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A&E Mater Public on a Saturday- filthy and only 3 doctors working

  • 04-12-2012 7:51pm
    #1
    Registered Users, Registered Users 2 Posts: 101 ✭✭


    On a Saturday lunchtime when I was in the Mater Public A&E there was only 3 doctors working. The Mater Public A&E sees 50,000 patients annually but would be busier at the weekend, yet there were only 3 doctors working. One lady had been waiting 13 hours. There are not enough doctors working in A&E. Funny thing, my friends have emigrated after not getting employment in the HSE.

    There smell was powerful and human excrement appeared to be on one of the chairs. The floors were unwashed. I asked the Indian cleaners about this. The place was dirtier than any chiper I have ever been in. I guess nobody is accountable? How would one go about getting a cleaning contract here?

    What are people supposed to do if they are sick?


Comments

  • Registered Users, Registered Users 2 Posts: 5,477 ✭✭✭Hootanany


    It's like the black hole of calc utter on there.


  • Registered Users, Registered Users 2 Posts: 6,769 ✭✭✭nuac


    Did either of you complain to the Mater?


  • Closed Accounts Posts: 7,230 ✭✭✭Solair


    Make a complaint to the Mater and follow it up with a complaint to HIQA

    http://www.hiqa.ie/contact-details

    Concern about Services HIQA :
    (021) 240 9646
    e-mail: concerns (AT) hiqa.ie

    They have much more enforcement powers than boards :D


  • Registered Users, Registered Users 2 Posts: 2,816 ✭✭✭Vorsprung


    What time were you there at?


  • Closed Accounts Posts: 1,443 ✭✭✭InchicoreDude


    I dont know what the Mater is like as I have never been there.

    However, there is a huge shortage of doctors in this country at the moment. See this link:

    http://www.independent.ie/national-news/junior-doctors-stage-publicity-stunt-to-protest-against-james-reillys-health-policies-3311070.html

    This is not just a publicity stunt; it highlights the very real problem of doctors being educated in Ireland and then leaving Ireland because they are treated like **** here.


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  • Banned (with Prison Access) Posts: 3,355 ✭✭✭gallag


    People don't want tax rises, they want benefits, they want hospitals filled with nurses and a police man on every corner. It's like I tell people who complained about icy roads up here, I am sure the gov could make every road ice free, just don't complane when your tax goes up.


  • Moderators, Society & Culture Moderators Posts: 9,768 Mod ✭✭✭✭Manach


    State inefficiency.
    It is the waste of existing tax revenue that is spent on state public bodies, which at last count are 1 for every 5000 citizens, and that revenue taken by the state is less money to invest both in personal skill-sets or businesses that grows the economy.


  • Closed Accounts Posts: 4,116 ✭✭✭RDM_83 again


    I dont know what the Mater is like as I have never been there.

    However, there is a huge shortage of doctors in this country at the moment. See this link:

    http://www.independent.ie/national-news/junior-doctors-stage-publicity-stunt-to-protest-against-james-reillys-health-policies-3311070.html

    This is not just a publicity stunt; it highlights the very real problem of doctors being educated in Ireland and then leaving Ireland because they are treated like **** here.

    I'l cry a river for those poor poor people having contracts reduced to ONLY 116,000-121000 euro!

    (and before a comparison is made to the USA medical students there graduate with truely stupendous debts)


  • Registered Users, Registered Users 2 Posts: 101 ✭✭mogrady14


    I am sorry for the patients. I amn't sorry for the doctors. Such frontline staffing is inadequate. We should have more frontline doctors and less money diverted to fund taxbreaks for Private hospital developers e.g. Mater Private Extension. Frontline heathcare for patients shouldn't be the area in the healthcare budget to suffer.

    Many Irish trained hospital doctors left Ireland as the HSE was not hiring. If they had it so good, why did they leave? There should be a set frontline A&E doctor to patient ratio.

    There should be accountability for cleaning of hospital wards and A&Es just like there is for chippers and fast food outlets. With Environmental Health Inspectors checking it out and transparency in Cleaning Contract allocation. Why isn't this being done?


  • Registered Users, Registered Users 2 Posts: 9,810 ✭✭✭take everything


    I'l cry a river for those poor poor people having contracts reduced to ONLY 116,000-121000 euro!

    (and before a comparison is made to the USA medical students there graduate with truely stupendous debts)

    You're talking about consultants.
    The mistreated doctors he's talking about are NCHDs not consultants.
    NCHDs still work illegal shifts of well beyond 24 hrs, can still work 80-100 hr weeks, are frequently bullied and treated appallingly, have huge responsibilities (it's only people's lives we're talking about shur), are generally overworked (because of chronic understaffing) and do not get anything near 116-121000.
    NCHD salaries start at around 40 grand (before tax).

    I'm sick of ignorant, anti-doctor sentiment.


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  • Closed Accounts Posts: 1,443 ✭✭✭InchicoreDude


    I'l cry a river for those poor poor people having contracts reduced to ONLY 116,000-121000 euro!

    (and before a comparison is made to the USA medical students there graduate with truely stupendous debts)


    I was referring to junior doctors (NCHDs) who believe me are NOT on anything near 100k.


  • Closed Accounts Posts: 4,116 ✭✭✭RDM_83 again


    I was referring to junior doctors (NCHDs) who believe me are NOT on anything near 100k.

    I'm replying to the article he linked to as evidence :rolleyes:

    "Dr. Mark Murphy, chair of the IMO’s NCHD (junior doctor) committee, said: “We are approaching a crossroads for the NCHD grade in the Irish healthcare services. There is deep unease amongst my colleagues that medicine is becoming a tainted profession and that there is an agenda to portray the medical profession as though they are driven by greed.

    ”IMO president Dr Paul McKeown added: “These figures represent a deep well of disquiet and apprehension amongst some of the most talented and skilled young professionals in this country and they make me fear for the future delivery of medical care in our health service.

    “We have put in place a policy that is leading to the export of our brightest and best and while we may not feel the repercussions for a few years, I have no doubt that our Health Service will suffer if these figures become a reality.

    ”Junior doctors who are appointed to a full-time consultant post will be paid lower salaries than existing specialists following a decision by the minister to pay new entrants 30pc less."

    It means that new consultants will be paid €116,000 if they are on a contract allowing them to treat public and private patients or €121,000 if they are confined to public patients only "

    There is only a minor reference to the extremely long week (due to the fact that EU working time act is not applied). If somebody provides a link to an article its normal to expect that the article supports that posters argument.

    I do think the EU working time act needs to be applied to Junior Doctors even from a purely patient based it does as people who're tired make mistakes.
    You're talking about consultants.
    The mistreated doctors he's talking about are NCHDs not consultants.
    NCHDs still work illegal shifts of well beyond 24 hrs, can still work 80-100 hr weeks, are frequently bullied and treated appallingly, have huge responsibilities (it's only people's lives we're talking about shur), are generally overworked (because of chronic understaffing) and do not get anything near 116-121000.
    NCHD salaries start at around 40 grand (before tax).

    I'm sick of ignorant, anti-doctor sentiment.

    See above part of post about article linked to. Also I note the lack of concern for patients who are suffering from being treated by individuals on 80 hour shifts.


    The average junior Doctor doesn;t have a fantastic basic (I'd argue that its still good in the current climate) , but on average they earn 43,000 on top of that so its pretty hard to say they aren;t rewarded for the overtime. And apparently one Junior Doctor did actually earn 136,000 :eek: (no idea of hours though!). So its disingenuous talking about they're basic pay and then comparing it too hours including overtime.

    Link
    http://www.irishhealth.com/article.html?id=18717

    In reference to the bullying point, from what I;ve heard that bullying is from fellow medical professionals *(so is it ok to have an anti senior doctor sentiment in relation to junior doctors, and an anti junior doctor sentiment in relation to medical students, and an anti them all in relation to nurses :confused: )


    I don't have an anti-doctor sentiment so don;t try and paint me as some Joe Duffy type! I have a number of friends actually supporting themselves through post-grad medicine courses (and even with paying fees and a reduced earnings its still very worthwhile) and some other friends long qualified from undergrad courses. What I disagree with is the idea of "long suffering doctors", people go into these things with their eyes open (I would hope).
    Medicine is a career that confers high status, is extremely secure, offers potential for very high earnings and unlike many careers can be thought of as extremely worthy in and of itself, yes you may have a 3-5 years that may not be nice but that is a sacrifice associated with a lot of highly coveted careers (the points aren;t through the roof for medicine in Ireland because of the coursework as difficult as it is but because of the intense competition for place due to all the people that want to become doctors)

    Out of curiosity would you prefer to work in a system like in the UK where there is more reasonable hours with a vastly reduced take home wage? I know I would prefer to be treated in that system!





    * Anacdotally and from this wikipedia article
    http://en.wikipedia.org/wiki/Bullying_in_medicine


  • Registered Users, Registered Users 2 Posts: 9,810 ✭✭✭take everything


    Also I note the lack of concern for patients who are suffering from being treated by individuals on 80 hour shifts.

    It's highly presumptuous to infer a lack of concern about patients.
    Especially when we're not talking about patients.
    (Hell, it'd be presumptuous even if we were talking about patients).
    Anyway, We're talking about doctors (NCHDs).
    Either way, a patient's welfare is implicit in any concern about an NCHD working 80 hours.
    The average junior Doctor doesn;t have a fantastic basic (I'd argue that its still good in the current climate) , but on average they earn 43,000 on top of that so its pretty hard to say they aren;t rewarded for the overtime.

    Don't know if that 43k is accurate. Either way, for someone dealing with life and death and who has spent 6 years in college, there are many other better-paid (by hourly rate) jobs out there.
    Either way, most NCHDs would tell you it's the hours/****ty conditions that are the problem not the pay (so the pay thing is kinda moot).
    Either way, even with 43k overtime (i really doubt that's an average figure btw) this is still far from the 121k referred to in your previous post.
    And apparently one Junior Doctor did actually earn 136,000 :eek: (no idea of hours though!).

    Yes, those headlines about the one specialist reg in the country doing a 1 in 2 or something (read:insane overtime) all year long. No way representative of your average NCHD.
    Bit in bold is important i would've thought. And conditions. And importance of the job. It still amounts to a very qualified guy doing a very important job, working every hour that God sends (that literally nobody else in the country does) for an hourly rate of pay that many others of similar qualification/education in other careers would turn their nose up at.

    In reference to the bullying point, from what I;ve heard that bullying is from fellow medical professionals *(so is it ok to have an anti senior doctor sentiment in relation to junior doctors, and an anti junior doctor sentiment in relation to medical students, and an anti them all in relation to nurses :confused: )

    Bullying from management:
    Coercion.
    Not being paid according to contract.
    (imagine your contract saying you are entitled to a certain allowance weekly but being told by management flat out they refuse to pay this- i'm experiencing that and it's 10% of my pay. 10% of my pay is being withheld seemingly illegally. Where does that happen in other jobs)
    Not having locum cover when your colleagues go on holiday.
    And NCHDs don't bully anyone, especially nurses. By strength of numbers alone, any NCHD knows NEVER to piss nurse off as they can make your life hell.

    At the very least, before someone engages in doctor-bashing, it'd be nice if they distinguished being NCHDs and consultants.
    Someone else can stick up for consultants but NCHDs in Ireland, of all people, don't deserve vilification.


  • Registered Users, Registered Users 2 Posts: 3,130 ✭✭✭Rodin


    3 doctors working in all of the Mater A and E? Absolute rubbish


  • Registered Users, Registered Users 2 Posts: 3,130 ✭✭✭Rodin


    I was referring to junior doctors (NCHDs) who believe me are NOT on anything near 100k.

    A brand new doctor earns about 29k gross as their basic for 39 hours


  • Registered Users, Registered Users 2 Posts: 101 ✭✭mogrady14


    Sadly, its true. There were only 3 doctors working in the Mater Public A&E on that Saturday. I asked the Nurse in charge. I was concerned about the long waiting time. HSE won't hire enough frontline staff.


  • Registered Users, Registered Users 2 Posts: 3,130 ✭✭✭Rodin


    mogrady14 wrote: »
    Sadly, its true. There were only 3 doctors working in the Mater Public A&E on that Saturday. I asked the Nurse in charge. I was concerned about the long waiting time. HSE won't hire enough frontline staff.

    There would have had to be a consultant in charge. So there were just TWO junior doctors working?


  • Registered Users, Registered Users 2 Posts: 101 ✭✭mogrady14


    I only know there were only 3 Doctors working that Saturday afternoon. I did not ask their qualification level.

    The waiting room was filthy. Excrement on one of the chairs. Floor looked like it hadn't been washed properly in years. You would never know we even had an economic boom. So, many private Hospitals receive tax breaks of 90-100% for their buildings and yet Public Hospitals like the Mater Public were left dirty and understaffed.


  • Registered Users, Registered Users 2 Posts: 3,130 ✭✭✭Rodin


    mogrady14 wrote: »
    I only know there were only 3 Doctors working that Saturday afternoon. I did not ask their qualification level.

    The waiting room was filthy. Excrement on one of the chairs. Floor looked like it hadn't been washed properly in years. You would never know we even had an economic boom. So, many private Hospitals receive tax breaks of 90-100% for their buildings and yet Public Hospitals like the Mater Public were left dirty and understaffed.

    Would you want to spend 6 years in college, with all the education needed to even get there, the hard work involved at college only to work in that A and E with all the stress and people giving you grief?


  • Closed Accounts Posts: 6,565 ✭✭✭southsiderosie


    Rodin wrote: »
    Would you want to spend 6 years in college, with all the education needed to even get there, the hard work involved at college only to work in that A and E with all the stress and people giving you grief?

    Given that medical education is publicly funded in Ireland, perhaps consultants should be less huffy about having to actually serve the public.


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  • Registered Users, Registered Users 2 Posts: 101 ✭✭mogrady14


    No, I would not like to work in A&E as a NCHD. Its a really tough job. Its scary that the A&Es are so understaffed. As a patient, I was shocked by the understaffing present. As a patient in A&E how can one have confidence in Irish hospitals which are so understaffed at frontlines? It sounds like something you would expect in a Banana republic. They still give grants for developing Private hospitals but won't even clean/staff frontlines in State hospitals.


  • Registered Users, Registered Users 2 Posts: 3,130 ✭✭✭Rodin


    Given that medical education is publicly funded in Ireland, perhaps consultants should be less huffy about having to actually serve the public.

    I'm not talking about consultants. I'm talking about the juniors and their working and training conditions which do not compare favourably with other countries, and which should have been addressed a decade ago


  • Registered Users, Registered Users 2 Posts: 3,130 ✭✭✭Rodin


    Given that medical education is publicly funded in Ireland, perhaps consultants should be less huffy about having to actually serve the public.

    A consultant will have paid back the cost of their education within 2-3 years of qualification from medical school. Easily.


  • Closed Accounts Posts: 4,116 ✭✭✭RDM_83 again


    At the very least, before someone engages in doctor-bashing, it'd be nice if they distinguished being NCHDs and consultants.
    Someone else can stick up for consultants but NCHDs in Ireland, of all people, don't deserve vilification.

    Well then as I pointed out in my previous post, I was replying to the content of the actual article linked too (but you seem to ignore that point even though I helpfully quoted most of the contents ;) ). I've no problem with differentiating between the two but Inchicoredudes post didn't and included a section on junior doctors reduced future earnings as consultants.

    I'm sorry but these days 20 euro an hour is a decent wage for some one thats (i'm saying decent not good btw) recently qualified even from a long difficult specialised course. Especially taking into account the potential higher earnings in future.
    Don't know if that 43k is accurate. Either way, for someone dealing with life and death and who has spent 6 years in college, there are many other better-paid (by hourly rate) jobs out there.
    Either way, most NCHDs would tell you it's the hours/****ty conditions that are the problem not the pay (so the pay thing is kinda moot).
    Either way, even with 43k overtime (i really doubt that's an average figure btw) this is still far from the 121k referred to in your previous post.

    Any reason why you doubt the figures your man has arrived at unless the HSE is doing some highly illegal accounting (though I think the figures are for 2011)

    And again in relation to the 121k figure in my post did you even read Inchicoredudes post and link attached to it (he says doctors, not junior doctors, the article states junior doctors concerns, and then goes on to state the concerns about the reduced wages of newly qualified consultants, are consultants not considered doctors now?)

    Also the fact is people don;t remain at the junior doctor grade forever, theygo on to become the highly paid bullys junior doctors complain about and presumably the cycle perpetuates

    What your referring to doesn;t sound like bullying to me it sounds like bad and oppressive management (not that its not a serious problem)

    Also again would you prefer to work in a UK style system with greatly reduced pay but greater staffing levels and better (though still long) hours?


  • Registered Users, Registered Users 2 Posts: 3,130 ✭✭✭Rodin


    Well then as I pointed out in my previous post, I was replying to the content of the actual article linked too (but you seem to ignore that point even though I helpfully quoted most of the contents ;) ). I've no problem with differentiating between the two but Inchicoredudes post didn't and included a section on junior doctors reduced future earnings as consultants.

    I'm sorry but these days 20 euro an hour is a decent wage for some one thats (i'm saying decent not good btw) recently qualified even from a long difficult specialised course. Especially taking into account the potential higher earnings in future.



    Any reason why you doubt the figures your man has arrived at unless the HSE is doing some highly illegal accounting (though I think the figures are for 2011)

    And again in relation to the 121k figure in my post did you even read Inchicoredudes post and link attached to it (he says doctors, not junior doctors, the article states junior doctors concerns, and then goes on to state the concerns about the reduced wages of newly qualified consultants, are consultants not considered doctors now?)

    Also the fact is people don;t remain at the junior doctor grade forever, theygo on to become the highly paid bullys junior doctors complain about and presumably the cycle perpetuates

    What your referring to doesn;t sound like bullying to me it sounds like bad and oppressive management (not that its not a serious problem)

    Also again would you prefer to work in a UK style system with greatly reduced pay but greater staffing levels and better (though still long) hours?

    Absolutely


  • Closed Accounts Posts: 6,565 ✭✭✭southsiderosie


    Rodin wrote: »
    A consultant will have paid back the cost of their education within 2-3 years of qualification from medical school. Easily.

    Doubtful. The actual value of the degree is quite high, especially considering the international mobility of English-speaking medical staff.

    And the broader point here is that if you work in the public health system, you should have some level of obligation to the public - if that means that senior staff need to put in one weekend at A&E a month, then so be it. People get sick outside of office hours Monday through Friday.


  • Registered Users, Registered Users 2 Posts: 9,810 ✭✭✭take everything


    What your referring to doesn;t sound like bullying to me it sounds like bad and oppressive management (not that its not a serious problem)

    Oppressive management is a nice euphemism for violating contracts.
    Also again would you prefer to work in a UK style system with greatly reduced pay but greater staffing levels and better (though still long) hours?

    If it provided better training and conditions, yes.


  • Registered Users, Registered Users 2 Posts: 5,848 ✭✭✭bleg


    mogrady14 wrote: »
    On a Saturday lunchtime when I was in the Mater Public A&E there was only 3 doctors working. The Mater Public A&E sees 50,000 patients annually but would be busier at the weekend,

    Nope!


  • Registered Users, Registered Users 2 Posts: 3,130 ✭✭✭Rodin


    ''On a Saturday lunchtime when I was in the Mater Public A&E there was only 3 doctors working. The Mater Public A&E sees 50,000 patients annually but would be busier at the weekend,''

    That's 136 people a day.

    I'd say those 3 docs easily deserve their money


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  • Registered Users, Registered Users 2 Posts: 3,130 ✭✭✭Rodin


    Doubtful. The actual value of the degree is quite high, especially considering the international mobility of English-speaking medical staff.

    And the broader point here is that if you work in the public health system, you should have some level of obligation to the public - if that means that senior staff need to put in one weekend at A&E a month, then so be it. People get sick outside of office hours Monday through Friday.

    And the docs have paid for the cost borne by the state for providing the education!!

    And A and E staff easily do a day in the weekend more than once a month


  • Closed Accounts Posts: 4,116 ✭✭✭RDM_83 again


    Rodin wrote: »
    And the docs have paid for the cost borne by the state for providing the education!!

    And A and E staff easily do a day in the weekend more than once a month

    I think though I could be wrong she is saying that more staff should be available for an A&E duties rather than increased weekend hours for people already in A&E (I can completely understand why people don;t want to work in A&E, know someone rostered from Stephens day to New Years eve!).

    AN example of this would be the ability to do the various scans in dublin hospitals at night rather than just the day.


  • Registered Users, Registered Users 2 Posts: 3,130 ✭✭✭Rodin


    I think though I could be wrong she is saying that more staff should be available for an A&E duties rather than increased weekend hours for people already in A&E (I can completely understand why people don;t want to work in A&E, know someone rostered from Stephens day to New Years eve!).

    AN example of this would be the ability to do the various scans in dublin hospitals at night rather than just the day.

    You would face fierce opposition from the radiographers, most of whom are women.

    The support staff are the real reason that hospitals don;t work the same 24/7. Speech and language, dieticians, OTs, physios, radiographers, technologists. The vast majority of those don't work weekends.

    And there simply isn't the money to provide that service.


  • Registered Users, Registered Users 2 Posts: 4,276 ✭✭✭Memnoch


    Well then as I pointed out in my previous post, I was replying to the content of the actual article linked too .....

    I guess this is the problem with articles on these kind of subjects where a lot of the truth lies in the grey area, also the agenda for which the article was written.

    But the reality for most NCHDs in Ireland is I suspect far from what you imagine.

    On overtime? 43K a year? That's ludicrous. I sincerely doubt there is any NCHD making that much overtime today. Maybe in the boom years. I think for most it would be in the region of 3-4k with perhaps 7k or so at the higher end. But even that doesn't tell you the reality of overtime. There might be the odd extreme case of some absolute nuts who are desperate for money and will take on every rostered overtime on offer, offering to do other people's calls for them. But the hours these people end up on are beyond dangerous for both doctor and patient. Also, this is only in the 'lighter' specialties like Psychiatry. You couldn't do that as general medical on call or surgical on call, you'd drop dead if you tried.

    Over the last few years most hospitals have stopped paying unrostered overtime. What this means is that you are only paid overtime if you are officially on call. How many doctors are on call on any given night is hard to see, it various from hospital to speciality.

    But the reality is that the majority of overtime done by doctors is unrostered/unplanned. Because NCHD staffing levels are so poor it is rare to have your work done by 5pm. A lot of NCHD's also start early to prepare for the consultants arrival. 8am for medical specialties and 7-8:00am for surgical specialties. Most NCHDs are happy to be out by 6pm though frequently you could be stuck till 7pm or later sorting stuff out.

    OFFICIALLY you are not supposed to work after 5 and this is the 'agreement' between the HSE/hospital and consultants who are supposed to be 'supervising' their nchd working hours. The reality is, if everyone left at 5 and handed over their remaining work to the oncall NCHD, the oncall doctor would be so buried catching up with other people's routine work they would struggle to manage emergencies, for which they are on call.

    The other truth about this is that any NCHD that insisted on leaving after 5pm because they were not being paid and were OFFICIALLY not supposed to work (since its illegal to make people work without paying them), would find themselves getting bad references and struggling to get another job at the end of their yearly renewed contract, or more, importantly advance their careers up the ladder.

    So there are a lot of NCHDs working 10-20 hours a week extra without any pay. They are doing this because the Hospital and the consultants know they can be exploited in this way and because any dissent on the issue can be punished with severe and lasting consequences for people's careers.

    The only exception to this, that I know of is in Psychiatry, where most NCHDs will routinely leave at 5pm no matter what and any unfinished work is handed off to the person on call. But what this is doing is creating a bad situation for patients. A routine psychiatry admission can take 2 hours+ but can also be easily done in an hour or so, depending by a skilled and competent NCHD. So many psychiatry NCHDs will refuse to a see a new patient if they arrive after 4pm. In fact, many will make themselves busy with ward work, or structure their working day so that their ward work is left till the end so that they are busy with other stuff at 3pm onwards. If the person on call is coming from a community clinic they might not arrive on time and patients are left waiting. As a result you could have people waiting 6-8 hours before they are seen for no reason other than administrative issues.

    This is a result of the people left being largely apathetic and knowing they have no future in this service.

    But if you think Psychiatric NCHDs are bad you have NO IDEA the amount of shenannigans many psychiatric consultants get up to.

    All this is just the tip of the iceberg. There are massive issues with racism and bullying in the health service. And the take home pay at the end of the day for NCHDs is actually really poor as a combination of overtime not being paid and all the taxes and charges that have been added on in recent years. There's a real and significant decline in living standards.

    Which is why you are finding that anyone who can emigrate is doing so. Even people who are at the higher end of the career ladder.

    Also.... this 'you will soon become a consultant' is complete nonsense. There are very limited numbers of consultant posts that become available and because consultants in Ireland are actually quite well paid, they are in general sought after and competitive. Most NCHDs working in the Irish Health Service will NEVER become consultants here. This is especially true if you are non-white.

    Walk into ANY irish hospital. Count the number of non-white junior NCHDs and junior level nursing staff. Now count the number of non-white consultants and non-white senior level nursing staff (especially the top nursing grades) (This problem is not as bad in Nursing as it is in medicine, at least that's my impression but I don't really know as much about the inside issues in nursing). This includes non-white people who have done their medical training here and may be naturalised Irish citizens.

    To say that intolerable working conditions are acceptable for NCHDs because they will become consultants eventually is wrong and unjustifiable to begin with. No one should be made to work such ludicrous hours, with very diminished pay in real terms, non-stop bullying and racism, to begin with.

    However, the justification, flimsy as it is, is also a falsehood.


  • Closed Accounts Posts: 4,116 ✭✭✭RDM_83 again


    Memnoch wrote: »
    I guess this is the problem with articles on these kind of subjects where a lot of the truth lies in the grey area, also the agenda for which the article was written.

    But the reality for most NCHDs in Ireland is I suspect far from what you imagine.

    On overtime? 43K a year? That's ludicrous. I sincerely doubt there is any NCHD making that much overtime today. Maybe in the boom years. I think for most it would be in the region of 3-4k with perhaps 7k or so at the higher end. But even that doesn't tell you the reality of overtime. There might be the odd extreme case of some absolute nuts who are desperate for money and will take on every rostered overtime on offer, offering to do other people's calls for them. But the hours these people end up on are beyond dangerous for both doctor and patient. Also, this is only in the 'lighter' specialties like Psychiatry. You couldn't do that as general medical on call or surgical on call, you'd drop dead if you tried.

    Over the last few years most hospitals have stopped paying unrostered overtime. What this means is that you are only paid overtime if you are officially on call. How many doctors are on call on any given night is hard to see, it various from hospital to speciality.

    But the reality is that the majority of overtime done by doctors is unrostered/unplanned. Because NCHD staffing levels are so poor it is rare to have your work done by 5pm. A lot of NCHD's also start early to prepare for the consultants arrival. 8am for medical specialties and 7-8:00am for surgical specialties. Most NCHDs are happy to be out by 6pm though frequently you could be stuck till 7pm or later sorting stuff out.

    OFFICIALLY you are not supposed to work after 5 and this is the 'agreement' between the HSE/hospital and consultants who are supposed to be 'supervising' their nchd working hours. The reality is, if everyone left at 5 and handed over their remaining work to the oncall NCHD, the oncall doctor would be so buried catching up with other people's routine work they would struggle to manage emergencies, for which they are on call.

    The other truth about this is that any NCHD that insisted on leaving after 5pm because they were not being paid and were OFFICIALLY not supposed to work (since its illegal to make people work without paying them), would find themselves getting bad references and struggling to get another job at the end of their yearly renewed contract, or more, importantly advance their careers up the ladder.

    So there are a lot of NCHDs working 10-20 hours a week extra without any pay. They are doing this because the Hospital and the consultants know they can be exploited in this way and because any dissent on the issue can be punished with severe and lasting consequences for people's careers.

    The only exception to this, that I know of is in Psychiatry, where most NCHDs will routinely leave at 5pm no matter what and any unfinished work is handed off to the person on call. But what this is doing is creating a bad situation for patients. A routine psychiatry admission can take 2 hours+ but can also be easily done in an hour or so, depending by a skilled and competent NCHD. So many psychiatry NCHDs will refuse to a see a new patient if they arrive after 4pm. In fact, many will make themselves busy with ward work, or structure their working day so that their ward work is left till the end so that they are busy with other stuff at 3pm onwards. If the person on call is coming from a community clinic they might not arrive on time and patients are left waiting. As a result you could have people waiting 6-8 hours before they are seen for no reason other than administrative issues.

    This is a result of the people left being largely apathetic and knowing they have no future in this service.

    But if you think Psychiatric NCHDs are bad you have NO IDEA the amount of shenannigans many psychiatric consultants get up to.

    All this is just the tip of the iceberg. There are massive issues with racism and bullying in the health service. And the take home pay at the end of the day for NCHDs is actually really poor as a combination of overtime not being paid and all the taxes and charges that have been added on in recent years. There's a real and significant decline in living standards.

    Which is why you are finding that anyone who can emigrate is doing so. Even people who are at the higher end of the career ladder.

    Also.... this 'you will soon become a consultant' is complete nonsense. There are very limited numbers of consultant posts that become available and because consultants in Ireland are actually quite well paid, they are in general sought after and competitive. Most NCHDs working in the Irish Health Service will NEVER become consultants here. This is especially true if you are non-white.

    Walk into ANY irish hospital. Count the number of non-white junior NCHDs and junior level nursing staff. Now count the number of non-white consultants and non-white senior level nursing staff (especially the top nursing grades) (This problem is not as bad in Nursing as it is in medicine, at least that's my impression but I don't really know as much about the inside issues in nursing). This includes non-white people who have done their medical training here and may be naturalised Irish citizens.

    To say that intolerable working conditions are acceptable for NCHDs because they will become consultants eventually is wrong and unjustifiable to begin with. No one should be made to work such ludicrous hours, with very diminished pay in real terms, non-stop bullying and racism, to begin with.

    However, the justification, flimsy as it is, is also a falsehood.

    Look at the article I linked to the figures refer to 2010 (I thought it was 2011 in my previous post so I stand corrected on that year) which is hardly the boom! (If you disagree with the writers analysis please tell me why?*)

    Looking at the midwest exclusively (because thats where i can find the figure for), there was only a 2.6% reduction in the overtime bill for junior doctors from 2010 to 2011 in that region. (the bill was 10.4 million)

    http://www.irishexaminer.com/ireland/kfidojcwidsn/rss2/

    to me this would signal that very large amounts of money were still being paid last year in junior doctors overtime (again if you;ve a problem with this analysis please tell me why and if the money isn;t going to junior doctors overtime bill where is it going :confused: )

    Nearly all the taxes and deductions have been applied across the public sector (and prsi changes etc across the private too).

    I know there is limited positions for consultants however its not true that some one is stuck on a basic 30k forever with basic pay for various registrars going from 50-76k before overtime and additional benefits

    http://www.hse.ie/eng/staff/nchd/benefits/salary.html

    And I'm not trying to blame the short falls of the Irish Health System on Junior Doctors or even consultants :eek: (in case its not clear from my previous posts) and I know they have a tough job and that their not asking to work insane hours. I am simply stating that Medicine is still a relatively lucrative career

    In relation to the racism I really can;t comment as not involved in any aspect of the profession and anyone i know involved is white. However I would say in Ireland there may not be a need to pin racism or other forms of discrimination onto an issue when simple cronyism could also be an explanation :(

    * and I don;t think there's any industry/profession in Ireland where those involved feel that conditions have risen during the recession and emigration is less appealing.


  • Closed Accounts Posts: 7,230 ✭✭✭Solair


    To me, it seems the problem is the whole management and career structure.

    From what I observe, the career structures and hospital management structures seem to be like something of of a Dickensian novel rather than the 21st century.

    The Non-consultant hospital doctors are still being termed 'junior doctors' by most commentators, when they're far from it. They're extremely well-qualified medical professionals, who just haven't reached the top level yet.

    The problem as I see it, is that they're overpaying the consultants and not paying the non-consultants enough.

    We seem to have created a career path that makes a NCHD a transitionary position / training position rather than a proper job.

    It should be perfectly possible and acceptable for a doctor to decide that he/she wants to be a hospital doctor, without being a consultant or without necessarily want to climb that particular greasy pole.

    I think there's also a tendency for the consultants to feel they deserve enormous pay because they had been treated so badly for most of their careers that by the time they reach that level, they feel they should be financially rewarded and make up for lost time during that period of their career.

    There seems to be a need for a lot of other job titles within the medical profession for hospital doctors who aren't consultants and their positions should be recognised properly.

    I've seen continental European healthcare systems and I know people working in them and in general the wage rates are definitely lower at the top, but they're often higher and more secure at the bottom and the middle and there seems to be a lot more career support, structure and general stability for hospital doctors.

    Little things like the doctors in France had an office to work from, decent facilities, a good level of pay (not crazy high but very comfortable) and reasonable hours.

    They were employed as public servants, and there was no real glamour in it other than in academic achievement from what I could see. There was a lot of emphasis on things like publishing papers, doing research etc more so than on pay levels.

    All we're doing in Ireland is slashing all the money into the top end of the career ladder and causing a lot of people to leave and go to systems that are better structured i.e. Australia, Canada, the US and even the UK.

    I also suspect that much like in the civil service, the senior Sir Humphry (Yes, Minister) types are protecting their patch and their huge pay levels while they're allowing their minions to take the pain. In the case of the doctors, that's the hospital doctors & younger doctors getting hit with all the austerity and cuts, while a lot of the consultants seem to be still swanning around on enormous salaries double-jobbing between the public and private sector.


    The whole thing needs to be properly and dispassionately analysed by someone from outside the system entirely and rebuilt from the ground up.

    The system was totally dysfunctional during times when we had huge amounts of money to spend on it and it's even more dysfunctional when cash is tight. So, something has to be radically changed and I think as it stands there are way too many vested interests to deal with to resolve it.

    We seem to be unable to rationalise the hospitals (too many voluntary hospitals etc that remain unmerged), we can't tackle consultants pay, medical career ladders, there are continuous reports of inadequate services and erratic provision of services, etc etc etc..

    The whole thing to me seems like the Government hasn't really dealt with health properly EVER. It's like trying to herd cats or something. This big amorphous "system" that seems to have no controls and operates based on historical, ad hoc systems that are in a lot of cases worst practice, not best practice.


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  • Registered Users, Registered Users 2 Posts: 13,104 ✭✭✭✭djpbarry


    However, there is a huge shortage of doctors in this country at the moment.
    Also again would you prefer to work in a UK style system with greatly reduced pay but greater staffing levels and better (though still long) hours?
    I'm not sure where this idea has come from that the NHS is so much better than the HSE. With regard to staffing levels, Ireland actually has slightly more doctors per head of population than the UK: 3.1 per 1,000 versus 2.7, with 3.1 being the OECD average.

    If we look at nurses, the difference is even bigger: 13.1 per 1,000 versus 9.6, with 8.6 being the OECD average.

    http://www.oecd.org/els/healthpoliciesanddata/oecdhealthdata2012-frequentlyrequesteddata.htm


  • Closed Accounts Posts: 4,116 ✭✭✭RDM_83 again


    ^^^

    Interesting I don't know why I assumed the U had better staffing levels, it does make Irish A&E system seem even worse in comparison though (from my limited experience the NHS maximum waiting times could be considered a HSE target time!)


  • Registered Users, Registered Users 2 Posts: 13,104 ✭✭✭✭djpbarry


    ^^^

    Interesting I don't know why I assumed the U had better staffing levels, it does make Irish A&E system seem even worse in comparison though (from my limited experience the NHS maximum waiting times could be considered a HSE target time!)
    I don't know - in my general experience, the health systems in the UK and Ireland are broadly similar, each with their own pros and cons, and each suffering from their own administrative problems it seems.

    You mention NHS waiting times, but try getting a GP/dentist appointment in the UK at short notice - it's often next to impossible. Whereas in Dublin, I rarely had a problem getting an appointment within 24 hours (or even 12 in a lot of cases).


  • Closed Accounts Posts: 4,116 ✭✭✭RDM_83 again


    Oh I'm well aware of that being in NI at the minute, the GP care is better in the ROI IMO, but then forking out 50 euro each time you would want it to be (I know the " real" cost in tax per visit may be closer than one thinks but I think the fact that one is physically paying the ROI GP changes the dynamic).

    However in a discussion about A&E there's no denying the NHS will have you seen much much faster.

    Edit: Also there is a genuine reason to think UK staffing levels are better in that they broadly follow the EU working time act which if the horror stories are taken at face value in general there should be a significantly higher amounts of staff actually in hospitals Ireland


  • Registered Users, Registered Users 2 Posts: 13,104 ✭✭✭✭djpbarry


    Oh I'm well aware of that being in NI at the minute, the GP care is better in the ROI IMO, but then forking out 50 euro each time you would want it to be...
    It does lead to fewer unnecessary visits:

    http://www.southofengland.nhs.uk/2012/07/12/51-million-unnecessary-gp-visits-nhs-investigate-why


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  • Closed Accounts Posts: 6,565 ✭✭✭southsiderosie


    Rodin wrote: »
    You would face fierce opposition from the radiographers, most of whom are women.

    As are the majority of nurses. Should they have nights and weekends off too?
    Rodin wrote: »
    The support staff are the real reason that hospitals don;t work the same 24/7. Speech and language, dieticians, OTs, physios, radiographers, technologists. The vast majority of those don't work weekends.

    And there simply isn't the money to provide that service.

    Seeing a nutritionist or a speech pathologist is not an emergency visit, so there is no reason for them to be available nights and weekends. But emergency treatment does require the availability of emergency room physicians (including pediatricians), nurses, surgeons, radiologists and obstetricians - at a minimum.

    I am not sure how it works in Ireland, but for my friends who are doctors in the US, despite 4 years of undergrad, 4 years of medical school, 6 years of residency (for surgeons), and a year of fellowship, full-fledged surgeons still need to be on call nights and weekends (in rotation, of course). So it is odd to me that doctors in Ireland can shake off these responsibilities after 1) a publicly funded education and 2) a relatively short period after completion of advanced training.


  • Registered Users, Registered Users 2 Posts: 3,130 ✭✭✭Rodin


    As are the majority of nurses. Should they have nights and weekends off too?



    Seeing a nutritionist or a speech pathologist is not an emergency visit, so there is no reason for them to be available nights and weekends. But emergency treatment does require the availability of emergency room physicians (including pediatricians), nurses, surgeons, radiologists and obstetricians - at a minimum.

    I am not sure how it works in Ireland, but for my friends who are doctors in the US, despite 4 years of undergrad, 4 years of medical school, 6 years of residency (for surgeons), and a year of fellowship, full-fledged surgeons still need to be on call nights and weekends (in rotation, of course). So it is odd to me that doctors in Ireland can shake off these responsibilities after 1) a publicly funded education and 2) a relatively short period after completion of advanced training.

    I think when you said that you aren't 'sure how it works in Ireland' you hit the nail fairmly on the head. Of course Irish surgeons are on call nights and weekends.


  • Registered Users, Registered Users 2 Posts: 101 ✭✭mogrady14


    HSE hiring Motivational Coaches not doctors: See articles in today's independent:
    http://www.independent.ie/national-news/hse-hires-motivational-coaches-to-give-senior-managers-morale-boost-3318791.html.


  • Closed Accounts Posts: 6,565 ✭✭✭southsiderosie


    Rodin wrote: »
    I think when you said that you aren't 'sure how it works in Ireland' you hit the nail fairmly on the head. Of course Irish surgeons are on call nights and weekends.

    Then why do you seem to be saying that this is an impossibility? And why, when I lived in Ireland, was it almost impossible for women to get emergency access to a doctor over the weekend (back when you needed a prescription for emergency contraception)? Why in general do people complain of not having enough consultants on staff in off-hours - which really seems to be the issue here?

    On this thread I have seen various reasons including too many are women and it would cost too much. But the real reason from a patient perspective seems to be, consultants don't want to work nights and weekends, and by and large they do so on a very limited basis. But unlike the US, doctors in Ireland are primarily public servants - and as such, I don't understand why access to medical services is not more public-friendly. If you are going to have crappy American-style private services, then let Irish doctors do what American doctors have to do - take on the financial risk of their education and early practice on as an individual, instead of society taking that risk on for you.


  • Registered Users, Registered Users 2 Posts: 3,130 ✭✭✭Rodin


    Then why do you seem to be saying that this is an impossibility? And why, when I lived in Ireland, was it almost impossible for women to get emergency access to a doctor over the weekend (back when you needed a prescription for emergency contraception)? Why in general do people complain of not having enough consultants on staff in off-hours - which really seems to be the issue here?

    On this thread I have seen various reasons including too many are women and it would cost too much. But the real reason from a patient perspective seems to be, consultants don't want to work nights and weekends, and by and large they do so on a very limited basis. But unlike the US, doctors in Ireland are primarily public servants - and as such, I don't understand why access to medical services is not more public-friendly. If you are going to have crappy American-style private services, then let Irish doctors do what American doctors have to do - take on the financial risk of their education and early practice on as an individual, instead of society taking that risk on for you.

    Because people often don't know what they're talking about.

    My reasoning of too many women was in response as to why routine scans are not done at weekends.

    What ''risk'' does society take on training doctors? And if you want doctors to pay to go to college, then surely people who do much less useful degrees should also have to pay? Degrees where the student doesn't have guaranteed employment and won't pay back the outlay like a doctor will.

    At the end of the day if you want more doctors on duty, they have to be paid for. It is very simple economics.


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