Working in private healthcare v public (HSE)

Sunsh!ne

I'm looking for peoples opinions/experiences/advise on working in the private healthcare system compared to public. I presently work in the public health system in a temporary capacity. The opportunity may arise in the near future to leave the position I'm in for a similar, more stable one in a private setting. I, like most others, would have trained and carried out work placement only in public hospitals and so I wouldn't have much experience with the private sector.

I suppose I'm looking for advice/opinions from people who have worked in both sectors. Is there much difference, is the private sector all about money and not the patient? Was there much difference in working conditions? Was having worked in the private sector looked on favourably or poorly if you tried to return to a position in the HSE?

Not sure what my issue with working in the private health sector is, growing up, I would never had health insurance and so private hospitals etc seemed like another world. I feel like I'm jumping ship so to speak by considering a job with one of them!

tallaght01

I would share your concerns regarding the inequity of the private sector, and I wouldn't work in it. BUT....I've been a patient in the private sector, and the care I received was excellent.

I think you will have more time to look after patients better in the private sector. It's just a case of which patients you'll be looking after.

papajimsmooth

Does working in the private sector slow down your training and career progression?

Vorsprung

papajimsmooth wrote: »

Does working in the private sector slow down your training and career progression?

There's very few training jobs in the private sector. Only private hospital that I'm aware of that has a training job is a surgical SHO job in the Bons on Dublin's northside.

That said, in my experience public sector NCHDs have helped out in the colocated private hospital. They are not paid to do it, the public sector isn't compensated for it either, but a blind eye is turned toward it as the trainee benefits in terms of training, and gets more experience doing the elective cases (hernias etc) which the private sector thrives on.

JuliusCaesar

Sunsh!ne wrote: »

I'm looking for peoples opinions/experiences/advise on working in the private healthcare system compared to public.

Hi Sunshine, I know where you're coming from! I did all my education and training in the UK and had -and still have -a strong committment to excellent health care for all, regardless of income. BUT the system is as it is in Ireland. A close relative died on a waiting list for public health; I had immediate care as a private patient and glad I am that I had it. Patients sometimes ask me a) do I work privately (Yes); b) if so can they be seen faster (Mostly, not always); c) is private care better (Hits the roof)

Unfortunately, quicker is often better.

All I can say is, I hate the system I work in; I hate the Minister's Boston,not Berlin policies; I'd rather have an NHS type system here. But I do have private health insurance. Ethically, professionals cannot support a 2 tier system - and we should be making this clear at the highest level.In the meantime, we have careers, families and our own wellbeing to think about.

opinion guy

JuliusCaesar wrote: »

A close relative died on a waiting list for public health;

Did the family sue the HSE then for failing to provide care ?
I hope so. This is the only way the HSE will take its duty seriously - if it becomes less expensive to treat people than not to treat them

maninasia

JuliusCaesar wrote: »

Hi Sunshine, I know where you're coming from! I did all my education and training in the UK and had -and still have -a strong committment to excellent health care for all, regardless of income. BUT the system is as it is in Ireland. A close relative died on a waiting list for public health; I had immediate care as a private patient and glad I am that I had it. Patients sometimes ask me a) do I work privately (Yes); b) if so can they be seen faster (Mostly, not always); c) is private care better (Hits the roof)

Unfortunately, quicker is often better.

All I can say is, I hate the system I work in; I hate the Minister's Boston,not Berlin policies; I'd rather have an NHS type system here. But I do have private health insurance. Ethically, professionals cannot support a 2 tier system - and we should be making this clear at the highest level.In the meantime, we have careers, families and our own wellbeing to think about.

There is a third way, a universal national health system that is billed equally no matter if the hospital is public or private, it is used very successfully in some Asian countries. It gives choice to the patient and creates positive competition between hospitals.

Private hospitals can provide faster and more efficient treatment in many cases not being weighed down by unions, so many public service rules and pensions etc. They help to clear the backlog in the system and push public hospitals to perform. They give medical personnel a chance to work outside the public one size fits all regime and they provide valuable employment.

Of course they often don't pay aswell as public hospitals but that is one of the reasons they are more efficient, for both patient and the taxpayer. Look at the state of the public system in Ireland..it wastes vast amounts of money for a very poor return and is failing patients with long waiting lists and reduced facilities. This is what happens from a lack of competition (the private market as it stands does not create competition for patients, just another tier as you rightly said). The private people are insulated in their part, and the public people are insulated in theirs.

AmcD

maninasia wrote: »

Private hospitals can provide faster and more efficient treatment in many cases not being weighed down by unions, so many public service rules and pensions etc. They help to clear the backlog in the system and push public hospitals to perform. They give medical personnel a chance to work outside the public one size fits all regime and they provide valuable employment.

No the unions aren't the main problem in the public hospitals, it is the sick elderly patients. Of course private hospitals can be efficient because they don't have emergency departments. Therefore they don't have to deal with poor patients with complex medical and social problems.
Instead they can have a huge turnover of private patients who are usually in for straightforward things like varicose vein surgery or coronary angiograms.
Of course there is a role or place for private hospitals, but it is more for the "worried well" who are looking for quick access to care.

maninasia

That's the way it works NOW.

But if patients billable hours were all paid through a universal national health system it would not matter which hospital (public/private) the patient went to and it would encourage investors to build and operate private hospitals (as long as the billable amount was set where they could clear a profit). The patient is the customer and he is entitled to shop around. If he's not happy with a doctor/consultant in one hospital he goes to another for a second opinion, within a few days. If he has no confidence in the surgical team of one hospital he can easily choose another, so on and so forth.

Many private hospitals in Asia operate under this model (they have the normal functions of a regular public hospital in Ireland and also have training programs. NOT what you just talked about), they are slightly cheaper than public hospitals and less crowded, as some patients still prefer to go to the overcrowded but larger and more famous hospitals. They also operate A&R etc.

Each hospital (public/private) also has extra services such as single rooms, elective surgery, health screening etc. that can be billed under private means.

This mix of public and private hospitals brings down waiting lists, gives employment, makes public spending more efficient, creates competition between hospitals to get more recognition and provide better services and gives choice to the patient. Your very unreasonable dislike of the private sector and lack of understanding how it works in other countries (like many people in public services in Ireland) is actually causing many serious problems for patients. In the model here, 'sick elderly patients' will be welcomed as much as any other patient, it is all billable to the universal health system after all and no patients can be turned away unreasonably.

tallaght01

A natoinal health insurance system is all very well, like they have in Holland. But it's not the right system for Ireland right now.

It requires a high level of entrepreneurship, and capital outlay, which is htink on the ground in ireland these days.

it requires extra contributions by employers, when many are trying to cut their bills to stay in business.

Or else it requires a pre-existing network of high quality hospitals, which is not what we have in Ireland.

Also it requires government legislation to make the private providers run non profit services that they don't want to, as AMcD pointed out. The only way the Dutch managed to get around this was to redistribute soe of the profits from the more profitable hospitals to the less profitable ones, which woldn't survive one day at the FF tent in the Galway races

It's a good strategy. One I'm a big fan of. But can't see it working in a recessionary economy, known for susceptibility to lobbyists.

AmcD

maninasia wrote: »

Your very unreasonable dislike of the private sector and lack of understanding how it works in other countries (like many people in public services in Ireland) is actually causing many serious problems for patients. In the model here, 'sick elderly patients' will be welcomed as much as any other patient, it is all billable to the universal health system after all and no patients can be turned away unreasonably.

What gave you the impression I have a very unreasonable dislike of the private sector? I work as a GP and therefore I work in the private sector. This also happens to be the the most efficient part of the Irish health service, which looks after 90%+ of daily patient health contacts.

I did not make any pronouncements about how the private sector works in other countries because I have not worked in the private healthcare sector in any other countries. I can discuss private healthcare in Ireland because I am very familiar with it.

I would much prefer if there was universal health insurance and no two tier system. At present, general practice in Ireland is the closest thing we have to a "one tier" system. For example, emergency appointments are given for sick babies, regardless of whether they have medical cards or not. There is generally same-day access for both private and medical card patients. It would certainly make my life easier if I didn't have to charge private patients for consultations. Unfortunately I don't think we have the resources to pay for this yet.

My problem with private hospitals is that it is difficult to mix business with healthcare. There is no profit to be made (in Ireland anyway) in sick, poor, elderly people with complex medical needs. Therefore these people will not have access to private hospitals. Their needs for healthcare will be greater and more expensive. The public hospitals look after this. As I have said before, I would prefer if patients had equal access to healthcare based on need, rather than ability to pay. I don't think any country has found the perfect solution to this yet.

AmcD

Apologies to the OP by the way- Sunsh!ine was only looking for peoples' experience of working in public vs private and whether this was detrimental to a future career.

RobFowl

Like AMcD I'm a GP and although an independent contractor I hope quite a number of state contracts. GP in Ireland is probably the best model of how private and public can work together with bot treated relatively equally (at primary care level).

The issue with private hospital is that there is a perception they "cherry pick" the more profitable and straight forward cases. There are honourable exceptions and the AE style units at the Beacon/Hermitage as well as the chest pain clinic at the Mater private are to my mind examples of how urgent care should be provided.

Careers in public health care can be very satisfying in that nothing is turned away and the ability to pay do not influence the procedures and treatments available.

maninasia has a point re the bureaucracy and resistance to change in the public system though, (although I wouldn't blame unions entirely for this. They do provide valuable protection for many workers and fight for their working conditions etc. This is not necessarily a bad thing..).
Working in the private system tends to mean you deal with less acute conditions and more elective (planned in advance) care.

Personally I do feel GP with all the frustrations you encounter there strikes a good balance (when its done well) in the Irish system.

I would favour a one tier system more like the Dutch system than the NHS. Can't see it happening any time soon though

Sunsh!ne

Thanks for all the replies, seem to have inadvertently started a interesting debate. Unfortunately they don't really answer my OP in relation to working conditions etc in private healthcare. I agree with many of the points raised about private hospitals but I don't see anything changing in the near future. Which brings me back to my original query, am I better working in the public system or private?