Intern/SHO Salary

Forklifted

Hi all,

Graduate Entry Med student here trying to budget for the future. Can anyone tell me what I could realistically expect to earn as an intern and SHO at by standards? I've seen the Payscales pdf on the HSE website (Intern = €30,257) but how much does call/overtime actually add to the base salaries in general?

Does anyone have any recommendations on where you can earn a lot in your SHO years?

Sorry if this has come up before but with all the changes recently most of the older threads on this topic are redundant.

Many thanks

lonestargirl

I would make the assumption that the only extra you will get is call. Many places are not paying unrostered overtime or the living out allowance and I can only see others following in their footsteps.

You also have to consider your living costs, rent outside the cities would be cheaper. Peripheral hospitals may have a more hectic call schedule but it would be very isolating being away from family and friends. I know money seems important right now but it's important to look after yourself and not drive yourself to burnout.

Malmedicine

lonestargirl wrote: »

I would make the assumption that the only extra you will get is call. Many places are not paying unrostered overtime or the living out allowance and I can only see others following in their footsteps.

You also have to consider your living costs, rent outside the cities would be cheaper. Peripheral hospitals may have a more hectic call schedule but it would be very isolating being away from family and friends. I know money seems important right now but it's important to look after yourself and not drive yourself to burnout.

You want to earn big money quickly ? DON'T DO MEDICINE IN IRELAND. I'll echo the above, unrostered overtime not being paid, you could do more call and that would bump your salary slightly. But having worked 100 hour medical call weeks, working over Christmas Eve, Day and Stephens Day and then to see your salary arrive and it be less than half of what you earned, its gutwrenching. With Medical Council Fees, MPS, Union fees being huge to take into account also. You do get some reprieve with approx 650 euro extra on your tax free allowance for the profession. This barely covers some of the equipment you'll need, or make up for the cost of courses minus the hse 450 euro. Locuming used to be a good way of making good money for very little effort but its increasingly difficult to come about and unless you somehow managed to get a decent stretch of it it wouldn't be worth losing a year of "training".

My advice finish intern year THEN LEAVE don't look back just go. Austrailia, New Zealand, America, Canada, Uk. All better or equal pay with much better training. Come back if you want can when you are a consultant.

Forklifted

Thanks for all the tips.

I'm more concerned with my loan than being rich to be honest. I know that medicine will allow me to be comfortable without the burden of the loan.

Does anyone have any experience on how much on call realistically adds to those inter/sho salaries?

take everything

Forklifted wrote: »

Does anyone have any experience on how much on call realistically adds to those inter/sho salaries?

Less and less.
Deductions are definitely over 50% (pushing 60% IIRC) when you take that PRD/USC crap into account (on top of the 40% which pretty much all your call will be taxed at). I really think it's unfair on those doing difficult call- slave labour really.

And don't dream of getting Living Out Allowance (even though it's in the contract). What a laugh. The guts of 3 grand every year (nearly 10% of salary) being (what i can only infer is illegally) withheld from a fair chunk of NCHDs.
And you'll probably be dead from fighting them for mileage/notional pay/increments as well.

As mentioned you'll also be shelling out for MPS/IMC registration/CPD courses (and hotels/traipsing up and down the country) if you're not on a training scheme. And you won't get money back if you fail exams.

As mentioned locum work is all but gone. Christ, i can't believe i earned in 3 weeks a few years ago what i earn in 3 months now doing that. :pac:

Forklifted

Thanks again.

So the reality is to really only budget using the base salary then.

Can someone tell me about the reality of a pathway to higher speciality training (e.g. cardiology)? I understand that its:

1 year intern
2 year basic speciality training (SHO)
6 hears higher speciality training (SpR)

How does this work in practice, i.e. is it ever that smooth, or is it extremely competitive? I'm also confused as to the difference between a Reg, Senior Reg and SpR.

Ryder

Forklifted wrote: »

Thanks again.

So the reality is to really only budget using the base salary then.

Can someone tell me about the reality of a pathway to higher speciality training (e.g. cardiology)? I understand that its:

1 year intern
2 year basic speciality training (SHO)
6 hears higher speciality training (SpR)

How does this work in practice, i.e. is it ever that smooth, or is it extremely competitive? I'm also confused as to the difference between a Reg, Senior Reg and SpR.

Relatively smooth...intern 1 year
Sho 2 years. Reg 1/2 years. Spr - specialist registrar, is on a training scheme 5 years, plus one or two years abroad on fellowship. Cardiology is currently very competitive so if you really want it, try to get some research done during term/ summer...talk to a sho/reg...always looking for help.

If working in Ireland is important to you (as a consultant) I would advise training here

opinion guy

Ryder wrote: »

If working in Ireland is important to you (as a consultant) I would advise training here

Rubbish. If he goes to the US and becomes expert in some cool new cardio technique they will be begging for him to come back. Reality is that in a few years time the way they are going here they will be delighted if anyone is even willing to work here as a consultant regardless of where they trained

Ryder

Almost every trainee goes overseas to learn new techniques...their one or two year fellowship is as long as the US trainees...so will be as expert. Currently some consultancy posts ate unfilled, but as far as I can see those are largely on peripheral centers where there may be other considerations.

Bottom line, I think, it would be bad advice to tell someone to do all their training overseas. Unless they have way above average clinical or academic expertise they will fond it hard to compete against someone who's been in the system for 8 plus years and then gone away. How many consultants are there currently in public practice who didn't train here?

dissed doc

Ryder wrote: »

Relatively smooth...intern 1 year
Sho 2 years. Reg 1/2 years. Spr - specialist registrar, is on a training scheme 5 years, plus one or two years abroad on fellowship. Cardiology is currently very competitive so if you really want it, try to get some research done during term/ summer...talk to a sho/reg...always looking for help.

If working in Ireland is important to you (as a consultant) I would advise training here

Complete nonsense about training in Ireland. It's the same BS I heard 10 years ago. You will never pay off your loan. What may come about is loan forgiveness if you train I Ireland but that has never been discussed and requires forward planning. Your intern salary is just undet €900 every two weeks. You will never pay off 100k in Ireland. I was pointing this out years ago on this forum; consultant salary in Ireland is currently around €4500/month net so expect under 4k/month within a few years. .

Easiest option is to start doing SHO shifts in the UK through locum agencies.

Ryder

dissed doc wrote: »

Complete nonsense about training in Ireland. It's the same BS I heard 10 years ago. You will never pay off your loan. What may come about is loan forgiveness if you train I Ireland but that has never been discussed and requires forward planning. Your intern salary is just undet €900 every two weeks. You will never pay off 100k in Ireland. I was pointing this out years ago on this forum; consultant salary in Ireland is currently around €4500/month net so expect under 4k/month within a few years. .

Easiest option is to start doing SHO shifts in the UK through locum agencies.

Start your career locuming in the UK? That's genuinely terrible career advice. Is the nchd salary scale that much better in the UK? Could you link it please?

dissed doc

Ryder wrote: »

Start your career locuming in the UK? That's genuinely terrible career advice. Is the nchd salary scale that much better in the UK? Could you link it please?

It's not career advice, the OP was asking about paying off the loan, and that is the best and easiest option. For example, after doing intern year to get registered, then do SHO locums in the UK. Rates are around UK£40/hr (sometimes higher depending on need) through your own limited company. Most hospitals will pay for accomodation on site so limited or no expenses.

You would expect to gross around UK£8000/month as an SHO locum in the UK. With some careful planning, you could certainly hit into that EUR100k loan in Ireland pretty heavily with 12 months locumming (and that is on an EWTD-friendly 48hr week).

No different to people doing PGY1 or PGY2 in the US (like Intern and SHO 1) and then moonlighting to start paying off the loans there.

But yes, I forgot the mantra: repeat after me: never leave Ireland, you must train here or no-one will ever talk to you at a conference, it looks bad to do anything except what you think you are expected to do, etc., etc., etc., . Heard it all before, doesn't make a bit of difference except the people that step outside the box have done better than those that followed the typical advice.

Ryder

dissed doc wrote: »

It's not career advice, the OP was asking about paying off the loan, and that is the best and easiest option. For example, after doing intern year to get registered, then do SHO locums in the UK. Rates are around UK£40/hr (sometimes higher depending on need) through your own limited company. Most hospitals will pay for accomodation on site so limited or no expenses.

You would expect to gross around UK£8000/month as an SHO locum in the UK. With some careful planning, you could certainly hit into that EUR100k loan in Ireland pretty heavily with 12 months locumming (and that is on an EWTD-friendly 48hr week).

No different to people doing PGY1 or PGY2 in the US (like Intern and SHO 1) and then moonlighting to start paying off the loans there.

But yes, I forgot the mantra: repeat after me: never leave Ireland, you must train here or no-one will ever talk to you at a conference, it looks bad to do anything except what you think you are expected to do, etc., etc., etc., . Heard it all before, doesn't make a bit of difference except the people that step outside the box have done better than those that followed the typical advice.

Sure, the mantra...everyone leave, its terrible, depressing etc etc. Start off doing locums through your own company? How does CME work...teaching etc?

Those that think outside the box do better.. You have some examples in mind?

Working abroad undoubtedly suits dome people,maybe even the best choice for some, but not if you ultimately intend working here long term. Current employment patterns bear that out. And to clarify I mean doing all your training abroad, there is absolutely no problem in doing some time abroad if that's what you want

briankirby

Can you actually just set up a limited company and have the NHS pay the company directly.I guess as a locum you are self employed. Sounds like a pretty sweet deal for anyone trying to pay off those loans

RobFowl

briankirby wrote: »

Can you actually just set up a limited company and have the NHS pay the company directly.I guess as a locum you are self employed. Sounds like a pretty sweet deal for anyone trying to pay off those loans

No these posts are all salaried with no exceptions (PS NHS is the UK only).
The point of intern and SHO jobs are largely for training purposes. These are not supposed to be viewed purely in terms of earning potential but in terms of how they train you to be a GP/Consultant/PHD/other once you have finished training.
Hunt for jobs simply on the basis of which pay best and you will end up with a deeply disappointing career.

briankirby

I see what u are saying but for someone who is 150k in debt and wants to chip away at it it seems like a good option.Not sure why dissed doc mentioned limited company then.Maybe he is mistaken

RobFowl wrote: »

No these posts are all salaried with no exceptions (PS NHS is the UK only).
The point of intern and SHO jobs are largely for training purposes. These are not supposed to be viewed purely in terms of earning potential but in terms of how they train you to be a GP/Consultant/PHD/other once you have finished training.
Hunt for jobs simply on the basis of which pay best and you will end up with a deeply disappointing career.

RobFowl

briankirby wrote: »

I see what u are saying but for someone who is 150k in debt and wants to chip away at it it seems like a good option.Not sure why dissed doc mentioned limited company then.Maybe he is mistaken

I see your point but it's misguided. 150k is a 10years plus level of debt. As a junior doc you're not going to clear it but as a trained doc then you can make the sort of money needed.
GP training takes 5 years and FT GP's are still starting on 70-90k with extra for OOH's work. If money or clearing debt is your focus thats a better route to follow.
That said as a career your need to pick a speciality you love and picking one purely for cash will cause misery....

dissed doc

RobFowl wrote: »

I see your point but it's misguided. 150k is a 10years plus level of debt. As a junior doc you're not going to clear it but as a trained doc then you can make the sort of money needed.
GP training takes 5 years and FT GP's are still starting on 70-90k with extra for OOH's work. If money or clearing debt is your focus thats a better route to follow.
That said as a career your need to pick a speciality you love and picking one purely for cash will cause misery....

Sorry, that is nonsense. Consultant salaries are currently around €4.5k/month and set to drop to the a target net income of €4k within 5 years. You will *never* pay off that debt.

In Ireland, doing a few years hospital rotations and then doing GP locums is th best route. Training schemes in aireland are complete BS and a complete waste of time IMO. You are takki g about salaried positions which is never ever going to make a dent in that level of debt. You need to get active and work.

To answer the above question, yes its normal for people to work through their own LLC in the UK. NHS will not contract directly so you go through agencies, who will bill you out for 15% higher for example.

Forklifted

Thanks for all the replies. An interesting debate.

My main worry is that the repayments for the first 4 or 5 years (€1200/month) will be crippling and I thought if I could do one year somewhere where I could cut that debt in half it would make life easier after that. Is SHO locums in the UK the best way to do that?

How much would one year out of training really affect my career thereafter?

dissed doc

Forklifted wrote: »

Thanks for all the replies. An interesting debate.

My main worry is that the repayments for the first 4 or 5 years (€1200/month) will be crippling and I thought if I could do one year somewhere where I could cut that debt in half it would make life easier after that. Is SHO locums in the UK the best way to do that?

How much would one year out of training really affect my career thereafter?

I don't think it makes a bit of difference. Despite what you will hear, no one actually cares if you spend 20 years doing SHO in some small town waiting to get an SpR post. There is zero goodwill and zero loyalty by the state employer or senior consultants. The only real thing that is risky is you will see what it's like outside the completely institutionalised Irish NCHD scene. People don't like hearing that how they are living and working is complete crap.

No one cares if you did some SHO scheme in Ireland with some supposedly reknowned consultant. 10 years later it doesnt matter a damn, like the leaving cert when you are in final med. No-one cares about your grinds, A in maths or points.

RobFowl

dissed doc wrote: »

Sorry, that is nonsense. Consultant salaries are currently around €4.5k/month and set to drop to the a target net income of €4k within 5 years. You will *never* pay off that debt.

In Ireland, doing a few years hospital rotations and then doing GP locums is th best route. Training schemes in aireland are complete BS and a complete waste of time IMO. You are takki g about salaried positions which is never ever going to make a dent in that level of debt. You need to get active and work.

To answer the above question, yes its normal for people to work through their own LLC in the UK. NHS will not contract directly so you go through agencies, who will bill you out for 15% higher for example.

This advice is unfortunately well out of date and incorreect. Due to the changes in the medical practitioners act NCHD's in training can only work in the hospital or training unit they are attached to.
Also the days of non GP's doing GP locums are gone as the MPS and Medisec will no longer cover non vocationally trained docs for GP work (they changed this about 2 years ago for anyone looking for cover from then).

Re the debt it is huge but not insurmountable.
The consultants salary scale is €116 -121k
Using the 2011 salary calculator http://www.irishtimes.com/indepth/budget2011/calculator/
This gives a starting salary of €5795 a month (not €4,500!) increasing to just over €6000 after 5 years.
the repayments on 150k over just 5 years are € 2845 a month or over 10 years €1500 a month. Tough but far from impossible.

Regarding taking time out from training to earn money doing locums, firstly you need enough experience to get and be able to safely do the locum. This means you will have to do some training positions at SHO level at the very least. Gaps in the CV have to be explained and while travel and experience abroad are sometimes looked on well anyone I've know who took time out to locum had great difficulty getting on to training schemes after. Dissed Doc may not rate training schemes here but at the end of the day you need to get on one somewhere in order to train and qualify as a GP/Consultant/PHD/other.

The situation is certainly a lot tougher than a few years ago but nowhere near as negative as some of the posters would have you believe.....

PS re the LLC route, training positions are all salaried with no exception. Locum work (in the UK) you are technically self employed but almost all of it is accessed through agencies. You can set up a LLC for locum work but in the UK it's of limited benefit as locums are still self employed there as opposed to here where the revenue views locums a being employed by the agency the work for (either GP/Hosp or locum agency)

briankirby

RobFowl wrote: »

This advice is unfortunately well out of date and incorreect. Due to the changes in the medical practitioners act NCHD's in training can only work in the hospital or training unit they are attached to.
Also the days of non GP's doing GP locums are gone as the MPS and Medisec will no longer cover non vocationally trained docs for GP work (they changed this about 2 years ago for anyone looking for cover from then).

Re the debt it is huge but not insurmountable.
The consultants salary scale is €116 -121k
Using the 2011 salary calculator http://www.irishtimes.com/indepth/budget2011/calculator/
This gives a starting salary of €5795 a month (not €4,500!) increasing to just over €6000 after 5 years.
the repayments on 150k over just 5 years are € 2845 a month or over 10 years €1500 a month. Tough but far from impossible.

Regarding taking time out from training to earn money doing locums, firstly you need enough experience to get and be able to safely do the locum. This means you will have to do some training positions at SHO level at the very least. Gaps in the CV have to be explained and while travel and experience abroad are sometimes looked on well anyone I've know who took time out to locum had great difficulty getting on to training schemes after. Dissed Doc may not rate training schemes here but at the end of the day you need to get on one somewhere in order to train and qualify as a GP/Consultant/PHD/other.

The situation is certainly a lot tougher than a few years ago but nowhere near as negative as some of the posters would have you believe.....

PS re the LLC route, training positions are all salaried with no exception. Locum work (in the UK) you are technically self employed but almost all of it is accessed through agencies. You can set up a LLC for locum work but in the UK it's of limited benefit as locums are still self employed there as opposed to here where the revenue views locums a being employed by the agency the work for (either GP/Hosp or locum agency)

Yes,training positions are salaried but as u stated locum jobs(in uk hospitals) view u as being self employed meaning u can set up an LLC there and have the money paid to your company.I think this is what dissed doc is getting at.Id be willing to bet there are foreign trained doctors doing this.The ones who know there is no hope of them getting on a training scheme.With locum rates,if u did this for a few years the debt would easily be paid off.And thats if u dont get on a training scheme.Happy days for those who are worried about paying back the debt.

Ryder

@Dissed doc..off topic, but I dont want your incorrect assertions about training in Ireland to go unchallenged. Im sorry that you feel the training is terrible and loyalty is lacking. 13 years as an NCHD and I see it much differently. NCHD life is tough (always has been). The hours are no different now to when I started as an intern (and apparently were the same 13 years before that again). Training has improved immensley. Weekly journal clubs, case discussions, consultant/spr led tutorials prior to exams, college training days.....do you not get any of these? Did you not even hear of them? I genuinely havent worked in a hospital where there was not weekly teaching of some sort. Sprs/regs teaching shos on the job. Did your consultants not guide/advise you?...any of them? The popular thing now is to slam the Irish system. Absolutely the hours are tough, pay is crap...and unpaid, the employer body had little regard for us, but training is not crap. Irish trainees walk into senior positions abroad, often above trainees of that system and are held in high regard.

@OP..I didnt get into the thread to comment on money, Ive really no idea about locum pay, but any begining doctor needs training. Even after intern year, you will find yourself very inexperienced and doing odd locums here and there, across multiple specialities, where they will have no loyalty to you will result in ZERO training. The medical council now require all doctors to show evidence of continuing professional development. Any mistake you made as a locum, without requisite training would reflect all the worse on you. Its a professional responsibility. Spending years as a locum will not derail your career, but are an unnecessary diversion, and may have a negative impact. It depends. As Robfowl said, 100,000e loans are a long term bet and the banks know that. Theres always some people who advise stepping outside the box, its just interesting that they never seem to do it themselves......

Marcusm

RobFowl wrote: »

Re the debt it is huge but not insurmountable.
The consultants salary scale is €116 -121k
Using the 2011 salary calculator http://www.irishtimes.com/indepth/budget2011/calculator/
This gives a starting salary of €5795 a month (not €4,500!) increasing to just over €6000 after 5 years.
the repayments on 150k over just 5 years are € 2845 a month or over 10 years €1500 a month. Tough but far from impossible.

I'm not a doc but I am a financing specialist. I'm not sure your analysis is quite right; the debt has been accrued at the end of the graduate programme but any prospect of a consultant's post is (at least) 10 years away. The debt will be much larger by then if indeed the institution permits effectively a further 10 year period with limited or no repayments. I'm surprised that any rational institution is continuing to provide finance for graduate medicine in Ireland - the post qualification remuneration structure for the average doctor does not permit repayment in a reasonable period. It seems to me also to be a millstone given that, on graduation, an intern year is not even guaranteed, much less a high paid subsequent post.

It's not a risk that I would look to underwrite without significant additional security, meaning that graduate medicine courses would be limited entry.

RobFowl

Marcusm wrote: »

I'm not a doc but I am a financing specialist. I'm not sure your analysis is quite right; the debt has been accrued at the end of the graduate programme but any prospect of a consultant's post is (at least) 10 years away. The debt will be much larger by then if indeed the institution permits effectively a further 10 year period with limited or no repayments. I'm surprised that any rational institution is continuing to provide finance for graduate medicine in Ireland - the post qualification remuneration structure for the average doctor does not permit repayment in a reasonable period. It seems to me also to be a millstone given that, on graduation, an intern year is not even guaranteed, much less a high paid subsequent post.

It's not a risk that I would look to underwrite without significant additional security, meaning that graduate medicine courses would be limited entry.

Financial institutions no longer provide gradmed finance AFAIK as the figures do not add up for repayment during postgrad training. A repayment scehdule would have to be agreed but as intern pay is about 30k + overtime (possibly as little as 8k) the repayments in the first few years will be minimal. Working locums as an untrained doc is very dodgy professionally and possibly not even feasible with the new clinical governance guidelines. Hence my feeling is repayments simply won't occur on the bulk of the debt until the doc is finished training, on the specialist register or at least eligible to work independently. For an Irish doc to do that they would have to (the minimum needed) get on the "general " register and quite frankly I don't think a doc with 1/2/3 years experience will be permitted on that branch of the register.

nerrad01

Marcusm wrote: »

I'm not a doc but I am a financing specialist. I'm not sure your analysis is quite right; the debt has been accrued at the end of the graduate programme but any prospect of a consultant's post is (at least) 10 years away. The debt will be much larger by then if indeed the institution permits effectively a further 10 year period with limited or no repayments. I'm surprised that any rational institution is continuing to provide finance for graduate medicine in Ireland - the post qualification remuneration structure for the average doctor does not permit repayment in a reasonable period. It seems to me also to be a millstone given that, on graduation, an intern year is not even guaranteed, much less a high paid subsequent post.

It's not a risk that I would look to underwrite without significant additional security, meaning that graduate medicine courses would be limited entry.

the banks have stopped giving out the full loan, so now the max is 60k to cover fees only. BOI require a guarantor and UB are the only ones providing the loan without it, i can see the loan situation getting worse as i think paying back 60k will be a struggle whereas 100k is next to impossible while having any sort of reasonable lifestyle. The schools seem to have a similar attitude to the HSE in that they dont care what happens to you after as long as they get their fees.

(im pretty sure your the disposable cash you would be left with each week would be similar to the dole, despite prob having worked an 80 hour week, with some 24-36 oncall shifts thrown in there and having punished yourself with 4 years of med school!)

chanste

Does anyone know if there is a good reason why some of us can't get some of the debt written off? I mean I know it won't look good for a credit rating but honestly I don't care about that I will happily rent. I suspect the advice of a good accountant may be of use when dealing with the banks to discuss repayments.

If I pay with my basic hours my rent, and some very basic living expenses it would only leave a few hundred per month to go off this loan, when what is needed is well over €1000. The banks cannot get blood out of a stone and nobody is going to end up in court over this if they can show that they are paying what they can afford - and by that I mean what a person can afford doing a basic week. It wouldn't be expected in any other circumstance to do excessive hours to pay the bills.

nerrad01

chanste wrote: »

Does anyone know if there is a good reason why some of us can't get some of the debt written off? I mean I know it won't look good for a credit rating but honestly I don't care about that I will happily rent. I suspect the advice of a good accountant may be of use when dealing with the banks to discuss repayments.

If I pay with my basic hours my rent, and some very basic living expenses it would only leave a few hundred per month to go off this loan, when what is needed is well over €1000. The banks cannot get blood out of a stone and nobody is going to end up in court over this if they can show that they are paying what they can afford - and by that I mean what a person can afford doing a basic week. It wouldn't be expected in any other circumstance to do excessive hours to pay the bills.

im sure they would restructure the loan to make it more bearable, as you said its practically impossible to live while paying off the full loan....Or head to austrailia and never look back!!

dissed doc

RobFowl wrote: »

This advice is unfortunately well out of date and incorreect. Due to the changes in the medical practitioners act NCHD's in training can only work in the hospital or training unit they are attached to.
Also the days of non GP's doing GP locums are gone as the MPS and Medisec will no longer cover non vocationally trained docs for GP work (they changed this about 2 years ago for anyone looking for cover from then).

Fair enough, I completely forgot about how the stalinist control over doctors has advanced so far!

Re the debt it is huge but not insurmountable.
The consultants salary scale is €116 -121k
Using the 2011 salary calculator http://www.irishtimes.com/indepth/budget2011/calculator/
This gives a starting salary of €5795 a month (not €4,500!) increasing to just over €6000 after 5 years.
the repayments on 150k over just 5 years are € 2845 a month or over 10 years €1500 a month. Tough but far from impossible.

Here is where you are wrong though. Use taxcalc.eu for public sector to calculate the salary asthe Irish Times is not valid for 2013 and for public sector workers. At the moment €116k is €4718/month. The Croke Part II cuts will mean another 6.3% off of that, thus given a gross of €108k (4487/month). There will be further cuts within the next 5 years thus my prediction of net €4k/month for new consultants. That is the rough net income of a new Fachtarzt in Germany (but reached around 5 years after graduation, not 15 years like in Ireland).

You start as an intern on €1900/month, and as a consultant 10 years later on €4k/month. That is the future so no, there is absolutely no way any person could afford €1500/month repayments for a decade while earning not much more than that. Rent+ living on €400/month? I laugh out loud

Agnieszka_88

I would honestly love to see one of those loan agreements. How high are the interest rates? If I appreciate the interest to 6,5% (customary for personal loans), and the term is 10 years, you'd have to pay around 1.100 EUR every month, which is, of course, absolutely impossible. I'm a financial auditor, so I deal with company loans all the time, and all I have to say is that there have to be some hard core guarantees on this kind of loan, because there is no chance on earth that anyone could pay it back in 10 years time with these pay scales. The banks will get their money all right, they'll either restructure the loans against additional fees or they'll have your guarantor pay for you.
60T is difficult but doable, about 700/month.

Edit: Just wanted to add that there is no way that the 100T loans will ever be offered again, because they would have to be booked as high risk capital under the new Basel III rules. The bank would have to prove that they have enough liquid assets to cover the risky amount, and no bank holds that much cash (simplification, I know), especially not in this economy and with those tax rates.

dissed doc

Agnieszka_88 wrote: »

I would honestly love to see one of those loan agreements. How high are the interest rates? If I appreciate the interest to 6,5% (customary for personal loans), and the term is 10 years, you'd have to pay around 1.100 EUR every month, which is, of course, absolutely impossible. I'm a financial auditor, so I deal with company loans all the time, and all I have to say is that there have to be some hard core guarantees on this kind of loan, because there is no chance on earth that anyone could pay it back in 10 years time with these pay scales. The banks will get their money all right, they'll either restructure the loans against additional fees or they'll have your guarantor pay for you.
60T is difficult but doable, about 700/month.

Edit: Just wanted to add that there is no way that the 100T loans will ever be offered again, because they would have to be booked as high risk capital under the new Basel III rules. The bank would have to prove that they have enough liquid assets to cover the risky amount, and no bank holds that much cash (simplification, I know), especially not in this economy and with those tax rates.

I am definitely not a financial auditor, but originally when these were coming out (circa 2007) consultant salaries were a whopping €12,071/month *net* (based on the €240,000/year public only contracts). Net income for a new consultant 6 years later in 2013 after Croke Park II is 37% of the original salary. That is what you call a pay cut; I don't think the banks really expected the HSE, DoH or government to introduce such financially instability to doctors lives.

Bizarrely, the HSE contracts forbid the doctor from working privately even on their own time. It's 24/7 obligation to the HSE so no chance of even earning extra money to pay off the loans.

ThatDrGuy

I would have to say personally Irish medical training is god awful. Its only the vast volumes of patients you see combined with the dangerous out of your depth but no support so go to do it situations that lead to learning. I learned to use CPAP on a severely hypoxic patient by googling it. I was working for a professor of resp medicine at the time! You see people coming out of SHO schemes unable to treat Afib but who can strip and rebuild a broken printer in 2 minutes. Training is the dirtiest word in the HSE vocabulary. The ships surgeon on the space shuttle, head of medicine at nasa, associate prof of neurology : he hasn't spent 13 years training! Not to say Irish medics and surgeons are bad at what they do. It just takes an unacceptable amount of time ( and personal sacrifice ) to get to that stage: for 4,500 ish a month and a 20% chance of a job its downright lunacy. If I was doing it again I would have headed straight to OZ and never looked back.

take everything

ThatDrGuy wrote: »

You see people coming out of SHO schemes unable to treat Afib but who can strip and rebuild a broken printer in 2 minutes.

Brilliant.

his_dudeness

dissed doc wrote: »

Bizarrely, the HSE contracts forbid the doctor from working privately even on their own time. It's 24/7 obligation to the HSE so no chance of even earning extra money to pay off the loans.

Am I wrong in saying that the new contracts with their "rostering" arrangements maxes out at 40hours - and in any case, EWTD appplies to consultants too.

If/when I finish and get consultancy, I'll be taking my 100k and clocking out at my 40 hours. Might actually get a bit of a life (albeit at a standard considearbly less than I would have expected) **** for paying off student loans but could bring around a new breed of less private practice driven consultants.

It'll make **** of patient care and patient continuity though....

Forklifted

Looks like this has sparked a good debate, thanks for all the replies. There are many more in my situation so this is a worthwhile conversation (p.s. we seek no pity as we got ourselves into this).

I'm beginning to understand that I will still be under qualified post-Internship or even after one or two years of SHO to consider locuming under an LLC.

Like many early GEMs I have the full €100k however some of the financial advisors who have commented will be appalled to know that I do not have a guarantor for it - just life insurance. I suppose they can always kill me if I'm struggling to pay it back!! This puts the ball in my court on graduation (somewhat!).

For those who wanted the details, the loans are at 4% with no repayments for the four years, leaving you with about €106k on graduation. Then the loan reverts to a 15 year term at the same interest rate but with an understanding that it will be paid in 10 year based on the assumption that you will make more in the later years. There is also an interest only option for intern year which would be around €400-500 per month. Nobody will be paying €1500 per month, its just not possible for the initial 4/5 years.

I suppose my initial question was really seeking to find out if the overtime/call adds up. One poster mentioned that inters might get as little as €8k for that but even after tax that roughly amounts to my (interest only) loan payment for the year. This makes a huge difference to me if true.

Too

It depends on:
1 what speciality (unrostered OT)
2 whether hospital pays unrostered overtime
3 if you work the day post call or not
4 frequency of call

In surgery you will double your gross with OT in most jobs but your net is only about 47% of this. In medicine your gross is less and in micro path etc there is no overtime.

This does not take into account croke park II. Deduct another 10% off your gross.

Nor does it take into account the effect of the "NCHD spring". Many interns only work 48 hrs on average and it looks like this will be extended up through the ranks so SHO and reg income will dramatically reduce.

I echo the comments above. In my experience, Irish training (for those who work hard, are copped on, take the initiative and basically put in the time and effort) is excellent and Irish trained doctors are sought the world over. However knee jerk implementation of EWTD onto the beurocratic unionised chaos that is the Irish system will, in my opinion, result in alot of very poor, badly trained and disillusioned doctors.

I would not like to be starting out again in medicine in Ireland today. If you want to stay then do but make sure your eyes are open and your goals are realistic. however after your intern year is a good time to consider moving. The US if you have the drive and the pedigree but otherwise consider Australia or Canada.

dissed doc

Too wrote: »

It depends on:
1 what speciality (unrostered OT)
2 whether hospital pays unrostered overtime
3 if you work the day post call or not
4 frequency of call

Personally I think they will introduce the EWTD at 48hrs/week max, and that will be all you can get paid for then. But, you will still end up doing the 70hrs+/week like 15 years ago, but unpaid. Nothing will actually change except a reduction in the overtime bill through a box-ticking EWTD-compliant rota.

dissed doc

ThatDrGuy wrote: »

I would have to say personally Irish medical training is god awful. Its only the vast volumes of patients you see combined with the dangerous out of your depth but no support so go to do it situations that lead to learning. I learned to use CPAP on a severely hypoxic patient by googling it. I was working for a professor of resp medicine at the time! You see people coming out of SHO schemes unable to treat Afib but who can strip and rebuild a broken printer in 2 minutes. Training is the dirtiest word in the HSE vocabulary. The ships surgeon on the space shuttle, head of medicine at nasa, associate prof of neurology : he hasn't spent 13 years training! Not to say Irish medics and surgeons are bad at what they do. It just takes an unacceptable amount of time ( and personal sacrifice ) to get to that stage: for 4,500 ish a month and a 20% chance of a job its downright lunacy. If I was doing it again I would have headed straight to OZ and never looked back.

Yeah but it's denial and only way to work through the "cognitive dissonance" of spending so long in what is meant to be training. Studies say that specialists are at their best if they get out into practice in their 30s. So Irish grads get posts in their 40s and somehow "okay" it in their heads, but the research says that they wasted their time, because specialists in the US, UK, Netherlands are out as consutlants 5-6 years from graduation but spending 14yrs+ in training in Ireland makes you somehow better? BS. Complete horsesh1t, TBH.

irish grads are not sought after; this is historic due to previous ties with the UK which are now rapidly fading due to bridges being burned by our dear leaders (.eg., Pakistan recruitment drive). They speak English and have cost nothing to train; Aus or Canada gets a "free" specialist that can communicate. That is what is sought after. Ego and self-delusion over a decade and a half in training are not.

As an aside, the HSE and DoH have effectively implemented what is being planned in the UK with consultants and "super-consultants". 90% of the consultants will have limited incomes and no bonuses and 10% will have access to extra financial awards, etc., . Right now, this will take only 5-10 years to implement in Ireland as consultants on higher contracts dwindle in number and more people take up the regular contract. None of these things are things that the IMO or any doctor can fight against as it is being completely unilaterally imposed.

his_dudeness

The interns will always be the first to be brought in line with EWTD, they're just an easier grade to organise and for the most part dont cover ED so its only ward work that'd have to be changed.

An option to maximise your OT is to pick a smaller hospital where doctor numbers are too small to fully implement the 48hour working week, hospitals like Roscommon, StnJohns in Limerick, Wexford.youll end up working more, and it'll probably be quieter, and cost of living at these smaller hospitals tends to be less too, so better take home pay. Cn do the same at SHO too, pick a medical scheme that has you manning Ennis and Nenagh. It'll be soul destroying but technically "training" and prob best bet to maximise take home pay. I did 6 months in Roscommon as an intern three years ago on a 1 in 5 rota doing 28 hour shifts and made a packet.

The private hospitals take on RMO staff at pretty competitive rates too, without needing too much experience. I have a lot of friends working in a certain private hospital in the west while they're doing research and seem to be doing okay out of it.

Bella mamma

RobFowl wrote: »

Also the days of non GP's doing GP locums are gone as the MPS and Medisec will no longer cover non vocationally trained docs for GP work (they changed this about 2 years ago for anyone looking for cover from then).

About 6 months ago (no less), I asked The Medical Council about this as you are correct in that The MPS etc will not cover for GP work if you are not a GP. It's listed as one of the 6, or so, exclusions including Cosmetic work, OBGYN etc. The reason I asked is twofold: SHOs who don't get on the GP training scheme (a common occurrence) don't want to stay on in hospitals AND I know a doctor who did their 2 years of SHO training (BST) and has been working in a GP office since, which is 3 years since they finished SHO training and did The MRCPI. They work full time in 2 practices in Dublin, 4 days plus 1 day. They were unable to get on the scheme x 3 and did not apply this year in case fast-tracking comes in next year. The Medical Council were very clear in telling me that any doctor could work in a GP office as long as they did not "mis-represent themselves as a GP". They agreed that patients would think such a doctor was indeed a GP, but as long as the doctor didn't say they were a GP, it was fine. This doctor is also on the list for the national cervical smear taking programme. Surely there must be more non-GPs doing GP work and using the term 'assistant' if patients ask? (Though patients would never ask). What will happen to these doctors now? And most importantly, how are they covered insurance wise??

OP: How much per year are GEM fees? Are they €13k x 4 years and the remainder for living expenses? I agree with around €8k in overtime payments, €12k max. SHO is not much better, at a salary of €38.8k plus that overtime. Sadly if you don't really want to, you will be in a much better position to emigrate and do all your training abroad. You can do GP in England too.

Chanste: Why would you think that your loan could be written-down, are you equating it with negative equity write-downs? That's completely different. It can be re-structured. You have earning potential but there is no way they will reduce it.

chanste

Bella mamma wrote: »

Chanste: Why would you think that your loan could be written-down, are you equating it with negative equity write-downs? That's completely different. It can be re-structured. You have earning potential but there is no way they will reduce it.

TBH although I know I don't have a mortgage, I guess I was thinking that for a loan this big there ought to be some kind of wiggle room. If personal insolvency systems can allow someone to write off part of the negative equity of a house, I'm not sure exactly why I shouldn't be able to do the same. People who bought property and then got stung by the recession aren't so different to me having got a large student loan of €100k with what was at the time looking like a much more stable proposition, then because of the recession and cut backs its far more difficult to earn significantly. When I got the loan I also did not need a guarantor, but I also didn't require life insurance (at least I don't remember getting any - but I'm certain about the guarantor).

For the record, I am not planning on defaulting on my loan or anything of the sort, but I think that the only way I could manage to pay this loan would be interest only, and because this would prohibit me from ever getting a mortgage having a loan this big with capital that isn't reducing, what could be worse about defaulting? It is in the banks interest to make me see why paying it is a better option, and the best way I can think of doing that is to either prolong the reduced interest rate which I was on as a student or to write down a chunk of the loan.

chanste

Just thought I'd draw attention to this for people who end up struggling with med loans. This is from the personal insolvency act of 2012. If I understand it correctly (and please do correct me before this starts giving me undue hope) a "Debt Settlement Arrangement" (DSA) will allow a person to apply to have unsecured loans above the value of €20,000 paid off within 5 or 6 years taking into account their means.

The page is well worth a read for anybody with money worries.
http://www.citizensinformation.ie/en/money_and_tax/personal_finance/debt/personal_insolvency/personal_insolvency_options.html

Forklifted

Bella mamma wrote: »

OP: How much per year are GEM fees? Are they €13k x 4 years and the remainder for living expenses? I agree with around €8k in overtime payments, €12k max. SHO is not much better, at a salary of €38.8k plus that overtime. Sadly if you don't really want to, you will be in a much better position to emigrate and do all your training abroad. You can do GP in England too.

They started out at €13k but they've risen to €15k now. Looks like it could rise another €1k each year at the moment as the Higher Education Authority keep cutting their contribution to the overall fee.

I need to decide what it is I want to do. GP seems like the best route considering age, lifestyle etc in Ireland. But I don't know what the jobs market is like here in Ireland for qualified GPs?

Personally I don't mind going abroad to train (be it to the US for Internal Med + a fellowship or to the UK for GP) but I know there will be many in my position who don't want to or can't leave.

Forklifted

chanste wrote: »

Just thought I'd draw attention to this for people who end up struggling with med loans. This is from the personal insolvency act of 2012. If I understand it correctly (and please do correct me before this starts giving me undue hope) a "Debt Settlement Arrangement" (DSA) will allow a person to apply to have unsecured loans above the value of €20,000 paid off within 5 or 6 years taking into account their means.

The page is well worth a read for anybody with money worries.
http://www.citizensinformation.ie/en/money_and_tax/personal_finance/debt/personal_insolvency/personal_insolvency_options.html

I know that they have similar measures in the UK but if you go before the judge as a qualified doctor he'll throw it out immediately based in future earning potential alone. I think the reality is that it will have to be paid!

etymon

Dug out my loan agreement from 2010 which is interesting. 100k over 4 years, 25k each year, no life assurance, no security, no repayment schedule AT ALL. The duration of the agreement is year to year i.e. 2010 - loan amount = 25,000 repayable by 23 September 2011 in one instalment. 2011- loan amount is now 50,900 repayable by 24 September 2012 in one instalment. Obviously I didn't pay that and now i am up to 75k plus but what is to stop me from paying them 200 quid a month for the rest of my life? Apart from the obvious i.e. the debt never goes away. Meh, I've lived with debt long enough. I could handle it.

Forklifted

etymon wrote: »

Dug out my loan agreement from 2010 which is interesting. 100k over 4 years, 25k each year, no life assurance, no security, no repayment schedule AT ALL. The duration of the agreement is year to year i.e. 2010 - loan amount = 25,000 repayable by 23 September 2011 in one instalment. 2011- loan amount is now 50,900 repayable by 24 September 2012 in one instalment. Obviously I didn't pay that and now i am up to 75k plus but what is to stop me from paying them 200 quid a month for the rest of my life? Apart from the obvious i.e. the debt never goes away. Meh, I've lived with debt long enough. I could handle it.

At the moment, there technically isn't much to stop you doing that. But in reality they will make life more difficult than it should be. Constant letters, phone calls, the odd court appearance to start with. The prospect of renting for most of your life due to a poor credit rating. Plus every time you acquire an asset they'll chase it.

I don't think its worth thinking about the option of not paying it as it'll have to be paid.

HeadPig

I feel physically ill reading about the mistreatment and exploitation of Irish doctors. Disgusting. Wish we had the power to strike.

his_dudeness

HeadPig wrote: »

I feel physically ill reading about the mistreatment and exploitation of Irish doctors. Disgusting. Wish we had the power to strike.

We do.

drzhivago

Forklifted wrote: »

Looks like this has sparked a good debate, thanks for all the replies. There are many more in my situation so this is a worthwhile conversation (p.s. we seek no pity as we got ourselves into this).

I'm beginning to understand that I will still be under qualified post-Internship or even after one or two years of SHO to consider locuming under an LLC.

Like many early GEMs I have the full €100k however some of the financial advisors who have commented will be appalled to know that I do not have a guarantor for it - just life insurance. I suppose they can always kill me if I'm struggling to pay it back!! This puts the ball in my court on graduation (somewhat!).

For those who wanted the details, the loans are at 4% with no repayments for the four years, leaving you with about €106k on graduation. Then the loan reverts to a 15 year term at the same interest rate but with an understanding that it will be paid in 10 year based on the assumption that you will make more in the later years. There is also an interest only option for intern year which would be around €400-500 per month. Nobody will be paying €1500 per month, its just not possible for the initial 4/5 years.

I suppose my initial question was really seeking to find out if the overtime/call adds up. One poster mentioned that inters might get as little as €8k for that but even after tax that roughly amounts to my (interest only) loan payment for the year. This makes a huge difference to me if true.

Coming to this late but have significant experience of hospital earnings and potential and also locum earnings and potential

I note the contribution from a few financial advisors and this looks worrying for anyone intending to study GEM in the next few years

FACTS

• No Guarantee of job on graduation from college = Quite a number of graduates will have to emigrate at this point
• 2nd Year post grad = SHO - Most jobs at this level now attached to some sort of training scheme (even if only in name without the actual training as some have alluded to) which means person is on Trainee register which PROHIBITS working outside your hospital - SO ILLEGAL TO DO LOCUMS
• SHO Earnings are quite low if paying rent/living expenses you might not even be able to afford that years interest on the 100+K accumulated debt at that point
• SHO PAID HOURS are reducing in line with EWTD, WORKING HOURS MAY NOT actually reduce but paid hours will
• Moving from SHO - REGISTRAR = competitive application process and not always enough jobs for applicants which means more years on lower scale as SHO in NON training job with potential to do locums or EMIGRATE
• SPR very competitive to get on to and if proceeding to this point it will be at least 10 and more likely 12 years post UNIVERSITY that you will complete SPR and get CCST (Certificate of Completion of Specialist training) which allows you to apply for consultant job but no guarantee of same -- AS SPR you wil earn more than SHO BUT you will have higher outgoings through exams conferences reserach etc that you will have to pay yourself so ability to pay back on laon may actually decrease in these years also as there are the exam fees/courses etc
• NEW CONSULTANT SALARY = 109-116k NET POSITION again means probably will only be able to afford small payments off loan
• IN REALITY your first job as an intern has salary of 30K, IF you asked for a mortage in that year which is a 20+ year term loan then you would be unlikely to get more than 75K in current climate and YET you will have graduated with a loan 33% more to be repaid ina shorter time --

Taking all of above into account TBH looks like writing is on the wall for graduate entry medicine unless schemes of refunding are put in place with debt forgiveness for working in certain areas/hospitals/specialities

I wish you luck as I do not see a way out of this

Regarding your question on earnings as an INTERN, I think you have to figure in the 48 hour maximum and dont expect any more earnings than that in INTERN year, if you do i fear you will be disappointed


This is an issue that you shoudl take to USIT / IMO / Local politicans to show you cant afford to work after paying for this education unless they structure things differently

drzhivago

Have had an interesting chat with a financial person

He knows career path for docs in Ireland and also the gaps ie not enough jobs at various levels

One option he has suggested is
Intern in Ireland
Move to UK for SHO job for 2-3 years
When ;and in UK declare bankruptcy (a la what we read in newspapers except you would actually be based there and not juts on paper)

Bankruptcy in UK does not affect GMC registration unless you become bankrupt because of the method of running your medical practice or unethical behaviour

at this point we cant find the relevant data/legislation related to how this would affect your Irish registration if you maintain such while you go to UK, there are some constraints in irish Veterinary registration related to undischarged bankrupts but cant seem to find similar for docs

So in essence Go East young men and girls would seem to be the answer to your massive debts, in particular if you dont get intern job here but can secure Foundation job in UK

briankirby

dissed doc wrote: »

Sorry, that is nonsense. Consultant salaries are currently around €4.5k/month and set to drop to the a target net income of €4k within 5 years. You will *never* pay off that debt.

In Ireland, doing a few years hospital rotations and then doing GP locums is th best route. Training schemes in aireland are complete BS and a complete waste of time IMO. You are takki g about salaried positions which is never ever going to make a dent in that level of debt. You need to get active and work.

To answer the above question, yes its normal for people to work through their own LLC in the UK. NHS will not contract directly so you go through agencies, who will bill you out for 15% higher for example.

Hey dissed doc,
When u say the agencies will bill you for 15% what do u mean exactly?Is it that they take 15% of your pay?Working 50 hours a week as an sho locum in the UK as u mentioned you could be making £8000 a month gross.If u set up an LLC that a tax rate of 21%.Your hospital accomodation will be paid for and through the LLC u can claim back for petrol and food if you are travelling every 4-6 months. Anybody who is worried about debt should just do this or do as drzhivago suggested and declare bankruptcy.This would be 75000 net a year excluding malpractice and all that.Im sure there are ways of getting the effective tax rate lower than 21% as i bet many are doing.