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Mandate graduate doctors do 5 years in Ireland post qualification?
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Anything to back that up or is it just a feeling you have?Capercaillie wrote: »The majority inferior.0 -
Hi Leo. No it's a bad idea.0
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How small a number of large hospitals?They have more administrative staff and nurses than the OECD average, and too few doctors. Nurses and admins are cheaper, but they can't get patients in and out as quickly as doctors can.
The issue here is of course, cost. We have too many large hospitals. But they still have to be staffed. So you bulk up on the cheaper admin & nursing staff to keep the numbers up and make it look like your hospitals are fully staffed.
But you don't have enough doctors.
So despite the place being swamped with staff, you can't get people through the system because everyone is waiting for a doctor to become available.
Technically, fixing the Irish health system is easy:
Close all of the smaller regional hospitals and concentrate major services in a small number of hospitals located in strategic positions.
Yes, it means that some people in remote parts of the country will be 30 minutes further away from the nearest hospital. And it means that someone who chooses to live rurally will die, whereas previously they would have lived. But nationally the quality of service will improve drastically. And that's the statistic that matters.
The only barriers to this are political.0 -
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Technically, fixing the Irish health system is easy:
Close all of the smaller regional hospitals and concentrate major services in a small number of hospitals located in strategic positions.
Yes, it means that some people in remote parts of the country will be 30 minutes further away from the nearest hospital. And it means that someone who chooses to live rurally will die, whereas previously they would have lived. But nationally the quality of service will improve drastically. And that's the statistic that matters.
The only barriers to this are political.
So who cares about a man, woman or child dying or having to suffer because they live In a rural location aslong as the statistics improve? Do you know or have you heard of anyone using the Donegal cancer bus to Galway?0 -
Capercaillie wrote: »Willing migrant workers who are of inferior quality.Iwasfrozen wrote: »Anything to back that up or is it just a feeling you have?
The HSE are on record saying they can not source sufficient numbers of adequately qualified doctors to meet the manpower crisis in our health service. Many NCHD and consultant posts remain unfilled. Some of those doctors who were employed (having been deemed adequate) were unable to pass the exams that the HSE set as the minimum standard. Irish graduates by definition have achieved that standard.
The unfortunate truth is that the health service is woefully understaffed by doctors (regardless of how many people may be wearing blue scrubs), foreign nationals have been propping up the service for years, with little benefit to themselves (due to many of the posts they fill being unrecognised for training) and at a great disadvantage to their home countries in many circumstances.0 -
Long term here's what I would do, initially lock in doctors too X years working in Ireland or they owe X sum (to make this fairer not to penalise those that actually drop out, put it on UK student loan style system so if they have actually moved abroad to earn american mega salaries they will have to pay it back)
Long term, train a lot more doctors expand the amount of places, drop the hours drop the wages let being a doctor be something that allows people to have a life and attract the people that want to do the job for the love of it not the money.
We can never compete with the USA or to some extent Aus for cash and thats a problem because as far as I can see the earning potential is a big motivator, this will be denied by the medics here but if its about hours the UK would be a far bigger destination (they have eu working time rules actually followed)
ps google the junior doctor overtime bill =-O0 -
RDM_83 again wrote: »Long term here's what I would do, initially lock in doctors too X years working in Ireland or they owe X sum (to make this fairer not to penalise those that actually drop out, put it on UK student loan style system so if they have actually moved abroad to earn american mega salaries they will have to pay it back)
And what about other graduates that have benefited from 'free' third level education? Law graduates - barristers and solicitors can earn multiples of what doctors earn. Buisness and Finance grads - huge potential earnings, especially in the UK or USA. Teaching graduates - sure don't most of them end up on huge TD salaries and pensions:rolleyes:RDM_83 again wrote: »Long term, train a lot more doctors expand the amount of places, drop the hours drop the wages let being a doctor be something that allows people to have a life and attract the people that want to do the job for the love of it not the money.
If we could retain, or more likely encourage the return of the doctors we are already training we would be a long way to adequately staffing the service. But 'drop the wages' will only make the situation worse, if that's possible. An intern salary is just over E30,000. For that you have attained the best exam results in the country leaving school, slogged it out in college for 6 years, and often work on average between 65 and 100 hours per week, in breach of the EWTD. There is overtime paid, usually at time and a half and often not at all. The system simply couldn't afford to employ enough doctors to work a standard, or even EWTD compliant week. The consultant salary starts at E116,000 (I know it's under review atm, not sure if the increase (to E127,000 I think) has been agreed). While that might seem like a nice package, if you have the smarts and the ambition to make it in medicine, you have the ability to earn much more than that in other areas. So, no, money is not the driving force for the vast majority of doctors.RDM_83 again wrote: »We can never compete with the USA or to some extent Aus for cash and thats a problem because as far as I can see the earning potential is a big motivator, this will be denied by the medics here but if its about hours the UK would be a far bigger destination (they have eu working time rules actually followed)
ps google the junior doctor overtime bill =-O
Many Irish graduates do end up in the UK, but the NHS is not without its problems. Australia and NZ seem to have a good work-life balance and is proving very popular with graduates. AFAIK, salaries in OZ/NZ are similar to here, but hours are far less and training is far more structured. Many who have gone in the past for training with the intention of coming home have decided to stay.
The idea of forcing people to work in our broken system is flawed on so many levels. It also must be noted that it is not possible to fully train in Ireland in many specialties - graduates must go abroad to gain experience in areas where there is no expertise here. Previously most doctors left Ireland towards the end of their training. Now they seem to be going earlier due to the excessive working hours, poor conditions, lack of training structure and clarity and generally poor morale. Irish graduates have to do at least 1 year here or in the UK post graduation if they want their qualification to be recognised. The hours of graft during even that year sees them 'paying their way' IMO.0 -
When my uncle was dying, one of my cousins friends was a doctor in the ICU. She came into the rest room area and was chatting away to us and told us she was moving onto her 26th hr of duty and said its quite regular. Insane:eek:0
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Apart from being illegal in the EU. You're making a job that's already not looking particularly attractive given all the news about long hours and **** conditions, and making it look even less attractive by forcing people into 5 years of servitude. If numbers are crap now, they'll be even worse with such a restriction in place.
I would support the mandatory 5 years but there should be a fair contract drawn up with a max working week of about 40 hrs and a decent salary.0 -
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Dunno, you'd have to do the maths on it. I'm sure there's an optimal calculation of size per capita cross-referenced with distance. I did some rough sum before on another thread a long time ago, but it escapes me now.Deleted User wrote: »How small a number of large hospitals?
This is the emotive argument, but unfortunately it all comes down to bare numbers at the end of the day.So who cares about a man, woman or child dying or having to suffer because they live In a rural location aslong as the statistics improve? Do you know or have you heard of anyone using the Donegal cancer bus to Galway?
As a nation we want to be able to live in any ****hole backwater and still have hospital services on our doorstep. But we don't want to pay for it. These things are not compatible, one of them has to go. So we can either increase the average household's tax bill by €4,000 a year so that the HSE's budget is bumped by 50%.
Or we can make our hospital system more effective at the current cost by reducing the immediate availability of services to remote rural areas.
I'm pretty sure I know which option most people will go for.0 -
I didn't find any of the foreign doctors which was all the doctors I dealt with bar one, to be any way inferior.Capercaillie wrote: »Willing migrant workers who are of inferior quality.
Are the nurses not in a lighter blue? Either way there were 15 of them at the main station in AE and that was just the collection at the station. It was hard to even make your way through the crowd of them.Lucas Castroman wrote: »Before offering your considered opinion on a topic perhaps you should be sure of your facts. Everybody in A+E wears scrubs so they could have been doctors, nurses, porters etc.
Like I said, I went to two different hospitals with the same condition, if the public hospital thought I needed three antibiotics they were clearly wrong. Because one was enough. If they make a profit on each drug then yes they are putting people on more drugs to pull in more money.Obviously they felt it was clinically indicated. Are you suggesting a public hospital makes money by putting a person on more drugs? If anything it costs them money.
They don't teach them for free do they?how do public hospitals make money off foreign doctors?
You can shout and throw insults around all you like, but that was my experience of the two hospitals. It was clear the private hospital was doing more with less and saving money doing it. The public hospital was like a war zone where they work twice as hard and get nowhere, while charging the state and insurance companies through the teeth for a sub standard service. It's clear mismanagement or a lack of management. The public hospital is over run and that's a massive part of the problem but there doesn't seem to be any sign of them even trying to do anything about it.0 -
Lucas Castroman wrote: »There seemed to be as many of the blue shirts as patients, I assume the ones in blue clothing are all doctors of some sort.
Before offering your considered opinion on a topic perhaps you should be sure of your facts. Everybody in A+E wears scrubs so they could have been doctors, nurses, porters etc.
They had me on 3 different antibiotics.
Obviously they felt it was clinically indicated. Are you suggesting a public hospital makes money by putting a person on more drugs? If anything it costs them money.
I think public hospitals have become over concerned with bringing in more money to the point they do pointless extra work so they can increase the bill to private health insurers.
You've offered no evidence to support this.
Public hospitals have way more staff than they need because they're taking money off the foreign doctors.
Read the news, public hospitals have serious shortages of doctors. Also please explain the delusional workings of your mind - how do public hospitals make money off foreign doctors?
then of course there's the roving gang of doctors that come in and talk over you as if you were some sort of a plant in the corner.
Large public hospitals are teaching centres. Besides, I'm not surprised they ignored you given the waffle you spout.
On a separate issue three antibiotics is far too much. No wonder antibiotic resistance is on the rise.0 -
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They have more administrative staff and nurses than the OECD average, and too few doctors. Nurses and admins are cheaper, but they can't get patients in and out as quickly as doctors can.
The issue here is of course, cost. We have too many large hospitals. But they still have to be staffed. So you bulk up on the cheaper admin & nursing staff to keep the numbers up and make it look like your hospitals are fully staffed.
But you don't have enough doctors.
So despite the place being swamped with staff, you can't get people through the system because everyone is waiting for a doctor to become available.
Technically, fixing the Irish health system is easy:
Close all of the smaller regional hospitals and concentrate major services in a small number of hospitals located in strategic positions.
Yes, it means that some people in remote parts of the country will be 30 minutes further away from the nearest hospital. And it means that someone who chooses to live rurally will die, whereas previously they would have lived. But nationally the quality of service will improve drastically. And that's the statistic that matters.
The only barriers to this are political.
A lot of people don't choose to end up where they end up Seamus. A lot of people are born into socio economic circumstances enabling benefits over another through school systems ect. This ultimately leads them to where they are in life. It's not as simple as people choosing to live and die in some area most of the time.0 -
I didn't find any of the foreign doctors which was all the doctors I dealt with bar one, to be any way inferior.
Are the nurses not in a lighter blue? Either way there were 15 of them at the main station in AE and that was just the collection at the station. It was hard to even make your way through the crowd of them.
Like I said, I went to two different hospitals with the same condition, if the public hospital thought I needed three antibiotics they were clearly wrong. Because one was enough. If they make a profit on each drug then yes they are putting people on more drugs to pull in more money.
They don't teach them for free do they?
You can shout and throw insults around all you like, but that was my experience of the two hospitals. It was clear the private hospital was doing more with less and saving money doing it. The public hospital was like a war zone where they work twice as hard and get nowhere, while charging the state and insurance companies through the teeth for a sub standard service. It's clear mismanagement or a lack of management. The public hospital is over run and that's a massive part of the problem but there doesn't seem to be any sign of them even trying to do anything about it.
If they make a profit on each drug then yes they are putting people on more drugs to pull in more money.
As already said public hospitals don't make a profit from prescribing more meds. If anything, reducing medications handed out would reduce costs. Not all antibiotics are the same. Being on three antibiotics rather than one does not necessarily constitute waste. Some have greater antibacterial coverage.
They don't teach them for free do they?
Universities make lots of money out of foreign medical students who pay massive tuition fees - this may be the source of your confusion.
Foreign doctors are employed workers just like Irish doctors, who don't pay "fees".
Perhaps the reason the private hospital seems more sedate/organised is because they can be more selective about the patients they accept. They perform elective procedures and manage patients who are generally stable.
You're severely misinformed but don't let that stop you from having your strong opinions. Anyways work tomorrow I'm sure :roll eyes:0 -
Lucas Castroman wrote: »If they make a profit on each drug then yes they are putting people on more drugs to pull in more money.
As already said public hospitals don't make a profit from prescribing more meds. If anything, reducing medications handed out would reduce costs. Not all antibiotics are the same. Being on three antibiotics rather than one does not necessarily constitute waste. Some have greater antibacterial coverage.
They don't teach them for free do they?
Universities make lots of money out of foreign medical students who pay massive tuition fees - this may be the source of your confusion.
Foreign doctors are employed workers just like Irish doctors, who don't pay "fees".
Perhaps the reason the private hospital seems more sedate/organised is because they can be more selective about the patients they accept. They perform elective procedures and manage patients who are generally stable.
You're severely misinformed but don't let that stop you from having your strong opinions. Anyways work tomorrow I'm sure :roll eyes:
No offence to clinicians but they often know next to nothing about antibiotics. My girlfriend at the time was prescribed an antibiotic which didn't help her. I went to the clinician with her and asked what type of bacteria do these antibiotics target and what type of bacteria are causing the problem? He couldn't answer. It turns out the bacteria causing the infection weren't the type of bacteria targeted by this antibiotic. In fact the broad range antibiotic killed all the other bacteria and left these ones. Thereby reducing competition for the ones causing the problems.
ALWAYS ask the clinician what type of bacteria are targeted by antibiotics. If they can't answer change GPs.0 -
So they don't charge insurers for medications used? They wouldn't do things like use up leftover budget before year end?Lucas Castroman wrote: »As already said public hospitals don't make a profit from prescribing more meds.
I talking specifically about foreign student doctors. Do they pay student doctors? Any time I've been in the public hospital doctors always had one or two in toe, so they're all paid for medical staff?Universities make lots of money out of foreign medical students who pay massive tuition fees - this may be the source of your confusion.
Foreign doctors are employed workers just like Irish doctors, who don't pay "fees".
I don't see how their more selective. They treat people who can pay but I don't think they cherry pick who they're going to treat. The private hospital I went to had an A&E, it just wasn't open 24/7.Perhaps the reason the private hospital seems more sedate/organised is because they can be more selective about the patients they accept. They perform elective procedures and manage patients who are generally stable.
How can I be misinformed by what I experienced?You're severely misinformed0 -
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So they don't charge insurers for medications used? They wouldn't do things like use up leftover budget before year end?
I talking specifically about foreign student doctors. Do they pay student doctors? Any time I've been in the public hospital doctors always had one or two in toe, so they're all paid for medical staff?
I don't see how their more selective. They treat people who can pay but I don't think they cherry pick who they're going to treat. The private hospital I went to had an A&E, it just wasn't open 24/7.
How can I be misinformed by what I experienced?
Bingo. They do claim back money on the insurance if the patient has it. They also claim back money for scans. You would have to wonder if half the scans ordered for patients would be ordered if they weren't on the VHI i.e they might not be needed.0 -
This is the emotive argument, but unfortunately it all comes down to bare numbers at the end of the day.
As a nation we want to be able to live in any ****hole backwater and still have hospital services on our doorstep. But we don't want to pay for it. These things are not compatible, one of them has to go. So we can either increase the average household's tax bill by €4,000 a year so that the HSE's budget is bumped by 50%.
Or we can make our hospital system more effective at the current cost by reducing the immediate availability of services to remote rural areas.
Sh*thole? The places you are referring to are peoples homes, their lives, their family.
What do you propose realistically? That everyone moves to an urban location or they don't deserve the same level of care? What about a 6 month old baby who is ill? An 80 year old man who has just being diagnosed with cancer? Should they up an leave by themselves and move closer to a hospital or is it tough luck suffer and die, they made a choice?
This is an emotive argument because it's real people I'm talking about, not statistics. Management in hospitals is where the issues lies.0 -
steddyeddy wrote: »Bingo. They do claim back money on the insurance if the patient has it. They also claim back money for scans. You would have to wonder if half the scans ordered for patients would be ordered if they weren't on the VHI i.e they might not be needed.
So let me get this clear, you're suggesting doctors in public hospitals are prescribing lots of unnecessary medications and and ordering scans that are not required just because you have medical insurance. This is simply not the case.0 -
Sh*thole? The places you are referring to are peoples homes, their lives, their family.
What do you propose realistically? That everyone moves to an urban location or they don't deserve the same level of care? What about a 6 month old baby who is ill? An 80 year old man who has just being diagnosed with cancer? Should they up an leave by themselves and move closer to a hospital or is it tough luck suffer and die, they made a choice?
This is an emotive argument because it's real people I'm talking about, not statistics. Management in hospitals is where the issues lies.
Also people who are sick won't be able to work and afford to move. The right wing "If his daddy was as rich as my daddy he could have my life" only gets you so far in logical thinking.0 -
Sh*thole? The places you are referring to are peoples homes, their lives, their family.
What do you propose realistically? That everyone moves to an urban location or they don't deserve the same level of care? What about a 6 month old baby who is ill? An 80 year old man who has just being diagnosed with cancer? Should they up an leave by themselves and move closer to a hospital or is it tough luck suffer and die, they made a choice?
This is an emotive argument because it's real people I'm talking about, not statistics. Management in hospitals is where the issues lies.
It's not that they dont deserve it, it's that it is near impossible to provide it. If someone decides to live over an hour away from a hospital what do you expect to happen? By living in a rural area you are going to have less services.0 -
shruikan2553 wrote: »It's not that they dont deserve it, it's that it is near impossible to provide it. If someone decides to live over an hour away from a hospital what do you expect to happen? By living in a rural area you are going to have less services.
There's that word that comes up in right wing rhetoric with regards life circumstances "decides".0 -
shruikan2553 wrote: »It's not that they dont deserve it, it's that it is near impossible to provide it. If someone decides to live over an hour away from a hospital what do you expect to happen? By living in a rural area you are going to have less services.
Add to this that smaller hospital have less case mix, less expertise and poorer results. It makes sense to concentrate our resources in larger 'centres of excellence'. However, for this to work properly, we need to provide basic care in rural areas and a proper ambulance service, including air ambulance so that those who live in rural areas have access to the same level of care as urban dwellers. Unfortunately, that's not the case at present in many rural areas in Ireland.0 -
steddyeddy wrote: »There's that word that comes up in right wing rhetoric with regards life circumstances "decides".
Im sure there are people who cant leave but there are also people who can but decide to build there house in a random location far from anyone else. You can hardly claim that everyone building and living far from everyone else is because of bad luck or they just had to buy that house an hour drive from town.ProfessorPlum wrote: »Add to this that smaller hospital have less case mix, less expertise and poorer results. It makes sense to concentrate our resources in larger 'centres of excellence'. However, for this to work properly, we need to provide basic care in rural areas and a proper ambulance service, including air ambulance so that those who live in rural areas have access to the same level of care as urban dwellers. Unfortunately, that's not the case at present in many rural areas in Ireland.
I would agree with that. Something like equipping doctors to better handle the basic stuff. You'll still have to travel for more serious conditions though as it's just not possible to provide everything within close distance to everyone, there will always be someone just outside the range.0 -
I have a friend who was in a car crash and he was left sitting until they heard he was covered by the other drivers insurance and they sent him in for a load of tests because of the insurance, they even told him as much. Or at least gave him the impression he was getting the fast track because it turned out he was covered by insurance.Lucas Castroman wrote: »So let me get this clear, you're suggesting doctors in public hospitals are prescribing lots of unnecessary medications and and ordering scans that are not required just because you have medical insurance. This is simply not the case.
The fact remains the bill I got from the public hospital (you get a bill if your on insurance) was substantially more than exactly the same care in a private hospital. When you take into consideration they ran out of sheets in the public hospital because they had to hand them out instead of towels that they'd ran out of, it shows that the public hospitals are not able to manage their resources.0 -
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ProfessorPlum wrote: »Add to this that smaller hospital have less case mix, less expertise and poorer results. It makes sense to concentrate our resources in larger 'centres of excellence'. However, for this to work properly, we need to provide basic care in rural areas and a proper ambulance service, including air ambulance so that those who live in rural areas have access to the same level of care as urban dwellers. Unfortunately, that's not the case at present in many rural areas in Ireland.
This exactly. It's logical that we can't treat every disease equally in all locations (E.G cystic fibrosis) however we need a basic level of care in all hospitals for the prevalent diseases and terminal cases.0
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