Ireland on the brink...how can health professionals help???

Nchd2010

Seeing as the government has essentially nationalised the states second largest bank, and the health service is one of the largest areas of expenditure, just wondering if any health professionals out there have any ideas on how we, as professionals with ethical commitments can help our country. I have a few suggestions:

1 Stop paying radiographers more than doctors just to take pictures. In fairness, there's a bit of skill involved in ultrasonography, but really, charging €200 plus standard overtime for an on call CT seems a bit much

2 Stop wasting money on unnecessary tests. Not everyone with chest pain and elevated FDP needs a CTPA. Not everyone with chest pain needs a chest x ray.
LFTs, U/E, FBC most likely do not need to be repeated on a daily basis.

3 Prescribe generically

4 IV meds are far more expensive in most cases. Use po paracetamol and ppi's, there's literature to support this.

5 Stop using colloid. Unless absolutely necessary. It's expensive, causes allergic responses, and not supported by a sufficient body of evidence.

6 Be nice to your fellow professionals. It'll improve morale.

chanste

I have to applaud the patriotism here! And it must be said we would be generally better off to adopt this mentality in every other industry too!

We live in a great country (political views aside) lets do our bit.

Being a med student I can't do any of the things on your list though

bleg

We can extract a 50c levy on behalf of the state for every prescription item that cancer sufferers, homeless people and other people with a medical card.

Nchd2010

Tbf, I really don't think cynicism serves any purpose. Tbf, the availability of drugs like temsirolimus, sumatinib, sunitinib etc, and even bevacizumab in metastatic cancer really is astounding in a small country. Even if it is strictly regulated by ICORG. NICE guidelines don't really support these advances so in fairness, a €0.50 levy seems somewhat reasonable.

Though there has to be a better way than targetting the old and the sick.

Traumadoc

NICE guidelines do not support stress tests :rolleyes:

Nchd2010

Really? Did NOT know that. Tbf i've always wondered about stress tests really. Either patient is low risk and doesn't require investigation, or they're high risk and require either invasive or non-invasive imaging.

Have you any idea what kind of literature backs this up? (the NICE guideline, not my surmising)

bleg

Chemotherapy is provided for the most part under the High Tech scheme. It's the additional meds that cancer sufferers will now have to pay for.

Traumadoc

Nchd2010 wrote: »

Really? Did NOT know that. Tbf i've always wondered about stress tests really. Either patient is low risk and doesn't require investigation, or they're high risk and require either invasive or non-invasive imaging.

Have you any idea what kind of literature backs this up? (the NICE guideline, not my surmising)

I think everyone low or high risk requires investiogation


http://www.nice.org.uk/nicemedia/live/12947/47938/47938.pdf

do not give oxygen either.

ThatDrGuy

Me remembers the handing over of a list of over 200 methods of saving money for a certain hospital last year to management by the NCHDs. It was tossed in the bin. You might prescribe generically all you want, doesnt mean the chemist will dispense it. Radiographers have a union, you dont - no one will touch them. Cost of CTPA around 300 euro. Cost of missing a PE, several hundred thousand euro and your career. Most of our fellow "professionals" are heavily unionised lazy ass drones who we subsidise mightily by working obscene amounts of overtime (largely for free these days). Moral is low because things are $hit and getting worse by the day. Massive amounts of the 700 million in cuts will be levied on doc's because we are the weakest link. Get out while you can.

Chuchoter

bleg wrote: »

We can extract a 50c levy on behalf of the state for every prescription item that cancer sufferers, homeless people and other people with a medical card.

To be honest thats a bit silly. 50c is nothing. You can't even get coffee for that.

RobFowl

crayolastereo wrote: »

To be honest thats a bit silly. 50c is nothing. You can't even get coffee for that.

It's 50c now but already nutterings that it'll increase in the next budget.

opinion guy

To be honest I don't think this 50c thing is so bad. IT has a max of 10euro per month per family and people are getting drugs worth hundreds at a max of 120eur per month

bleg

opinion guy wrote: »

To be honest I don't think this 50c thing is so bad. IT has a max of 10euro per month per family and people are getting drugs worth hundreds at a max of 120eur per month

You don't have a clue.

opinion guy

bleg wrote: »

You don't have a clue.

Thank you for that intelligent contribution. Care to comment on what I actually said instead of attacking me ?

anotherlostie

I believe that the real savings from the GMS tax will come about in relation to a reduced drug spend rather than the money the tax collects (are pharmacists getting anything extra for the extra admin/ hassle on this by the way?)

When an elderly relation of mine died, we found a mountain of unopened medication in his house - doctor wrote script and he got everything, regardless of whether or not he needed it (inhalers and eye drops being classic examples of where a monthly repeat is not necessarily needed). If people have to pay something, it might make them more judicious in asking for what they need rather than getting their entitlement, and there's potential for huge saving here.

Of course the flip side is that people might not take their medicine, but the two people I know who have argued this with me both have money to go out boozing at the weekend, every weekend, so two drinks less and there's your €10. Unfortunately our extremely generous benefits system is going to have to be cut back and yes it's tough but what about the people just above the threshold who pay €120 a month when it used to be €42 less than 10yrs ago.

opinion guy

anotherlostie wrote: »

When an elderly relation of mine died, we found a mountain of unopened medication in his house - doctor wrote script and he got everything, regardless of whether or not he needed it (inhalers and eye drops being classic examples of where a monthly repeat is not necessarily needed). If people have to pay something, it might make them more judicious in asking for what they need rather than getting their entitlement, and there's potential for huge saving here.

In fairness thou - this is an argument for centralized computerized prescribing, no? How does one doctor know what the other has prescribed otherwise?

Of course the flip side is that people might not take their medicine, but the two people I know who have argued this with me both have money to go out boozing at the weekend, every weekend, so two drinks less and there's your €10. Unfortunately our extremely generous benefits system is going to have to be cut back and yes it's tough but what about the people just above the threshold who pay €120 a month when it used to be €42 less than 10yrs ago.

Fair point

Kurtosis

The 50c levy tries to address over-prescribing/dispensing by making patients decide what medicines to get based on their financial means. How our Minister for Health thought this would be the most effective measure, I do not know...it's just another instance of lazy decision making.

People who have the money will have no problem paying and will continue to get all their medicines dispensed. Those who do not have the money will probably choose to get the medicines they perceive to have the largest effect (symptomatic relief) and may neglect some important prophylactic medicines, leading to increased long term complications with their condition.

For people who have a stockpile of medicines, this levy may prevent further items being dispensed, but does not address the issue of why they have an excess of certain medicines. Are they not taking them at all? Are they not taking the prescribed dosage? Is the medicine being over-prescribed? Covering up these issues is not going to result in improved clinical outcomes for any patients.

A more effective solution (though obviously more complex) should involve the patient and healthcare professionals involved in their care regularly discussing and reviewing the patient's therapy in a structured manner.

bleg

We just asked people in the pharmacy if they wanted everything as they handed in/ordered their scripts.

The 50c levy may not even cover the costs of its administration and wastes pharmacists time when health policy is to free up their time to make them more available for other tasks.

There is no cap at 10 euro a month. If you go over, you still pay. You can then have to fill out a form and send it off (another 50c) to the Primary Care Reimbursement Service. The head of the PCRS has said that his organisation will not reimburse anybody less than 5 euro.

The Dept for Health and Children recently commissioned an independent report to look at primary care funding.
http://www.dohc.ie/publications/resource_allocation_financing_health_sector.html

The authors of this report stated:

“In the view of the group, the recently introduced capped co-payment for prescriptions for medical card holders is unlikely to meet the criterion of raising enough revenue to justify the administration costs,” the report said.

“Evidence suggests that any deterrent effects will be to reduce the use of both necessary and less necessary drugs, with possible harmful effects on health.”

http://www.irishtimes.com/newspaper/ireland/2010/0710/1224274419367.html?via=rel


Lets recap: with the imposition of the 50c charge Mary Harney is ignoring the advice of GPs, pharmacists, patients and also the expert group that she charged with investigating resource funding in Irish Healthcare. Her move also flies in the face of international best practice.

People will probably stop taking their statins and BP meds as they have no directly observable effect. Pretty shocking in a country like Ireland with a high incidence of cardiovascular disease.

It makes no sense.
None at all.

Nonoperational

Bleg I completely disagree with you.

anotherlostie

opinion guy wrote: »

In fairness thou - this is an argument for centralized computerized prescribing, no? How does one doctor know what the other has prescribed otherwise?

It was a one horse village, so it would have been the same GP month after month, giving the same script (and probably a three month one). Maybe if people start telling their GP's that they don't need 'that one', compliance issues might become more readily addressed than they clearly were at the time my relative was taking his medication as there were 'ongoing' tablets among the stock pile.



I can't believe the €10 cap is not there from the start - it's not like there wasn't time to plan for this! Though I don't think there are two many families with more than 20 items per month though when I was in the business I never worked in an area with a very high GMS base. But I'm still curious as to what, if any, additional payment the pharmacist is getting for this, and Bleg didn't address that in his/her detailed response. And who knows, maybe a few benevolent pharmacists will waive the fees for their regular patients who may be in desperate straits, though the guys in the Pharmaceutical Society ivory towers would probably deem this unethical!

bleg

No, pharmacists get no additional payment for doing this and yes some will pay the fee for people in dire straits i.e. out of their own turnover.

opinion guy

bleg wrote: »

There is no cap at 10 euro a month. If you go over, you still pay. You can then have to fill out a form and send it off (another 50c) to the Primary Care Reimbursement Service. The head of the PCRS has said that his organisation will not reimburse anybody less than 5 euro.

Sorry I dunno I just heard Harney on the radio saying there was a 10 euro a month limit. Was she skirting over the fine details ??

bleg

opinion guy wrote: »

Sorry I dunno I just heard Harney on the radio saying there was a 10 euro a month limit. Was she skirting over the fine details ??

She was. The technical nature of the PCRS payments mean that you have to go into the finer detail. Journalists generally tend not to go into detail about these details as it's pretty boring stuff.

JuliusCaesar

ThatDrGuy wrote: »

Me remembers the handing over of a list of over 200 methods of saving money for a certain hospital last year to management by the NCHDs. It was tossed in the bin. You might prescribe generically all you want, doesnt mean the chemist will dispense it. Radiographers have a union, you dont - no one will touch them. Cost of CTPA around 300 euro. Cost of missing a PE, several hundred thousand euro and your career. Most of our fellow "professionals" are heavily unionised lazy ass drones who we subsidise mightily by working obscene amounts of overtime (largely for free these days). Moral is low because things are $hit and getting worse by the day. Massive amounts of the 700 million in cuts will be levied on doc's because we are the weakest link. Get out while you can.

You do realise that your non-medical colleagues read this forum too? And are thinking 'typical arrogant medic'? I'm glad I don't work with you.

knipex

JuliusCaesar wrote: »

You do realise that your non-medical colleagues read this forum too? And are thinking 'typical arrogant medic'? I'm glad I don't work with you.

Doesn't change the fact that in general terms he is correct.

NCHD's are an easy target and tend to get screwed when other sectors get protected.

Hospital cleaners on 30 to 35K plus overtime and allowances.
Electricians going to strike because other staff were allowed to change light bulbs or because they were no longer going to be paid a call-out fee to press a button on an alarm panel.
Nurses striking for a 35 hour week and a 10% pay increase (a staff nurse starts on €30,234 rising automatically to €43,800 plus allowances and overtime).
Porters on 35K plus that can never be found.
16% plus absenteeism in some hospitals.

In general terms its hard to dispute the evidence.

SleepDoc

JuliusCaesar wrote: »

You do realise that your non-medical colleagues read this forum too? And are thinking 'typical arrogant medic'? I'm glad I don't work with you.

So what? He/she may not win an award for diplomacy but their comments were pretty spot on.

beagle001

Get rid of all the contract agencies operating in the hospitals and re hire the contractors on a part time basis.
If thats not legal then advertise the jobs

tallaght01

JuliusCaesar wrote: »

You do realise that your non-medical colleagues read this forum too? And are thinking 'typical arrogant medic'?

Which is just as much of a generalisation as anything said by the doc above.

Nchd2010

I deliberately didn't mention porters in the opening post, because it really is too obvious a target for cost savings. Before I go on, I will say that I have often worked with some really nice guys, with a genuine dedication to the job and a desire to work for patients...

But on the other hand, some porters are earning easily €70-80k a year, for a non-skilled, manual job. A lot of people find this difficult to believe. The chicanery of some calling in sick, so that someone else gets to work overtime etc really is galling.

As I said, a lot of non-medical friends are incredulous at the amount of money porters are on, but I always point out that the other non-skilled workers in hospitals, the cleaners, are privatised, are almost exclusively non-Irish and are probably saving a fortune for the hospitals.

opinion guy

Nchd2010 wrote: »

€70-80k

What@?@?@?@?@:eek::eek:

Nchd2010

Yeah and to make it even better, it's essentially a public sector job, almost impossible to get sacked, with a defined benefits pension and a militant union. And if you're in with the boss, it's fairly easy to get jobs for the rest of your family. Obviously that's before the hiring freeze.

JuliusCaesar

knipex wrote: »

Hospital cleaners on 30 to 35K plus overtime and allowances.

In what hospitals? Where I work they are all contract cleaners - certainly not on any huge wage.

knipex wrote: »

Electricians going to strike because other staff were allowed to change light bulbs or because they were no longer going to be paid a call-out fee to press a button on an alarm panel.

True, although I suspect the media reports didn't reflect exactly what was going on.

knipex wrote: »

Nurses striking for a 35 hour week and a 10% pay increase (a staff nurse starts on €30,234 rising automatically to €43,800 plus allowances and overtime).

This is wrong? What do you think nurses should be paid? Could that 43K be after 15 years service? Is that too much?
They should work more hours? A 35 hour week is normal.

knipex wrote: »

Porters on 35K plus that can never be found.
16% plus absenteeism in some hospitals.

Can't comment on the porters; again, where I work the porters are great.

Absenteeism? Yes I've had a hard time explaining to my GP why I need a sick cert for 10 days when in fact I've been ill for 3. The way the HSE counts sick days is CRAZY and guaranteed to give them a lousy sickness rate.

tallaght01 wrote: »

Which is just as much of a generalisation as anything said by the doc above.

........which was the point :rolleyes:

SleepDoc

JuliusCaesar wrote: »

A 35 hour week is normal

Ha!

knipex

JuliusCaesar wrote: »

In what hospitals? Where I work they are all contract cleaners - certainly not on any huge wage.

The vast majority of Hospitals retain a certain amount of in house staff. it varies from hospital to hospital but in the majority yes. Their title also varies from hospital to hospital but in some they are called ward attendants and split into two groups food and cleaning.

Base salary is 30 to 35K depending on hours etc. Overtime and weekend \ night allowances apply.

Contract cleaners earn a union rate of a little over €9 per hour.

JuliusCaesar wrote: »

True, although I suspect the media reports didn't reflect exactly what was going on.

Oh I agree and there are many many other stories that the media never hear about.

JuliusCaesar wrote: »

This is wrong? What do you think nurses should be paid? Could that 43K be after 15 years service? Is that too much?
They should work more hours? A 35 hour week is normal.

13 years actually of guaranteed increments. Pay increases associated with time served, not work ethic, not ability, not effort but time served........ How can anyone justify that ?

I know many many many people working in jobs equally as hard on far less than 43K after 20+ years. And don't forget that allowances and overtime are on top of that......

One other thing that confuses me. Nurses claim to be salaried but then are entitled to overtime ? I have never seen that elsewhere. A Salary is a Salary and you work what ever it takes to get the job done...

As for a 35 hour week being normal ? Normal where ? I don't know a single person who works a 35 hour week. 39 hours is probably normal but a large percentage of people work far more with no overtime.

JuliusCaesar wrote: »

Can't comment on the porters; again, where I work the porters are great.

I will have to take your word for that. Are they underpaid as well ??

JuliusCaesar wrote: »

Absenteeism? Yes I've had a hard time explaining to my GP why I need a sick cert for 10 days when in fact I've been ill for 3. The way the HSE counts sick days is CRAZY and guaranteed to give them a lousy sickness rate.

Its not that unusual actually. How absenteeism is measured is very different to how sick days are measured.

Pete4779

SleepDoc wrote: »

Ha!

You realise the 35hrs is shift work right, it's not a 9-5 morkeshing suite in baggot street job. 35hrs is also average, excluding week of continuous night shift, then early or late shifts, MOnday to Sunday. Let's see you do 5 nights in a row including througha weekend from 8pm to 8am before making a judgement call eh, mate?

SleepDoc

Pete4779 wrote: »

You realise the 35hrs is shift work right, it's not a 9-5 morkeshing suite in baggot street job. 35hrs is also average, excluding week of continuous night shift, then early or late shifts, MOnday to Sunday. Let's see you do 5 nights in a row including througha weekend from 8pm to 8am before making a judgement call eh, mate?

I'm not your mate.

Lets see you do four on call shifts in eight days (88 hours in total) plus 2 "normal" days (16 hours).

I am eminently qualified to laugh at the notion of 35 hours being a normal week in the health service.

opinion guy

Pete4779 wrote: »

morkeshing

Guh ???

JuliusCaesar

I'm a psychologist; but I take my breaks with physios, SALTs, nurses, and various ancilliary staff.

I don't complain about my pay (which is fine) or my hours (9-5). However, my colleagues are paid less and the nurses do unsocial hours. The nurses now work 35 hours, but their breaks are no longer paid for, so they are at work the same length of time. Recently a consultant deigned to sit with us, and complained about their pay cut. It was hard to sympathise as we've all lost the same percentage.

It seems to me that your gripes would be less if you had an effective union. Or do you also deny the right of workers to organise?


PS As for the subject of this thread, I have heard stories of admin staff - by which I mean managers - going off to conferences abroad and within Ireland which can only be called junkets. Subject of conference has nothing to do with their job, although it does have to do with health. Where are the investigative journalists?
In the meantime, no paid CPD for me!

Nchd2010

Recently a consultant deigned to sit with us, and complained about their pay cut

Not trying to be controversial here (honestly), but in fairness, whilst consultants in Ireland are indeed well paid, we do have a very high standard of consultant in Ireland, at least in the university teaching hospitals. Most Irish consultants will have published extensively in peer-reviewed, high impact journals and will have travelled extensively in order to further their knowledge.

Back to topic though, does anybody agree with any of the suggestions I made? Has anyone any other ideas that may help? Surely there's some thought and innovation out there...somewhere?

bleg

Nchd2010 wrote: »

Back to topic though, does anybody agree with any of the suggestions I made? Has anyone any other ideas that may help? Surely there's some thought and innovation out there...somewhere?

This was posted on another forum I post on:

For a while we were doing Health screening but had to stop for economic reasons. We had ten, all day health screenings and the following are the results.

Number of people screened.....................214.

Number with raised Cholesterol...............104.

Number with raised BP........................... 65.

Number with raised Blood
Glucose. (non -diabetic)......................... 24.

Number referred to GP............................143.

None of the people screened were on any previous medication. We put a notice in the window prior to each health screening day and asked people to call in and book a time. There was no charge to any person. The figures are very impressive. A nurse did each of the tests.

Using a quick calculation and based on 4 full days health screening in each pharmacy in the country per year; the above service could be set up for about €2.4 million per year.

The benefits to the people are obvious.
Pharmacists get to use our consultation areas.
Drug companies increase sales from new prescribing.
The Govt. benefits by reduced hospital visits.
The population gets healthier.

This could even be a joint funded public/private partnership between the HSE and IPHA.

bleg

I would be in favour of removing the GMS code for Glucosamine, Evening Primrose Oil, Omega 3 fish oils etc... A month's supply of Naudicelle (evening primrose oil) is fairly steep and the benefits of it are not well established.


The Hardship scheme also needs to be seriously looked at. People shouldn't get multi vitamins like Centrum on this scheme and it should be limited to essential medicinal items that patients need.

kelle

Nchd2010 wrote: »

1 Stop paying radiographers more than doctors just to take pictures. In fairness, there's a bit of skill involved in ultrasonography, but really, charging €200 plus standard overtime for an on call CT seems a bit much

We don't just point and shoot to "take pictures". We have standard positioning techniques we learn over a 4-year course and we are liable if we don't position a patient properly and a condition or fracture is not demonstrated. Some areas are very difficult to radiograph, such as C6 - T1 on an RTA if the patient has big shoulders. And you are required to get perfect radiographs on small children, despite the fact they are natural wrigglers and toddlers are SO strong! And all this while trying to keep radiation doses to a minimum.

Do we earn more than doctors? Link?

Can I find out where I would earn €200 for doing a CT? I don't earn anywhere near that for doing a CT on-call.

Nchd2010

we are liable if we don't position a patient properly and a condition or fracture is not demonstrated. Some areas are very difficult to radiograph, such as C6 - T1 on an RTA if the patient has big shoulders

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Not true... If there are any consequences, the doctor, as clinician is responsible for ensuring that an adequate radiograph is performed.

Do we earn more than doctors? Link?

I certainly hope not. Though I'd imagine that on an hourly basis at a junior level there probably isn't a huge amount of difference.

Can I find out where I would earn €200 for doing a CT?

Yep. pm me, I'll let you know.

drkpower

Nchd2010 wrote: »

Not true... If there are any consequences, the doctor, as clinician is responsible for ensuring that an adequate radiograph is performed..

That's not correct actually. The radiographer wil be solely liable if the xray was negligently performed and the doctor, when reviewing it, could not be expected to have realised it was performed negligently.

Of course, if they work in a public hospital, neither will be liable as the State will be.

maninasia

Nchd2010 wrote: »

Not trying to be controversial here (honestly), but in fairness, whilst consultants in Ireland are indeed well paid, we do have a very high standard of consultant in Ireland, at least in the university teaching hospitals. Most Irish consultants will have published extensively in peer-reviewed, high impact journals and will have travelled extensively in order to further their knowledge.

Back to topic though, does anybody agree with any of the suggestions I made? Has anyone any other ideas that may help? Surely there's some thought and innovation out there...somewhere?

No use if they are unavailable or too few though is it? Their knowledge will not be APPLIED. The best thing they could do is take a significant pay cut or to be contractually bound to public clinic only (this would immediately increase their productivity!).

kelle

Nchd2010 wrote: »

Not true... If there are any consequences, the doctor, as clinician is responsible for ensuring that an adequate radiograph is performed.

Before we had CT, we were crucified if we couldn't demonstrate this region! Believe me, lots of tears were shed trying...

Nchd2010 wrote: »

I certainly hope not. Though I'd imagine that on an hourly basis at a junior level there probably isn't a huge amount of difference.

You said it yourself in your OP!

Stop paying radiographers more than doctors just to take pictures

Nchd2010 wrote: »

Yep. pm me, I'll let you know.

Ple-e-e-e-e-ease!!!!!!!:D

drkpower wrote: »

That's not correct actually. The radiographer wil be solely liable if the xray was negligently performed and the doctor, when reviewing it, could not be expected to have realised it was performed negligently.

Thank you, Drk!

Fado Fado

maninasia wrote: »

No use if they are unavailable or too few though is it? Their knowledge will not be APPLIED. The best thing they could do is take a significant pay cut or to be contractually bound to public clinic only (this would immediately increase their productivity!).

I have no problems with contracts that ensure consultants work their contracted hours in a public hospital. I think it's a bit much, however, telling them what they can't do outside of those hours. After studying and working toward that position for well over a decade, surely they can be allowed to earn what they want on their own time, as long as it doesn't infringe on their public hospital duties?

Fado Fado

kelle wrote: »

Do we earn more than doctors? Link?

Yes they do, actually. As the DOHC salary scale shows, a radiographer in his or her first year out of college earns €36,186 for a week's work, while an intern - with far greater responsibility, it can surely be argued - will earn €33,619.

Now, I'm not bashing on radiographers - although I do think the on call fees they are payed for CT and MRI scans is ludicrous. For doing, for example, a non-contrast CT brain, which takes about 2 minutes (certainly no more than 5) between 12pm on a Saturday and 9am on a Sunday, the CT Radiographer gets paid €119.23 - per scan. The doctor who reports the scan certainly doesn't get paid that fee. And you could easily do ten such scans during the Saturday/Sunday on call.

It would be far far cheaper to pay a CT radiographer a sessional rate to stay in house and do the scans. But this won't happen in the forseeable future, of course, because the radiographers are represented by that roadblock in the way of an efficient health service - SIPTU. This is the same union that organised an electrician strike in St. James's Hospital because management had the audacity to suggest that a job ensuring some other such exorbitant callout fee could be managed by a lesser paid worker.

Nchd2010

At the risk of going off topic, I genuinely can't think of any instance where a doctor reading a radiograph could reasonably claim that in the event of the radiograph being inadequate, he would not know it was inadequate. Can drkpower suggest an instance? just out of curiosity.

Traumadoc

Fado Fado wrote: »

I have no problems with contracts that ensure consultants work their contracted hours in a public hospital. I think it's a bit much, however, telling them what they can't do outside of those hours. After studying and working toward that position for well over a decade, surely they can be allowed to earn what they want on their own time, as long as it doesn't infringe on their public hospital duties?

Or could we be paid for the extra hours we do outside our contracted hours?

maninasia

Traumadoc wrote: »

Or could we be paid for the extra hours we do outside our contracted hours?

Having a private clinic aswell as public will lead to a conflict of interest especially when the public system is overstretched (due to many reasons but not least the high paid few in number consultants). Why should they be the best paid in Europe but allowed to hold down another job. There's no way in hell they can fully devote themselves to both jobs. Why is there such a long waiting list in the public system? Costs are important, top salaries should be cut as these guys earn plenty already from both jobs.