Ban on overtime for cuh's junior doctors

j.mcdrmd

This is interesting, I wonder what the consultants will say?

http://www.eveningecho.ie/2012/08/07/ban-on-overtime-for-cuhs-junior-doctors/

Longer waiting times, backlogs in the health system and cancellations of operations have been predicted due to a ban on overtime now in place for junior doctors in Cork’s main hospital.

Non-consultant hospital doctors (NCHDs) — also called junior doctors — have been written to by management at CUH.

In an email, seen by the Evening Echo, doctors have been told they must not work over the contracted 39-hours-a-week due to a ban on overtime that is in force from today.

The latest figures compiled by the HSE show junior doctors work more than 60 hours in an average week — and sometimes clock over 100 hours — while they are also unable to avail of adequate breaks.

The ban on overtime for nurses and doctors is in place for the rest of the year. All staff were told in an email that CUH is €10 million over budget for the end of July 2012 and that the Minister for Health, Dr James Reilly, will not be introducing a supplementary budget.

As a result, management was “under direct instruction from the HSE area manager to substantially reduce the CUH deficit in the remaining five months of 2012”.

Deputy Billy Kelleher, Fianna Fáil’s spokesman for health, said the cuts would inevitably impact on patient care.

He said: “Junior doctors along with nurses are the workhorses of the health sector — clearly any reduction in their hours will hit front-line services. The Minister has failed in his task to get the budget under control and to find the savings he had promised. We are now living with the ramifications of that.”
In the email, seen by the Evening Echo, it was stated that due to the ban on overtime all junior doctors must work 39 hours a week and partake in the rostered on-call system only, and are “required to go home post call”.

The hospital was “not in a position to pay for any additional hours beyond basic salary and rostered on call”.

“Management fully realises that these arrangements will require changes in how the services and NCHDs are organised in order to meet service requirements.

“In the interests of patient care it is advised that each NCHD discuss the new arrangements with their individual consultants,” the email said.

Biologic

j.mcdrmd wrote: »

“In the interests of patient care it is advised that each NCHD discuss the new arrangements with their individual consultants,” the email said.

That last line is sickening. It basically translates as "We've come up with a plan to maintain patient care. The plan is: you come up with the plan".

ThatDrGuy

The consultants will do what they generally do - side with the HSE against their staff and proceed merrily along pretending there
is no change. HSE will pretend CUH is independent and they have no control. CUH will say its up to the individiual and their consultant
to change their working practices. IMO will make vague noises but not do anything. NCHDS will be profoundly fūcked over. As usual.

his_dudeness

On the same day the Irish Times publish accounts of 4 junior docs around the country getting shafted......

Here's the article.l

j.mcdrmd

Where is the Irish Medical Council?

http://www.medicalcouncil.ie/About-Us/

"The Medical Council regulates medical doctors in the Republic of Ireland. The Council's purpose is to protect the public by promoting and better ensuring high standards of professional conduct and professional education, training and competence among doctors."

"It is charged with promoting good medical practice."

It is all about the protection of patients.

Are patients best interests served by being treated by doctors who are:-
working illegal hours?
being bullied?
whose contracts are not being honoured?

The Irish Medical Council must know that illegal practices are rife in Irish hospitals and they need to deal with the situation, in the patient interest.

MrCreosote

j.mcdrmd wrote: »

This is interesting, I wonder what the consultants will say?

The consultants will say nothing as usual.

What will be unspoken will be- "Just do the hours you normally do, not my problem if you're no longer getting paid for them. Think about the reference you'll need at the end of the year. Now, if you'll excuse me, I'm off to do a private clinic. See you on Friday."

j.mcdrmd

MrCreosote wrote: »

The consultants will say nothing as usual.

What will be unspoken will be- "Just do the hours you normally do, not my problem if you're no longer getting paid for them. Think about the reference you'll need at the end of the year. Now, if you'll excuse me, I'm off to do a private clinic. See you on Friday."

Maybe the powers that be are trying to make the consultants take responsibility for their team, and I am not too sure that would not be a bad thing.

Maybe the consultants will now be tasked with preparing rosters within the contracted hours for their staff, they will not be able to run off to private, and leave the trainees to look after the public side of things. Perhaps they will have to make sure that people have proper training and pay. It is a bit like what a senior manager is responsible for in most other careers really.

ThatDrGuy

j.mcdrmd wrote: »

Maybe the powers that be are trying to make the consultants take responsibility for their team, and I am not too sure that would not be a bad thing.

Maybe the consultants will now be tasked with preparing rosters within the contracted hours for their staff, they will not be able to run off to private, and leave the trainees to look after the public side of things. Perhaps they will have to make sure that people have proper training and pay. It is a bit like what a senior manager is responsible for in most other careers really.

RobFowl

j.mcdrmd wrote: »

Maybe the powers that be are trying to make the consultants take responsibility for their team, and I am not too sure that would not be a bad thing.

Maybe the consultants will now be tasked with preparing rosters within the contracted hours for their staff, they will not be able to run off to private, and leave the trainees to look after the public side of things. Perhaps they will have to make sure that people have proper training and pay. It is a bit like what a senior manager is responsible for in most other careers really.

I sense the power is strong in this one......

Traumadoc

ThatDrGuy wrote: »

The consultants will do what they generally do - side with the HSE against their staff and proceed merrily along pretending there
is no change. HSE will pretend CUH is independent and they have no control. CUH will say its up to the individiual and their consultant
to change their working practices. IMO will make vague noises but not do anything. NCHDS will be profoundly fūcked over. As usual.

Would you expect NCHDs also to stand up for consultants because their contract is not being honored?

ThatDrGuy

I can hand on heart honestly say I have never obstructed ICHA negotiations, never secretely undermined any consultant strategy, never sabotaged any consultant industrial action, never blackmailed any consultant, never forced any consultant to do anything outside of his range of expertise, never forced one to work while sick, never refused to sign a consultants time sheet, never forced cancellation of a consultants holidays at the last minute , never undermined a consultants training, never bullied a consultant and never forced one to emigrate.

Traumadoc

ThatDrGuy wrote: »

I can hand on heart honestly say I have never obstructed ICHA negotiations, never secretely undermined any consultant strategy, never sabotaged any consultant industrial action, never blackmailed any consultant, never forced any consultant to do anything outside of his range of expertise, never forced one to work while sick, never refused to sign a consultants time sheet, never forced cancellation of a consultants holidays at the last minute , never undermined a consultants training, never bullied a consultant and never forced one to emigrate.

I presume you feel the converse is the case , I most certainly have not done any of those things but I have called HR to give out about the non provision of locums, or the non-payment of unrostered hours. I have serious issue with having to sign overtime forms as I find it degrading both for me and the NCHDs

I do not believe that consultants will fight for NCHDs current contract - the consultants have enough trouble fighting the introduction of the new consultant grade ( ie the one the HSE want you to occupy).

If you want to see how to take an action , may I suggest you leave the IMO. When this happened last, it was like a kick up the a*** for them. things got done pretty quick.
Perhaps you should ask why IMO fees for NCHDs are more than consultant fees for the IHCA?

opinion guy

Traumadoc wrote: »

I presume you feel the converse is the case , I most certainly have not done any of those things but I have called HR to give out about the non provision of locums, or the non-payment of unrostered hours. I have serious issue with having to sign overtime forms as I find it degrading both for me and the NCHDs

I do not believe that consultants will fight for NCHDs current contract - the consultants have enough trouble fighting the introduction of the new consultant grade ( ie the one the HSE want you to occupy).

If you want to see how to take an action , may I suggest you leave the IMO. When this happened last, it was like a kick up the a*** for them. things got done pretty quick.
Perhaps you should ask why IMO fees for NCHDs are more than consultant fees for the IHCA?

Out of curiousity - do you discuss these issues with fellow consultants ?
Do they share your views ?(well we all know some do some don't - but just wondering what your take on consultants opinions are)

Traumadoc

opinion guy wrote: »

Out of curiousity - do you discuss these issues with fellow consultants ?
Do they share your views ?(well we all know some do some don't - but just wondering what your take on consultants opinions are)

Just like some NCHDs do not believe in industrial action ( splitters) to be honest most consultants are concerned that there are pay cuts on the way . The consultant talks on at the moment also will have a hugh bearing on the future of NCHDs after all many of you will be consultants in the next few years ( if there are jobs )

If you want to know what consultants feel about NCHD issues , ask yourself what do you feel about the GP trainee reg loss of allowances ( assuming you are not a GP trainee). You like me are probably against it, but thats as far as it goes.

opinion guy

Traumadoc wrote: »

Just like some NCHDs do not believe in industrial action ( splitters) to be honest most consultants are concerned that there are pay cuts on the way .

Splitters ?!? Scrap that this whole sentence doesn't compute to me

The consultant talks on at the moment also will have a hugh bearing on the future of NCHDs after all many of you will be consultants in the next few years ( if there are jobs )

At the rate nchd's are leaving I very much doubt it does matter as much as you think it does.

If you want to know what consultants feel about NCHD issues , ask yourself what do you feel about the GP trainee reg loss of allowances ( assuming you are not a GP trainee). You like me are probably against it, but thats as far as it goes.

I have asked consultants myself. And got some scary ass opinions in return but I won't share them here.

The reason I asked you this question - was not to canvas you about consultants actual opinion - but to guage if consultants actually discuss these issues amongst themselves. Its seems from your response that no they don't - they are much more interested in their own interests. Which is largely conforming to stereotypes. What annoys me about this - it isn't about you, and it isn't about the nchd's. YOU should concern with the working conditions of nchd's because it directly affects the care received by YOUR patients. Mistakes are made because docs are too tired, over worked and over trained (by the way - EXTREMELY brave of those nchd's in the Irish Times article to give voice to this - they should be commended).

Does that not concern you? Surely it is the responsibility of consultants to tackle this ? I mean, if the weight of responsiblity does not bother you. surely you being the one who would be dragged up in court should the worst happen, surely that should grab the attention of consultants ? Or are you all to preoccupied with contracts to let such trivialities take up your time ?

I can never get my head around it - how can consultants stand over the abysmal working conditions that puts staff and patients alike in danger ? You are uniquely placed to effect change. You are morally obliged to effect change. Are you really all so jaded by the time you get your consultant post that you truly don't care anymore ?

Traumadoc

opinion guy wrote: »

Splitters ?!? Scrap that this whole sentence doesn't compute to me


At the rate nchd's are leaving I very much doubt it does matter as much as you think it does.



I have asked consultants myself. And got some scary ass opinions in return but I won't share them here.

The reason I asked you this question - was not to canvas you about consultants actual opinion - but to guage if consultants actually discuss these issues amongst themselves. Its seems from your response that no they don't - they are much more interested in their own interests. Which is largely conforming to stereotypes. What annoys me about this - it isn't about you, and it isn't about the nchd's. YOU should concern with the working conditions of nchd's because it directly affects the care received by YOUR patients. Mistakes are made because docs are too tired, over worked and over trained (by the way - EXTREMELY brave of those nchd's in the Irish Times article to give voice to this - they should be commended).

Does that not concern you? Surely it is the responsibility of consultants to tackle this ? I mean, if the weight of responsiblity does not bother you. surely you being the one who would be dragged up in court should the worst happen, surely that should grab the attention of consultants ? Or are you all to preoccupied with contracts to let such trivialities take up your time ?

I can never get my head around it - how can consultants stand over the abysmal working conditions that puts staff and patients alike in danger ? You are uniquely placed to effect change. You are morally obliged to effect change. Are you really all so jaded by the time you get your consultant post that you truly don't care anymore ?

I cannot stand over my own working conditions, never mind others, and as for being "uniquely placed to effect change"? I am fighting to get patients into theatre who are waiting 4 years in pain for their operation FFS.
There is no point in arguing with you, blaming consultants will get you no where , NCHDs have to stand up for themselves. Thats what we did when we were NCHDs.

Avatarr

j.mcdrmd wrote: »

Longer waiting times, backlogs in the health system and cancellations of operations have been predicted due to a ban on overtime now in place for junior doctors in Cork’s main hospital.
d.

The game here is not the overtime, it is small change in relative terms. This is about the waiting list, less consultations equals less admissions and all the expense of the treatment (this is the real saving hse is after).

Reillys allay in getting the budget in order is that waiting list, increase it will result is less expenditure in hospital. Don't be surprised also if wards are closed for renevations, more patients on waiting lists. Patients, needless to say are big losers.

Any hospital admins or Docs online to respond.

resus

No

The "game" here is honesty. We as a collective health service can't afford, with the money we've been allocated, to achieve the level of health care we would like to achieve within the current administrative arrangements.

Options:

1) Change current administrative practices
From what I've experienced (on the front line) this is happening, all be it painfully slowly. There is still the practice of 5 departments having to change one lightbulb, but again, slowly slowly this is being addressed.

At the end of the day its peoples jobs that will be lost. Is it cheaper for the state to have these people on social welfare or paying taxes ? The latter I believe, remember your hospital electrician is giving >50% of his/her net back to the state, just as you are.

2) Reduce elective workload
This is happening all the time, the point of which NOTHING elective happening, has already become reality, eg. forced extended Christmas "holidays," ward revamps, etc. At the point of complete stagnation of elective activity, we start to cost the state more money in long term disease, disability, loss of income (getting people back to work) etc.

Then end of the day, the government has to stand up and state very clearly what we can and can not afford.
We can not have a safe healthcare system, with one of the lowest doctor : nurse : patient ratios in Europe.

YES we need to have an efficient system of administration. 5 departments to change 1 lightbulb can not continue. Let's continue the good work done to date to tackle this waste, we still have an awful long way to go to get in line with the private sector.

The real issue is how much of our finite budget we allocate to health?

NCHDS need to start fighting this mindful of the bigger picture. Complete compliance, ie. work what you're being asked by management to work and no more is a sickening prospect, given that direct harm is likely to come to patients. But this is ADMINISTRATIONS responsibility. More people will die and be harmed by continuing to evangelically prop up the underfunded system. Your true worth/value is not being appreciated, because as it is you're not being paid for what you work. This MUST be appreciated, the only way is through complete compliance.

his_dudeness

resus wrote: »

Complete compliance, ie. work what you're being asked by management to work and no more is a sickening prospect, given that direct harm is likely to come to patients. But this is ADMINISTRATIONS responsibility. More people will die and be harmed by continuing to evangelically prop up the underfunded system. Your true worth/value is not being appreciated, because as it is you're not being paid for what you work. This MUST be appreciated, the only way is through complete compliance.

Absolutely!

This should also have the effect of opening the admins eyes to the holes that are being hastily plugged. An all-out strike means NO work gets done so NO holes are found!

The difficulty is the reluctance of some NCHDs to adopt this role. I reme,ber some of the big NCHD meetings in Galway in 2009 and the variety of willingness to strictly adhere to this role was quite impressive. Everybody was there out of concern for their working lifestyles, but what not everyone is willing to allow the potential guilt of something going wrong. And saying the blame lies with manpower, even though it's true, does not seem to wipe the conscience.

j.mcdrmd

Traumadoc wrote: »

I cannot stand over my own working conditions, never mind others, and as for being "uniquely placed to effect change"? I am fighting to get patients into theatre who are waiting 4 years in pain for their operation FFS.
There is no point in arguing with you, blaming consultants will get you no where , NCHDs have to stand up for themselves. Thats what we did when we were NCHDs.

Well if you cannot stand over your own working conditions you realise that there is a problem here. So what are you going to do about it, given that you are in a team leader role?

I was watching Cian O'Conner on tv this evening and he said "you have to look after your horse, every decision we make is in the interest of the horse" His reasoning is that you are depending on the horse to perform and for that reason you need to develop trust and look after the horse.

"That's what we did when we were NCHDs."

No need to continue bad practice though is there?

RobFowl

Give you're horse (or have it given ) zuclopenthixol and it'll not feel the pain of hitting the hurdles so much! Risks losing a Gold medal though......

opinion guy

Traumadoc wrote: »

I cannot stand over my own working conditions, never mind others, and as for being "uniquely placed to effect change"? I am fighting to get patients into theatre who are waiting 4 years in pain for their operation FFS.

Whilst I have every sympathy for the people in pain for 4 years, whats going to kill them first ? Pain ? Or mismanagement by overworked, under-rested, under-trained staff ?

There is no point in arguing with you, blaming consultants will get you no where , NCHDs have to stand up for themselves. Thats what we did when we were NCHDs.

You just aren't getting it. Its not about NCHD's standing up for themselves, or consutlants standing up for themselves or whatever. Its about the patients. Its THAT bad. Working conditions need to be addressed not because of the doctors - but because the conditions are so BAD safety is at risk. It BLOWS my mind that consultants dont' seem to realise this.

HQvhs

Traumadoc wrote: »

I cannot stand over my own working conditions, never mind others, and as for being "uniquely placed to effect change"? I am fighting to get patients into theatre who are waiting 4 years in pain for their operation FFS.
There is no point in arguing with you, blaming consultants will get you no where , NCHDs have to stand up for themselves. Thats what we did when we were NCHDs.

I understand where you are coming from, it's very hard to get anything done in the health service. However, it's not enough to blame a faceless, ethereal 'management' as the source of all our woes, or to say that NCHDs should just stand up for themselves.

All my way through medical school I have been struck by how all doctors (both consultants and NCHDs) are so willing to take time out of their busy days to teach students, even when we get in the way. This happens not just in the large teaching hospitals attached to our university, but also in the smaller private hospitals we rotate through. The vast majority of these are not paid for their work, and most don't get any credit. There is a fantastic tradition in the profession of fostering the next generation of doctors. It is important that we do not let that cease after graduation, and that the most influencial doctors - consultants, like yourself - continue help make Ireland a better, and safer place to practice medicine so that we don't continue to lose half of our graduates every year. What is the point in investing so much time and resources educating doctors here, only to perpetuate a work environment that forces them to leave? Why put in so much effort to teach them to be competent, safe doctors, only to have them work in conditions that puts patients' health at risk?

It is hard for NCHDs to stand up for themselves when they feel that consultants do not support them, and that their career will suffer as a result. I know of many anecdotal accounts of interns being too afraid to ask their consultants to sign their overtime sheets because they are afraid of their reaction. But, equally, I have also heard of a few consultants who will happily sign the overtime sheets - it is these doctors who just need to show more public support to help give NCHDs the confidence to stand up for change with less fear of impacting their career.

Because the current situation affects the future medical profession, how you practice, and most importantly patient health - all doctors do have a certain responsibility to help in solving it, whatever way they can.

j.mcdrmd

RobFowl wrote: »

Give you're horse (or have it given ) zuclopenthixol and it'll not feel the pain of hitting the hurdles so much! Risks losing a Gold medal though......

But they shoot horses, don't they?

What is the position on caffeine for humans?

RobFowl

j.mcdrmd wrote: »

RobFowl wrote: »

Give you're horse (or have it given ) zuclopenthixol and it'll not feel the pain of hitting the hurdles so much! Risks losing a Gold medal though......

But they shoot horses, don't they?

What is the position on caffeine for humans?

Caffeine is at present allowed in sport but is on wada's "monitoring list" and has been banned above certain threseholds in the past ... It has actually proven performance enhancing effects

opinion guy

j.mcdrmd wrote: »

But they shoot horses, don't they?

What is the position on caffeine for humans?

RobFowl wrote: »

Caffeine is at present allowed in sport but is on wada's "monitoring list" and has been banned above certain threseholds in the past ... It has actually proven performance enhancing effects

I must say this thread has taken an unexpected turn

j.mcdrmd

I was impressed with the Cian O'Conner interview, especially in relation to team work and trust.

RobFowl brought up the performance enhancing point, Athens. Well it is Olympic season.

Then I wondered how doctors function whilst routinely working 36+ hour shifts, and if the amount of caffine consumed by some of them make it possible and if that is ok.

I think it is a breach of human rights to force people to work such long hours. I know the old argument is that the consultants did it to, back in the day. But I don't think that they are comparing like with like. Being on call used not mean work even harder than during the day.

Doctors are being abused and patients are at risk. How can anyone think that a human being can function for that length of time and perform to an acceptable level. The Irish Medical Council should deal with it.

I am wondering what will happen in CUH, where this problem seems to be coming to a head.

resus

j.mcdrmd wrote: »

I am wondering what will happen in CUH, where this problem seems to be coming to a head.

Nothing... except further bullying and exploitation of vulnerable workers until you'll no longer find an Irish trained NCHD in an Irish hospital.

opinion guy

j.mcdrmd wrote: »

I am wondering what will happen in CUH, where this problem seems to be coming to a head.

Most likely that mouthy ER consultant there will go on Pat Kenny's show again for a soft touch interview where he can badmouth nchd's, GP,s and anyone else who he happens to dislike on any given day

corkscrew12

HQvhs wrote: »

All my way through medical school I have been struck by how all doctors (both consultants and NCHDs) are so willing to take time out of their busy days to teach students, even when we get in the way.

emm...and is this medical school in IE? I would hardly say doctors here take time out of their busy days to teach in these teaching hospitals. There are exceptions but generally the Irish consultants and especially the NCHDs don't bother with students much less know your name.

chanste

corkscrew12 wrote: »

emm...and is this medical school in IE? I would hardly say doctors here take time out of their busy days to teach in these teaching hospitals. There are exceptions but generally the Irish consultants and especially the NCHDs don't bother with students much less know your name.

I disagree. I've only been a student in 2 hospitals so far (Tullamore and MWRH Limerick) but I've generally found that any time I've been stuck with something the NCHDs have been more than willing to give 10-15 mins of their time to help out. On 2 occasions myself and other students have been stopped in the halls by NCHDs offering to put on a class for us (its prob worth something for their CV, but the point stands - they offer to help)