to the res and watch telly-teach your junior doctor something.

WE don't ahve to get used to it. THe locum business is thriving thanks to HSE mismanagemnet. I can got to australi, new zealand, america and various other places. I never EVER have had the time to go to the res and watch telly - you must have had more cushy jobs than i've had.

11. I'm not maintaining any status quo. I'm actively involved in trying to improve training and conditions, mainly at a local level. However i really believe that whinging about money and training grants when the country is bankrupt and patients are dying for the lack of appropriate investment will not help anyone.

Let me be clear here. I am not whinging about money and training gratns. I am appalled at dangerous illegal working hours and lack of on the job training that spell the death of the irish health care system which will probably implode in the near future.

Seriously guys, I am a doctor. A conscientious one. Talk to your consultants about your concerns. I'm usually on first name terms with most of the consultants I have worked for and have had rows with several with regard to training and remuneration issues. Most really want the best for their colleagues and understand the position.

I have spoken to consultants. I've foudn them to be clueless of the situation and failing to realsie things have changed since they were nchds. A point that often goes unstated - there are LESS nchd's now than there were a few years ago. Which means the ones that are there are workign harder cause the sick people sure as hell haven't gone away. I know for a fact of nchd jobs that have quitely been done away with because we are all on 6 months contracts and nobody notices. This is suspect is the real reason why the HSE won't publish numbers of NCHDS employed.

Nchd2010 wrote: »

"Only in the medical profession can you be dismissed from your job for refusing to break the law." What?

"NCHD overtime is mandatory." If you want to work within the EWTD do so. If any disciplinary action is taken, you'll have a strong case. You'll win. A colleague of mine is unilaterally doing such a thing.

You may win. But you'll also never get on that SpR scheme you were hoping for and everyone knows it.

You're right in your opinion of the HSE though. They are a right shower. But my main point is that NCHDs are relatively well remunerated.

Noone but noone is disputing that.

Nchd2010 wrote: »

I responded to many posts by giving simple anecdotes about money and stuff like that, and tried to point out that there is an unjustified sense of entitlement amongst what is largely a middle class profession. If this is something you can't follow, I genuinely fear for you.

The initial topic of the thread was a whinge about training grant reduction. Not about provision of training. Just about how it's paid for. Understand? Therefore I think it's more than reasonable to point out that we are a well off group of people, who can and should afford to make a financial contribution to training. Obviously you don't agree and think everything should be handed to us on a plate. Which is a poor attitude really. And reminds me of the privately educated tossers who used to always be campaigning for free university fees back in my undergrad days. Direct question, do you think we should make a financial contribution towards our training?

Right I've had about enough of this sancitmonious tripe out of you so to shut you up, althou its more personal informaiton that I ideally want to give away, I too am doing a masters. It will cost in or around 12k by the time I am finished. I ahve zero problem paying for that myself - in fact I'm not even asking for anything from the training grant for it. I NEVER said I wasn't prepared to pay for my own education, your presumptiousness. Now does qualify me in your eyes to have an opinion on training matters ? Where do I pick up my gold medal for self-improvement so I can be like you ? And frankly you stuff this class war sense of entitlement crap up your arse. For one thing you are too young to actually know what workign class means (and I know you won't get that but trust me those ten years older than you will know exactly what I mean). For another thing - you know NOTHING about our backgrounds or why we are doing medicine. So back off on the arrogant presumptions then about how we all must be spoilt little D4 kids.

What I do object to is my 'training post' not including any actual training and instead being a service job forcing me to work illegal hours.

Right. And you haven't done this yet? Clearly a very strong feeling then. Probably easier just to whinge about it.

Oh things are afoot you can trust me on that.

Nchd2010 wrote: »

DO NOT DO THIS.

Seriously...if they accept your resignation, then they're not firing you. Therefore there is no case. Your job is gone.

If one really wanted to sue them you could take a contructive dismissal case.

The optics are poor. If hundreds of doctors do this and become locums earning outrageous money, you can imagine what the headlines in the Hedild will be. Bargaining power for when we want stable jobs will be on the floor.

Rubbish. Bargaining power will be maximised. Free market is the way to go.

This will also likely have a negative impact on your training and career prospects.

You may be right here.

You could argue that it's unethical...when you took the job, you accepted the terms and conditions and the custom and practice. Now you would be disregarding the care of patients.

Absolutely not. In fact I think one could take a case against the hospital for forcing you to work in dagerous conditions thus putting patient care at risk. Each and every one of use is obliged to fight or leave a system that forces us to work dangerous hours. One on gives your months notice as per contract their is nothing unethical about that. THe hosptials are morally and legally in breech by not honouring contracst and EWTD.

Just get involved with the IMO. Obviously they're not perfect. But guess what...we are the IMO. Anyone who complains about the IMO is really complaining about themselves. There simply isn't a way that another grouping or union would be more successful. If there are people that are incredibly brilliant at IR, then why are you sitting on your hands now...why has it taken you so long to do anything?

Bull. I have in the past and will in the future represent my own rights far better than the imo did/will.

Nchd2010 wrote: »

Right. I'm in a bit of a rush, so I've chosen to quickly take you to task on these little points.

Do you think all training should be free, in a country that is bankrupt, with insufficient funds to provide adequate care for patients, with healthcare inflation at record highs, and with a reasonably well paid NCHD workforce?

I don't think course should be free per se. I think training jobs should involve actual training as per contract and as per consultant contract. Thats a no-brainer.

You do not become a consultant, or anything like it after 4 years in the US. You may become an attending which is a completely different post, and not as independent as an Irish consultant. After that you'll probably do at least one fellowship, and even then, getting a tenured appointment will not be easy. Have you looked at the hours of work for residents in the US? There's plenty in recent issues of the New England about it if you want to have a gander, but believe me, it's no better than here in most specialties. Their remuneration is also substantially less.

Why do you point out their remuneration is less if its not about money for you.l WE KNOW it is less yet still we woudl go. Working hours int he US are regulated which they are not here -and the us limits are being tightened over time. You can work as an attedning in the US after 3 years as a hospital internist - they are crying out for them

Easy now... I've explained before, this is standard in many other professions. And I'm more than willing to walk the walk myself, as I've described.

Except it isn't. Most employers for the likes of accontants, solicitors, actuaries etc will pay for or at least contribute to the porofessional fees and training of their staff.

I'm by no means wet behind the ears. Trust me, i've plenty of life experience.

Just
Your early twenties and have spent the last two years working illegal horus, doing a masters and two memberships. You can't have left the house for more than basic groceries.

And I know I'm a lucky man to be in the position I'm in. I'm hugely privileged.

So where is it that you go about assuming the rest of us don't know this ? Get over yourself.

Also, to those going into overdraft. How??? Seriously, you must be earning at least double the average industrial wage. This is incredibly bad financial management. Get yourself an accountant or something. Living a reasonable lifestyle, even paying for a lot of courses should not put you anywhere near overdraft. I mean there's millions of people on less money managing to get by without getting into debt.

I'm repeating myself over and over guys. Just open your mind a bit:)

You open your mind a bit. You ahve no idea what other peoples personal circumstances are. You have no idea who they support or who depends on them. Again get over yourself and stop being so presumptious.

I don't see how I lack empathy either, I'm more than willing to spend my own money improving the quality of care to my patients, something which seems to be anathema to, well pretty much everyone else on here. Is saving the state money not showing empathy on a kind of a grand scale?

You seem to lack understanding of anyone who doens't see things your way. And I have to pull you up on this: what was your masters in that improved the quality of care to your patients ? Was improving care you only reason to do it ? It was entirely selfless was it ? It wasn't anything to do with getting on an SpR scheme by any chance now was it ? Empathy has nothing to do with money.

Nchd2010 wrote: »

I wasn't going to respond to that. Says more about the poster really tbf.

Well to be honest your constant denigrating of all of your colleagues on the basis of their class background say alot more about you my friend. Its a poor debating tactic to rely on background or authorithy instead of just logic to try and win your points. You don't know our backgrounds or reasons for doing medicine - stop making presumptions.

Finally, its irrelevant to the issue of unsafe workign hours and lack of proper structed training. I object to that because its a disservice to my patients. I believe my patients are entilted to be treated by a well rested and properly trained doctor and I will do what I need to do to achieve that. How dare you presume I'm raising these issues out of my own sense of entitlement. How dare you presume you are the only one prepared to spend money on a masters. And how dare you presume that your background and your qualificatinos gives you some sort of moral authority over the rest of us.

Nchd2010

Ok Pasatafarian, there's really a lot of agreement here

We both agree that training is inadequate, I even said in my first post that it was "appalling"

Most employers for the likes of accontants, solicitors, actuaries etc will pay for or at least contribute to the porofessional fees and training of their staff.

The HSE are contributing. Admittedly, it is a bit insulting that they don't pay the full fees for mandatory courses, but you referred to companies throwing money at you for training and then closing the plant. What happens if the HSE just decides to close down cos they've spent all their money training doctors?

My experience is that those who played the game and said the right things at the right meetings were promoted - even if they were **** at their jobs. Promotion had little to do with actual quality of work.

Yep, but at least part of your experience is in a plant that closed down. Successful companies do actually monitor outcome and performance. That's why they don't close down.

'come on guys quit whining its nto that bad'...arguing with those of us who want change

My point is that the change some seem to desire is fantastical. And really not going to happen while the country teeters on the verge of bankruptcy.

People who are in the same finanical position to you have wives and kids to support. Have a littl think how comfortable you would be if you were in that situation
Its a poor debating tactic to rely on background or authorithy instead of just logic to try and win your points

I don't think I'd have too much trouble supporting a wife and kids tbf. I know some people came from one parent families on a non-contributory widows pension, and managed to survive. It really is much harder than surviving on a doctor's salary.
I am relying on logic. But the facts are, most in medicine come from a middle class professional background and are unable to comprehend what it would be like to survive on a hell of a lot less money than they're on now. Hence they agitate for even more money!

Was improving care you only reason to do it ? It was entirely selfless was it ? It wasn't anything to do with getting on an SpR scheme by any chance now was it ?

I'm not going to say what my masters was in on a public message board. It was a clinical topic. The answers to your questions are yes, yes and no. ( But seeing as you have got the mad idea that I'm either a consultant or locum consultant, sure I wouldn't need an SpR scheme anyway!) Although, I'm just not planning on doing SpR training.

There are NCHD jobs that have been done away with, largely because the geniuses in the HSE think that a new consultant post should cause the sacrifice of two NCHD posts.

Why do you point out their remuneration is less if its not about money for you

Because it's swings and roundabouts. If you are going into overdraft on an Irish salary, then you're probably going to be completely goosed if you work in the china plates.

I'll finish this in a while.

Pastafarian

Nchd2010 wrote: »

Ok Pasatafarian, there's really a lot of agreement here

We both agree that training is inadequate, I even said in my first post that it was "appalling"

True. I do agree with some of your points.

The HSE are contributing. Admittedly, it is a bit insulting that they don't pay the full fees for mandatory courses, but you referred to companies throwing money at you for training and then closing the plant. What happens if the HSE just decides to close down cos they've spent all their money training doctors?


Yep, but at least part of your experience is in a plant that closed down. Successful companies do actually monitor outcome and performance. That's why they don't close down.

The plant closed. THe company goes from sterngth to strength. I'm not naming the company. Its a hugely successful company. The point was that they did not give their employees motivation to stay in that particular plant and staff turnover killed the place. THe HSE is in the same state currently - driving doctors (and nurses for that matter) away with thier appalling policies. Next stage is collapse.

My point is that the change some seem to desire is fantastical. And really not going to happen while the country teeters on the verge of bankruptcy.

Its not fantastical. It easy to improve without costing money. The HSe and the consutlants are blocking progress (ok I've been told by a consultant that they are against implementation of EWTD. Alledgely this is why where I work regs work the entire weekend - consultants demand it).

I am relying on logic. But the facts are, most in medicine come from a middle class professional background and are unable to comprehend what it would be like to survive on a hell of a lot less money than they're on now. Hence they agitate for even more money!

Again classism. Also who is agitating for more money ? This is a straw man argument. We are saying we will accept less money for working less hours and having proper training. Neigh I demand less hours and as a result less money as do many others. Will you get this straight please. NO ONE IS ARUGING FOR MORE MONEY.

There are NCHD jobs that have been done away with, largely because the geniuses in the HSE think that a new consultant post should cause the sacrifice of two NCHD posts.

lol I know. to be honest I'm waiting for the day when the consulatants are admitting their own endoscopy patients

Because it's swings and roundabouts. If you are going into overdraft on an Irish salary, then you're probably going to be completely goosed if you work in the china plates.

china plates ?!?!?
Yet many are quite happy to work in foreign places. How are you NOT getting this ? WE ARE NOT LOOKING FOR MORE MONEY. WE ARE HAPPY TO TAKE LESS MONEY FOR LESS HOURS AND BETTER TRAINING.

Honestly how many times do I need to say it ?

Nchd2010

"I have in the past and will in the future represent my own rights far better than the imo did/will."

. Indeed. And you're clearly doing a wonderful job of it. :rolleyes:

If you're not whinging about money or training grants, then that's great. It just seems like you were. There really is more common ground than I thought.

In terms of industrial action and resignation and that, from my somewhat limited legal experience, I'm pretty sure constructive dismissal wouldn't have a chance...there's implied acceptance of terms by custom and practice, and you've seen how the LRC has treated NCHDs.

Also optics are critically important. Do I really need to explain this? I will if you ask me to.

Working hours int he US are regulated which they are not here -and the us limits are being tightened over time. You can work as an attedning in the US after 3 years as a hospital internist - they are crying out for them

If you go through a few issues of the New England over the past year or two, the first few articles, kind of editorials, are constantly harping on about the negative impact on training that restricting working hours has had. Several colleagues in the states are also working way in excess of even the hours worked in Ireland. An attending internist in the china plates isn't really analogous to a consultant here. At all. It'd be closer to a associate specialist or terminal non-consultant career position, but even then, the analogy doesn't really fit. There's not really a comparison to be made tbh. It's just different.

Consultants may not be in favour of the EWTD, probably with good reason. As I've mentioned before, just look at what the royal colleges in the UK are saying. If you don't know, then I'll just say, to put it very mildly, they're not exactly effusively praising the concept.

consulatants are admitting their own endoscopy patients

Admitting elective endoscopy patients is really a bit wasteful. The sensible consultants I worked for advocated something along the lines of "are you still well?"...Admit per OPD letter. 2 minutes work!

Pastafarian

Nchd2010 wrote: »

. Indeed. And you're clearly doing a wonderful job of it. :rolleyes:

Again mind your assumptions. For obvious reasons I'm not going into details on such things.

If you're not whinging about money or training grants, then that's great. It just seems like you were. There really is more common ground than I thought.

I said about 6 times as did others that I would accept less pay for less hours and better training.

Also optics are critically important. Do I really need to explain this? I will if you ask me to.

Yes you do. I have no idea what you mean by this. As far as I'm concerned optics are things you poor drinks through or shine light through.

Nchd2010

My assumptions are based on your whining about not being trained, your consultants not doing their job and you working illegal hours, and being almost destitute. Is there something I'm missing in your marvellous and righteous defence and advocacy for your work and training conditions?

I was using the vernacular to say doctors whining will look bad. It will. Ask a random sample of say 100 people if they think doctors are well paid. If the pr battle is lost then your more than halfway to losing the war. Look at what harney did to the pharmacists. And the GPs for that matter. We can't even get the lrc to support some of our demands!

Pastafarian

Nchd2010 wrote: »

My assumptions are based on your whining about not being trained, your consultants not doing their job and you working illegal hours, and being almost destitute. Is there something I'm missing in your marvellous and righteous defence and advocacy for your work and training conditions?

I never said anything about being destitute. I said I would take a pay cut. Read the thread for god sake. I am not being trained and I am being forced to work illegally. I am doing something about it including reaching out to colleagues on this thread.
Reporting u for trolling also.

I was using the vernacular to say doctors whining will look bad. It will. Ask a random sample of say 100 people if they think doctors are well paid. If the pr battle is lost then your more than halfway to losing the war. Look at what harney did to the pharmacists. And the GPs for that matter. We can't even get the lrc to support some of our demands!

You are the one doing the pr damage trolling your own colleagues on a public website. You are a disgrace

drkpower

Nchd2010 wrote: »

I was using the vernacular to say doctors whining will look bad. It will. Ask a random sample of say 100 people if they think doctors are well paid. If the pr battle is lost then your more than halfway to losing the war. Look at what harney did to the pharmacists. And the GPs for that matter. We can't even get the lrc to support some of our demands!

Control the agenda. The agenda is dangerous working hours. The agenda is poorly trained doctors. The solution is more training; the solution is less working hours.

In 2000, NCHDs were then relatively well paid. Joe Public saw them as part of the elite. There was almost unanimous support from Joe Public for NCHDs. Ask yourself why.

dissed doc

Nchd2010 wrote: »

Ask a random sample of say 100 people if they think doctors are well paid. If the pr battle is lost then your more than halfway to losing the war. Look at what harney did to the pharmacists. And the GPs for that matter. We can't even get the lrc to support some of our demands!

I haven't really joined in with a lot of this, but I think your point on PR is not true. PR doesn't mean squat. The public do not vote on salaries. The bank and financial sectors ahve the worst PR on the planet yet they still get the bonuses and bailouts and (regarding some friends of mine working in the troubled banks) waiting for severance package lump sums.

So, PR is nonsense. It was relevant when hospitals respected professionalism in doctors, when a doctors residence was on site or nearby and the doctor could focus on actual medicine and not if they were ever going to get paid or attend state mandated training out of their own pocket.

Ignore PR and ignore public goodwill, and focus on what is necessary. Playing the passive oh-poor-me never got anyone anywhere, and in Ireland, the paymasters will more likely pay lip service to what a great job you do before giving you another levy and a paycut, while complaining what a bunch of self-righteous yobs you all are.

Ireland is not a country where the mass solves problems. It just whines about it when they are there and expects someone else to fix it. When the local hospital in e.g., Tralee shuts, people will whine, but they won't exactly go out work harder to raise more local money and pay staff to keep it open. It's not in the culture.

Leave! I have! I get to keep more than half my income - something that wasn't true in Ireland for the last year or so!

Nchd2010

I'm not going to respond to pastafarian at the mo cos he thinks I'm a liar, a hse plant and a consultant. I am tempted to point out a glaring inconsistency though.

To disseddoc. You make a good point. But we can't control the agenda and focus solely on working hours and training. The IMO can't go out and say that we're willing to take a paycut because, in fairness there are doctors out there who have overstretched themselves financially, and probably genuinely couldn't afford it. I really don't think enough doctors are genuinely prepared to take a 30-40% cut.

If we can't go out and take a (nother) cut, then we won't get the public on our side and we won't be strong enough to sustain a strike. And we really won't be able to control the agenda against the HSE's formidable pr machine.

SleepDoc

Nchd2010 wrote: »

I'm not going to respond to pastafarian at the mo cos he thinks I'm a liar, a hse plant and a consultant. I am tempted to point out a glaring inconsistency though.

To disseddoc. You make a good point. But we can't control the agenda and focus solely on working hours and training. The IMO can't go out and say that we're willing to take a paycut because, in fairness there are doctors out there who have overstretched themselves financially, and probably genuinely couldn't afford it. I really don't think enough doctors are genuinely prepared to take a 30-40% cut.

If we can't go out and take a (nother) cut, then we won't get the public on our side and we won't be strong enough to sustain a strike. And we really won't be able to control the agenda against the HSE's formidable pr machine.

The purpose of a strike is not to garner public sympathy. If there was an all out strike, it would last for about 5 minutes before being resolved in our favour. Public opinion (and yours!) go hang.

Jane5

Nchd2010 wrote: »

I'm not going to respond to pastafarian at the mo cos he thinks I'm a liar, a hse plant and a consultant. I am tempted to point out a glaring inconsistency though.

To disseddoc. You make a good point. But we can't control the agenda and focus solely on working hours and training. The IMO can't go out and say that we're willing to take a paycut because, in fairness there are doctors out there who have overstretched themselves financially, and probably genuinely couldn't afford it. I really don't think enough doctors are genuinely prepared to take a 30-40% cut.

If we can't go out and take a (nother) cut, then we won't get the public on our side and we won't be strong enough to sustain a strike. And we really won't be able to control the agenda against the HSE's formidable pr machine.

Everytime I think you've stopped surprising me you come back with something better.

Why do you think if we take another cut and outright impoverish NCHDs, that the public will suddenly be on our side? You think they give a crap what we get paid, as long as we do our job and keep them alive? They couldn't care less if we get a euro an hour. And if someone in my family were in hospital, I'd be the same. Not exactly the public's priority.

Why have you picked 30 to 40% as a cut that we should take in order to achieve this?

Why should we take any more cuts at all? We have taken much more than the average public servant when you factor everything into account.

I propose absolutely no change in basic salary. No change in hourly rate. Massive decrease in hours worked. 50 hours a week absolute maximum, and no shifts longer than 12 hours, ever.

This would decrease the overtime bill hugely. And allow for more docs to be taken on. But I cannot and will not take a cut in basic wage. I could not afford then to pay rent in the city I do my job in, and it would no longer be worth my while to work.

Nchd2010

I picked that figure as a guesstimate of how much most would be taking in overtime. I think it's probably reasonable across all specialties. Therefore bringing pay back to the basic rate. Which really doesn't impoverish nchds tbf.

But I really don't think there'd be support for this amongst the general nchd population. As you can see, some are already living beyond their means and going into overdraft even with overtime taken into account.

Whilst I agree your analysis seems sensible, it probably wouldn't facilitate the hiring of enough nchds to staff your new rotas, particularly when prsi paye etc are taken into account. The likely outcome would be th closure of smaller hospitals and the amalgamation into larger units of the aforementioned closed hospitals. There really isn't the desire out there for closure of inefficient hospitals as you can see by the situation in the west and even in Cork. Furthermore there just isn't the money in the public purse to fund the capital required to amalgamate and upgrade hospitals.

Like some nchds and many others, the government has been profligate in the past few years and the country, as I've stated is on the brink of default on sovereign debt and the appalling vista taut accompanies this.

You're right. This would be ideal, but we live in the real world, not the ideal world. Just like mmc in the uk whilst proclaimed as a panacea for medical training, has disenfranchised many many trainees and resulted in disastrous consequences, low morale, unemployed doctors, and anger on the streets from the grassroots.

Am i really being outlandish or can you actually see the sense and merit in my reasoned arguments?

dissed doc

Nchd2010 wrote: »

I picked that figure as a guesstimate of how much most would be taking in overtime. I think it's probably reasonable across all specialties. Therefore bringing pay back to the basic rate. Which really doesn't impoverish nchds tbf.

But I really don't think there'd be support for this amongst the general nchd population. As you can see, some are already living beyond their means and going into overdraft even with overtime taken into account.

Whilst I agree your analysis seems sensible, it probably wouldn't facilitate the hiring of enough nchds to staff your new rotas, particularly when prsi paye etc are taken into account. The likely outcome would be th closure of smaller hospitals and the amalgamation into larger units of the aforementioned closed hospitals. There really isn't the desire out there for closure of inefficient hospitals as you can see by the situation in the west and even in Cork. Furthermore there just isn't the money in the public purse to fund the capital required to amalgamate and upgrade hospitals.

Like some nchds and many others, the government has been profligate in the past few years and the country, as I've stated is on the brink of default on sovereign debt and the appalling vista taut accompanies this.

You're right. This would be ideal, but we live in the real world, not the ideal world. Just like mmc in the uk whilst proclaimed as a panacea for medical training, has disenfranchised many many trainees and resulted in disastrous consequences, low morale, unemployed doctors, and anger on the streets from the grassroots.

Am i really being outlandish or can you actually see the sense and merit in my reasoned arguments?

All well and good but

1. There are not enough doctors to staff the service based on EWTD maximum hours or anything near it. We have a very low number of doctors per capita compared to OECD averages, and it was down again this year.

2. The HSE/Dept. Health is agreeable to continue to pay 100+hr overtime salaries (which are illegal - except for doctors of course!) because the fines for breaching workers rights with regard to doctors are affordable and secondly, if they had to restric hours, they would either have to **** hospitals, go off call for most of them or else start bringing in locums. It's cheaper to pay the EWTD fines, pay overtime than staff hospitals with standard OECD levels of medical staff.

Recession or not, if people - "the public" want an adequate health service then now is the time to demand proper staffing, etc., . Unfortunately, ignorance is bliss and the consequences of bad health policy is seen in many countries already - not central EU or UK, but elsewhere, which is where we are going.

drkpower

Nchd2010 wrote: »

To disseddoc. You make a good point. But we can't control the agenda and focus solely on working hours and training. The IMO can't go out and say that we're willing to take a paycut because, in fairness there are doctors out there who have overstretched themselves financially, and probably genuinely couldn't afford it. I really don't think enough doctors are genuinely prepared to take a 30-40% cut.

Not sure if this is to me or disseddoc; either way, you are wrong. People said the same sh!te in 2000; they were wrong then and you are wrong now.

The only pay cut NCHDs need to offer is one based on reduction of hours. We all know no significant pay cut (30-40%) will happen imminently as no significant reduction in hours will happen. The spin is that NCHDs are willling to take the pain by taking a significant pay cut in return for a reduction in illegal working hours (quote the 60% pay cut that some 1in3 Surgical Reg in Bantry will take, if his hours are reduced to 39/week).

Then argue that the HSE have to be contractually dissuaded from making NCHDs work illegal hours by paying illegal hours with puntitive rates (double time for first 10 illegal hours worked, triple for second 10 illegal hours etc...). This is what I argued for in 2000 (and sadly, my colleagues and the IMO didnt put their heart into fighting for). If something along these lines can be negotiated, then the HSE really will have an incentive to reduce hours.

Two key points:

1. Even if succesful, very few NCHDs will take any significant reduction in salary, at least in the short term; in the long term, NCHDs are moving to shift work anyway so a full-scale re-negotiation will have to happen then anyway.

2. Its not that difficult to control the agenda; we did it in 2000 and fundamentally, little has changed. This is the agenda - very simple:
- We are willing to take the pain and a pay cut if the HSE stop making us work illlegal hours;
- The mean HSE are making us work illegal hours; this is bad for you and for us.
- we need to stop the HSE from doing this - they cannot be trusted - they are breaking agreements; they are breaking the law - the only thing they will understand is money - therefore we need to make it financially unatttractive to make us work these hours - we hope never to see the triple time that working 65/75/85 hours/week will bring us.
- if they stop us working these illegal hours, the exchequer saves money, money it badly needs.

Nchd2010

Even if succesful, very few NCHDs will take any significant reduction in salary,

Have you a different definition of successful or am I missing something? Surely the point of being successful is to reduce working hours and thus payment. Do you mean that success would be a binding commitment from the HSE, with enforceable sanctions leading to the scenario of improved working hours?

DoctorEmigrant

Nchd2010 wrote: »

You do not become a consultant, or anything like it after 4 years in the US. You may become an attending which is a completely different post, and not as independent as an Irish consultant. After that you'll probably do at least one fellowship, and even then, getting a tenured appointment will not be easy. Have you looked at the hours of work for residents in the US? There's plenty in recent issues of the New England about it if you want to have a gander, but believe me, it's no better than here in most specialties. Their remuneration is also substantially less.

I've been following this thread with interest for a few days, and I've been alternately impressed and disturbed by people's views on working conditions in Ireland. I hesitate to wade into this debate at this late stage, but I feel there has been some gross misstatement of fact on the part of at least one poster (and possibly not just one, I'm an equal opportunity disagree-r).

I graduated in Ireland within the last 3 years and worked in a major Dublin teaching hospital as an NCHD. At the time, working conditions were fair at best and I would say well reimbursed, although hours were long and at times dangerous to patient care. As a surgery intern I regularly worked in excess of 100 hours per week (this was the norm) and a times over 120 hours (not a rare occurrence either). At the time, training grants were in place as they had been for the previous 10 years, although my time as an intern was filled with rumblings of changes to come within the next 6 months.

I emigrated to the US just as the most significant upheaval between the IMO and HSE was occurring. Obviously, my experience of medical standards, training, patient care and work hours as they stand now in Ireland is non-existent and I will not make comment on such things.

What I CAN comment on, however, is the differences between working conditions as they stood 2 years ago in Ireland, and my experience in the US as a resident in a training program.

I am currently a second year resident in a large university teaching hospital in Massachusetts. My hospital has a bed capacity not dissimilar to the 3 biggest Dublin hospitals. It also has approximately 30 separate residency and fellowship training programs. We are also a major teaching hospital for a large medical school, and have medical students attached to all services year round.

I can speak at length about my reasons for coming to the US to train, but I'm sure that no-one wants to hear that and it would not be particularly germane to the conversation.

What I can tell you is that in my time here (14 months) I have breached ACGME (Accreditation Council for Graduate Medical Education) mandated work hour rules twice. Twice. In 14 months.

The ACGME has an approx. 40 page handbook regarding work hour rules that all residency programs must be compliant with. This does not mean should, or ought to be compliant with. Must means that if your program has a record of being non-compliant with work hour rules, the program accreditation will be suspended for a minimum of 1 year and the program will not be allowed to participate in the residency match process.

Chief amongst the work hour rules is the 80 hour rule. A resident cannot work more than 320 hours in a 4 week cycle, so no more than an average of 80 hours per week. This is across all residents, in all programs, on all rotations. I have rotated through surgical rotations and ICU rotations where I have consistently not broken this rule. I broke it once on an inpatient rotation during an exceedingly busy month where I worked 85 hours in 1 week. In return, I got a day off on the following (lighter) month. This was not to "delete" the infraction. It will still appear on work hour records that the ACGME review yearly, and will count towards my program's infraction rate. The day off was an apology from my program for having put me in that position.

Other rules include the 24+6, 10 hour break and 1 day off in 7. 24+6 means that on-call I can only directly manage patients for 24 hours. Starting at 7 am, I will see patients, admit them, manage them and perform procedures. When I hit 24 hours in the hospital (7am the next day), I am no longer allowed touch a patient, or even take a history. A further 6 hours may be spent doing paperwork, finishing admit notes, etc.
Every time I leave the hospital, I should not come back for at least 10 hours. I MUST not come back to work in less than 8 hours. On nights where I have stayed late for whatever reason (i.e. to 10-12pm) I have had attendings instruct me not to return until after 8am at the earliest.
Lastly on every rotation, I must have 1 full day off in every 7 days.

These are the big rules, there are many more subtler ones, but this gives you a big picture of working conditions. My program, and every other program in my hospital is rigorous about meeting these. I have also discussed these rules with med students who rotate through 4 other teaching hospitals affiliated with their med school, and with residents at those hospitals. Their adherence to work hour rules is no less rigorous than ours, and the hospital I work at is by no means an enlightened oasis amongst a desert of torturous workplaces. We are the rule, not the exception.

So, if American training is so light on hours compared to Ireland, it must suffer in terms of education, right?

Every day I am in the hospital, there is a minimum of 1 hour of dedicated training. This is the absolute minimum. On an inpatient rotation, there is a resident-led, attending facilitated EBM conference every morning for an hour. There is a lunchtime didactic teaching schedule with subspecialist lectures every day. There are frequent (once a week) optional late afternoon conferences in a grand rounds format. There is small group teaching of one hour per day with an attending every day. These conferences are almost always protected teaching time (i.e. no pages). For at least 2 hours every day you may (and are expected to) sign out your pager to an attending while attending these meetings.

Also, once a week, every week, we attend mandatory simulation center teaching, where we manage an acutely ill mannequin patient (think megacode from your ACLS) to brush up on our ACLS/ATLS/PALS skills. These are absolutely mandatory and again pagers are signed out to an attending.

So clearly, if I'm getting all this training, I must be paying for it, right? Certainly it seems to be a misconception with some posters here that to be invested in our training, we must invest financially in our training.

Every piece of teaching I get is paid for. Everytime I want to renew ACLS/PALS/ATLS, etc. it is paid for. Even if it hasn't expired, or even if I just feel like I need a refresher, it's paid for. No receipts, no reimbursement, no out of pocket expense. I get an educational stipend (for books,etc.) of about $500 per year. I have free electronic and hardcopy access to the largest medical library and largest collection of medical journals on the eastern seaboard. Any journal article they don't carry will be sourced for me, free of charge, up to 30 articles a year (in reality I have yet to use this as their subscribed database is vast). I carry a faculty appointment at the medical school affiliated with our hospital (as does every resident) and so am treated as an employee of that medical school, with such perks as free gym use, subsidised daycare, etc.

My program pays for my membership dues for the American Medical Association, Massachusetts Medical Society and the American College of Physicians (among others). I receive two paper journals in the mail biweekly (including the NEJM) courtesy of my program. Again, this is not the exception, far from it.

I took a significant paycut to come here, on the order of 50% of my after-tax pay compared to my last year in Ireland. My cost of living is about a third of what it is in Dublin, and this really isn't an issue. Even had I chosen a more expensive city (e.g. New York), I would still probably do ok on my current wages. Frankly, the paycut was beyond worth it for the change in work conditions.

I apologise for being exceedingly long-winded, but frankly I think an abundance of fact was necessary to clear up the blatant exaggerations being put forth by some posters. The vast majority of Massachusetts (and US) teaching hospitals provide the same level of training to their residents even in the midst of the deepest recession since the 20's (remember, the current economic climate is not just limited to Ireland). A hiring freeze is in effect at my hospital, and budget cuts have been made in a variety of areas. The education budget remains untouched. In the words of the chief operating officer for our hospital board: "Any hospital that is willing to endanger patient safety by cutting funding for physician and nurse training, without first investigating every other possibility for financial restraint, is no longer deserving of the title 'teaching hospital'"

dissed doc

What sort of insanity is this?

A training job with training money and courses? Access to online resources? Prioritising medical care over managerial security?

You could pay NCHDs a salary of zero and it would save 315 million of the health budget. That is it. That is all the NCHDs cost (~4500 x €70,000). Throw in taxes that take back around 40% of that net of levies and taxes, the entire cost of NCHDs to the state every year is €189 million.

Taking a 25% paycut? That will save the state the grand total of just over €47 million a year. Thank god! We are saved!! The recession is over and it WAS ALL THE DOCTORS FAULT. All the country needed was that €47 million.


.....bailing out the banks......€50,000 million

.....paying social welfare costs.....€20,000 million

.....net saving of a 25% paycut for all junior doctors.....€47 million

.....diverting attention to the doctors to avoid scrutiny of the state finances......priceless

The HSE does not want a large group of doctors to ever form as it would lead to difficulties for the HSE. Throw a smaller group enough overtime cash to keep them sweetish and they won't complain.

sam34

OK folks, i appreciate it is a topic close to everyone's heart and tempers run high...

...but please, no more personal comments/accusations/snide remarks, on either side.

resus

The following was posted on another thread (which was closed by moderators and poster referred here.) There is one particular point that I wanted to expand on, see my comment at the end.

"patient/doctor care worries
I am new to posting so please bear that in mind, thanks.

I have a family member who is an intern since July 1st and I have been told the following:

a. There is a shortage of NCHD's in Irish hospitals with Intern and SHO jobs not filled and nobody to replace them.

b. Patients are confused and upset by the change of teams.

c. Hours worked by Interns and SHO's are dangerously long (for the patients and doctors health) with shifts upto 26 hours and weeks up to 60+ hours.

d. Interns are left as the only doctor "on the wards" overnight from their first week. They don't even know their way around.

e. During up to 26 hour shifts no time is guaranteed for a meal break, often they just do not get fed.

f. "On call" is a euphemism for even harder work with less backup.

g. If two patients get very ill at the same time "on call" 1 of them might die.

h. Threats are made not to pay overtime.

i. The majority of the Interns who finished here in June have left the country because of their treatment by the HSE.

j. Points are up for medicine, I know this one is true I just wonder why?

Ok, so this may be exaggeration, the intern has no clue I am posting this, but they are forgiven if it is because of the long hard slog they put in to get here.

The intern is not complaining, say they are competent in fact.

I am worried about the patients of course. I am also worried about the intern as I already see a "pinched look" about what was a very fit, bright eyed and bushy tailed young doctor.

Anyone who knows the inside track from the teaching hospitals care to comment?

Also do they need to get insurance or does the hospital cover that?

Thanks if you read to the end.

J McDrmd"


All of the above is NO exaggeration and yes, Many interns are simply leaving the country. THIS WORRIES ME TOO. How can we influence our "powers that be" that treating their employees like modern day slaves, resulting in them LEAVING IRELAND, ( regardless of whether or not you agree with their reasons for leaving) is endangering patient care?