Sinn Fein - looming health service disaster?

ShowMeTheCash

Jawgap wrote: »

Why can't they draw doctors into General Practice then?

The ESRI have forecast will be 1800 GPs below where we should be by 2021. Also general practice gets squeezed - from an earlier article I posted up....



Nearly half of recently qualified GPs in one study said they were 'definitely' or 'possibly' emigrating - a further 24% were undecided and only 28% had ruled it out (ICGP - "Planning for the Future Irish General Practitioner Workforce -informed by a national survey of GP trainees and recent GP graduates)

This is a more complicated issue, throwing money at a problem seems to be the default position of ireland!... We have done a bang up job so far!

ShowMeTheCash

RecordStraight wrote: »

Apparently that idea has been abandoned for some reason.

Getting into symantics now.

Cap, reduction, cut - Outcome is the same.

SF are over simplifying in perhaps the execution of how to rectify a current problem but the idea is correct.

Jawgap

ShowMeTheCash wrote: »

This is a more complicated issue, throwing money at a problem seems to be the default position of ireland!... We have done a bang up job so far!

I quite agree, but I also think the SF Health Policy is populist nonsense that will actually make things worse (by driving doctors, nurses and other medical professionals from the system) and has zero potential to make things even fractionally better.

RecordStraight

ShowMeTheCash wrote: »

Getting into symantics now.

Cap, reduction, cut - Outcome is the same.

SF are over simplifying in perhaps the execution of how to rectify a current problem but the idea is correct.

If we lose even a small percentage of doctors from an already creaking system under the Sinn Fein proposals, I'm not sure the outcome will be the positive one you are hoping for.

Jawgap

ShowMeTheCash wrote: »

Getting into symantics now.

Cap, reduction, cut - Outcome is the same.

SF are over simplifying in perhaps the execution of how to rectify a current problem but the idea is correct.

Completely different - if your salary is capped at €100k you can never earn €101k

If your salary is levied at 15% then I can still earn €101k but I'll penalised disproportionately on that extra €1k

ShowMeTheCash

RecordStraight wrote: »

If we lose even a small percentage of doctors from an already creaking system under the Sinn Fein proposals, I'm not sure the outcome will be the positive one you are hoping for.

Again I disagree.

We have a problem but this idea that it is sooooo fragile that if we even look at it Doctors will be on the next ferry in their droves is a poor excuse!

Reform needs conviction..

ShowMeTheCash

Jawgap wrote: »

Completely different - if your salary is capped at €100k you can never earn €101k

If your salary is levied at 15% then I can still earn €101k but I'll penalised disproportionately on that extra €1k

Yeah cause caps never change!
Symantics!

RecordStraight

ShowMeTheCash wrote: »

Again I disagree.

There are mountains of evidence in this thread to demonstrate that pay is already an issue in trying to hire and retain doctors in this country. Cutting pay as Sinn Fein propose is going to cost us even more doctors from a system already at breaking point.

I encourage you to look at the evidence.

RecordStraight

ShowMeTheCash wrote: »

Yeah cause caps never change!
Symantics!

It's not semantics. It's a completely different mechanism.

ShowMeTheCash

RecordStraight wrote: »

It's not semantics. It's a completely different mechanism.

Fluffing the math is symantics, you might not see it that way but I do.
But let's argue over how cold the water is while we are drowning

Jawgap

ShowMeTheCash wrote: »

Yeah cause caps never change!
Symantics!

It's not really semantics.

If my salary is subject to a levy I can still earn an extra euro only I'll lose more of that Euro if I cross a threshold.

If it's capped, then it's capped. There is nothing I can do to earn, as salary, an extra cent.

Jawgap

ShowMeTheCash wrote: »

Yeah cause caps never change!
Symantics!

Btw, of course caps can change, but as long as there's one in place how can someone earn in excess of it?

they could take on another job or outside work - but if your employers tells you "I'm capping your salary at X" - how do you warn €X+1 unless the cap is varied upwards?

ShowMeTheCash

RecordStraight wrote: »

There are mountains of evidence in this thread to demonstrate that pay is already an issue in trying to hire and retain doctors in this country. Cutting pay as Sinn Fein propose is going to cost us even more doctors from a system already at breaking point.

I encourage you to look at the evidence.

We are a country at breaking point.
Our specilists are amoung the best paid in the world, junior doctors have a lot to aspire too but yet we still have an issue trying to hire and retain doctors....

This logic I find amazing!

Dog of Tears

Can there be a facet of democracy more depressing than the notion that there exists people who will argue there's no difference between a 'cap' and a 'levy' and yet their vote will count the same as yours?

ShowMeTheCash

Jawgap wrote: »

Btw, of course caps can change, but as long as there's one in place how can someone earn in excess of it?

they could take on another job or outside work - but if your employers tells you "I'm capping your salary at X" - how do you warn €X+1 unless the cap is varied upwards?

This logic means nothing.

I could draw up any number of forumla if you like to reduce and ensure paid salary never exceeds a certain amount, I could squeeze and squeeze the top end to a number that would not be attainable and say it's not a cap.

The naming convention is really just to prove popular this the "mod".

Jawgap

ShowMeTheCash wrote: »

We are a country at breaking point.
Our specilists are amoung the best paid in the world, junior doctors have a lot to aspire too but yet we still have an issue trying to hire and retain doctors....

This logic I find amazing!

We were a country at breaking point - not so much today.

the whole issue of pay and relativities has been thrashed out in the thread - maybe have a look?

Also the reasons why NCHDs and GP recruitment are problematic have also been thoroughly raked over - one of the reasons we have a problem holding on to our graduates in medicine is salary (along with other issues) - salary caps, increased marginal rates of tax etc do nothing to address one the core issues of NCHDs - their overall feeling of being undervalued and underappreciated.

SF's policies will not address this on any level.

ShowMeTheCash

Dog of Tears wrote: »

Can there be a facet of democracy more depressing than the notion that there exists people who will argue there's no difference between a 'cap' and a 'levy' and yet their vote will count the same as yours?

Maybe you should list what people you feel should not have a vote that counts?
Edited to remove personal abuse.

Jawgap

ShowMeTheCash wrote: »

This logic means nothing.

I could draw up any number of forumla if you like to reduce and ensure paid salary never exceeds a certain amount, I could squeeze and squeeze the top end to a number that would not be attainable and say it's not a cap.

The naming convention is really just to prove popular this the "mod".

Ok, we'll try again - if today I am paid €120,000 and my employers 'caps' my salary at €100,000 - I lose €20,000. I cannot get that back, unless the employer chooses to raise the cap or do away it with altogether.

If income in excess of €100,000 is levied at 15% then I lose €3,000 (15% of the €20,000) - I can maybe earn that back by taking on extra work etc.

That's the difference between a cap and a levy - perhaps SF abandoned the idea of a cap because it's a massive disincentive. The levy is not exactly a brilliant idea but at least there's some residual incentive to add on that extra hour of productivity.

ShowMeTheCash

Jawgap wrote: »

We were a country at breaking point - not so much today.

the whole issue of pay and relativities has been thrashed out in the thread - maybe have a look?

Also the reasons why NCHDs and GP recruitment are problematic have also been thoroughly raked over - one of the reasons we have a problem holding on to our graduates in medicine is salary (along with other issues) - salary caps, increased marginal rates of tax etc do nothing to address one the core issues of NCHDs - their overall feeling of being undervalued and underappreciated.

SF's policies will not address this on any level.

This makes no sense.

A specilist in this country are amoung the highest paid in the world.

You are comparing the lowest paid doctors (graduates) to make your argument suggesting a cap or a cut will make them more likely to leave.

When someone mentions cutting Public Sector salaries let's wheel out the lowest paid public sector employee with 15 kids and use them as an example!

RecordStraight

ShowMeTheCash wrote: »

We are a country at breaking point.
Our specilists are amoung the best paid in the world, junior doctors have a lot to aspire too but yet we still have an issue trying to hire and retain doctors....

This logic I find amazing!

That's not logic - that, unfortunately, is fact.

Jawgap

ShowMeTheCash wrote: »

This makes no sense.

A specilist in this country are amoung the highest paid in the world.

You are comparing the lowest paid doctors (graduates) to make your argument suggesting a cap or a cut will make them more likely to leave.

When someone mentions cutting Public Sector salaries let's wheel out the lowest paid public sector employee with 15 kids and use them as an example!

Nothing to do with that.

Imagine you're an Irish medical graduate - the world is your 'oyster' - you're at the bottom of the career ladder, but you can pretty much go anywhere and certain English speaking jurisdictions will happily and very actively welcome you.

As the survey discussed earlier - some will be tied here because of family commitments, but beyond that every graduate is in play - they can stay and run the gauntlet of a system with poorly defined career paths, in the hope that if they reach the top they won't face the uncertainty of a salary cap.

Or they can hop over to the UK and get on to a career track that guarantees them a consultant post once they hit all their milestones.

Or they can hightail to Oz, get paid more, have better weather and also be guaranteed a consultant post at the end of their professional training.

Or Canada, or the US etc etc

ShowMeTheCash

Jawgap wrote: »

Ok, we'll try again - if today I am paid €120,000 and my employers 'caps' my salary at €100,000 - I lose €20,000. I cannot get that back, unless the employer chooses to raise the cap or do away it with altogether.

If income in excess of €100,000 is levied at 15% then I lose €3,000 (15% of the €20,000) - I can maybe earn that back by taking on extra work etc.

That's the difference between a cap and a levy - perhaps SF abandoned the idea of a cap because it's a massive disincentive. The levy is not exactly a brilliant idea but at least there's some residual incentive to add on that extra hour of productivity.

I understand the math.

In truth the public sector if it was a business would have failed long ago, hospitals, schools essential areas would fail but as a society we cannot let them fail.

In the private sector it is simple, if there is no cash the option is take a cut or fail as a business!

Take your 120K, I could adjust the rates of taxtion and add levy's to make it your take home comes out less than the current rates and the introduction of a cap at 100K if you like.

ShowMeTheCash

RecordStraight wrote: »

That's not logic - that, unfortunately, is fact.

Point I am making we have some of the best paid, but we still cannot retain...
Would that not suggest the issue is not the salaries paid but other factors?

Jawgap

ShowMeTheCash wrote: »

I understand the math.

In truth the public sector if it was a business would have failed long ago, hospitals, schools essential areas would fail but as a society we cannot let them fail.

In the private sector it is simple, if there is no cash the option is take a cut or fail as a business!

.....

The public sector is not the private sector - are you suggesting that when hospitals expend their budgets or the Guards expend theirs that they should just shut up shop and turn people away or head home?

Say there's a major incident this evening and the hospitals get slammed, the Guards and Fire Service have turn out in numbers and the City Council has to activate it's emergency plan - all that has to be paid for and it has a budgetary impact - if, towards the end of the year, they find they've expended their budgets because they had to deal with a major incident should they just stop......

.....or maybe they should profile their budgets and stop dealing with incidents once a certain cost level has been reached.

ShowMeTheCash wrote: »

Take your 120K, I could adjust the rates of taxtion and add levy's to make it your take home comes out less than the current rates and the introduction of a cap at 100K if you like.

yes, you could, but I would still retain the capacity to add an extra euro to my income - if there was a salary cap I couldn't.

RecordStraight

ShowMeTheCash wrote: »

Point I am making we have some of the best paid, but we still cannot retain...
Would that not suggest the issue is not the salaries paid but other factors?

I agree that other factors are at work, but unfortunately Sinn Fein is proposing we cut the pay immediately, and sort out the other factors in some unexplained way at some point in the future.

Jawgap

ShowMeTheCash wrote: »

Point I am making we have some of the best paid, but we still cannot retain...
Would that not suggest the issue is not the salaries paid but other factors?

Well I've ignored this for long enough - where's the evidence to show that we have some of the best paid consultants?

ShowMeTheCash

Jawgap wrote: »

Nothing to do with that.

Imagine you're an Irish medical graduate - the world is your 'oyster' - you're at the bottom of the career ladder, but you can pretty much go anywhere and certain English speaking jurisdictions will happily and very actively welcome you.

As the survey discussed earlier - some will be tied here because of family commitments, but beyond that every graduate is in play - they can stay and run the gauntlet of a system with poorly defined career paths, in the hope that if they reach the top they won't face the uncertainty of a salary cap.

Or they can hop over to the UK and get on to a career track that guarantees them a consultant post once they hit all their milestones.

Or they can hightail to Oz, get paid more, have better weather and also be guaranteed a consultant post at the end of their professional training.

Or Canada, or the US etc etc

Good now we are getting somewhere, poorly definewd career path - Agree
Uncertainty of a cap - ???? Even though our specilists are the among the best paid in the world?? Makes no sense!

Hop over to the UK and get on to a career track that guarantees them a consultant post once they hit all their milestones - Agree

As for Oz and USA - That issue is different and I could got far to say that doctors in Ireland and the UK could do that.

Jawgap

ShowMeTheCash wrote: »

Good now we are getting somewhere, poorly definewd career path - Agree
Uncertainty of a cap - ???? Even though our specilists are the among the best paid in the world?? Makes no sense!

Hop over to the UK and get on to a career track that guarantees them a consultant post once they hit all their milestones - Agree

As for Oz and USA - That issue is different and I could got far to say that doctors in Ireland and the UK could do that.

Sourcey McSourcey? Perhaps post up something that back this claim - you've made it a few times now

Doctors from here can and do go to the US, Oz and Canada - that's why we're having to recruit in doctors from other other countries - in increasing numbers - to staff our health service.

FreudianSlippers

ShowMeTheCash wrote: »

I think your reasoning at it's core is flawed.

Jumping on a wandwaggon and pontificating about unknowns will not solve the problem.
The current systems is unsustainable, I could suggest do nothing and watch the whole thing implode also.

We need to be realistic.

If you look at the average salary of a GP in Ireland some polls had them at 80K -100K some as high as 116K.

This however this is in line with a lot of other european countries and the UK will pay GP's.

The issue with Ireland is we are corrupt as f##k!
Specialists in Ireland are amoung the highest paid on the plannet why?
The idea of a mass exodus of good doctors is propaganda scaremongering.

We have a below average health care system in this country but the ladder of power it seems it rotten through the core of everything we do here.

So called "Specilists" are paid too much they need to be rained in, if they leave they leave, we could lower this to bring it inline with at least the european average of the top paid positions.

When looking at numbers a political party will promise A but will deliver somewhere in the middle B, C or D, I would not let the numbers get in the way of a good idea!

So-called specialists? Nonsense of the highest order IMO; you're telling me that if you need brain surgery tomorrow you'd prefer that the neurosurgeon we have is no more skilled or valuable than a GP?

ShowMeTheCash

Jawgap wrote: »

Well I've ignored this for long enough - where's the evidence to show that we have some of the best paid consultants?

I do not have the stats but here is an article from the Irish Times

http://www.irishtimes.com/news/health/irish-hospital-consultants-among-highest-paid-in-the-world-1.1850847