Public sector or private practice

longtimelistener

Hi,

Long time listener, first time caller. I'm not sure if this is the right place for this question.

I'm looking for some totally independent career advice relating to whether I should continue in the public sector or move into private practice.

I am a highly qualified healthcare professional working in the HSE. I trained and worked abroad initially so I'm comparatively new to the HSE. Most of my colleagues would have trained and worked for their whole careers within the HSE.

I am currently on a temporary contract in a service. The team that I work with is wonderful. Every clinician is so skilled and experienced, along with being kind, compassionate and friendly. However, the service itself is in shambles. We are massively understaffed, demand is rising exponentially and waiting lists are just getting longer and longer. Everyone is stressed, burned out and just about coping with the pressures. We do not currently have a team leader due to staffing issues and we spend a lot of time going in circles and being inefficient as a result. There is minimal likelihood of these issues changing any time soon.

My pay is reasonably good, but career progression opportunities are frustratingly limited. I'm unlikely to be able to progress within this team, so I would need to move to a new team to get to the next grade (with no guarantee of such great colleagues).

The majority of the issues I have with my job are systemic, rooted in the fact that the HSE is bloated, inefficient, overly rigid and basically not fit for purpose.

I have considered leaving and going into private practice. I am attracted to the idea of the independence, the ability to choose the work I want to do, and the knowledge that I could use technology to enhance my efficiency and skills. However, many of my colleagues seem to think it's best to just persist with the HSE due to security. Private work is also very lonely and isolated compared to team working.

I unfortunately cannot trial a hybrid approach as I have requested and been denied the opportunity to reduce my full-time hours due to service pressures.

I have done very rough costings and I would have to work harder privately to earn an equivalent salary (when things such as PTO and rent/bills/etc are factored in). That being said, with time I would have the potential to be earning an excellent salary if the practice takes off (my skills are highly in demand so I have every reason to suspect it would).

I suppose I'm wondering, what do others think? Stay with the security of the HSE, with good pay and perks but huge systemic failings and high work stress, or chance going private with no guarantee of a similar income, having to market myself, no PTO or perks, but having the potential to be totally in control and potentially very high earnings with time? Low risk/low reward or high risk/high reward?

redsheeps

It's such a toughy. Sounds earily similar to my own situation. I'm sticking it out in the public sector for the time being for the purposes of a mortgage approval. Once the house purchase goes through and I can risk the private sector I'd consider it but it absolutely comes with all of the caveats you've mentioned.

As you've done, I'd probably run through a checklist of some kind with the pros and cons. Things jumping to mind are:

• Do you plan to make a mortgage application any time soon? My experience has been that the bank sees permanent public sector and approval is a doddle. This is obviously a massive pro for public sector but I have colleagues in the private sector earning in two hours what I earn in a full day but they have additional costs to pay. So it's swings and roundabouts.
• Do you find you like the team work from a social point of view and not just work support. Nothing wrong with this at all of course. Obviously for different life reasons and covid you may or may not have limited socialising opportunities. To me this would be a big one. I have gone through periods where work lunches and tea breaks sustained me through periods of life where outside work socialising was limited.
• Are you eligible for more senior grades now or have you more time to do before becoming eligible? If I had more time to do before becoming eligible I'd stick it out just to get the formal confirmation of having done your time if you decided to move back into the public sector. If I was stuck at a lower grade but was eligible for the upper grades and the seniors there look to be staying put then I'd definitely compare my potential private income to that I'd be limited to by not getting to move up to senior grades.
• How often do senior panels come up for your discipline? If it's infrequent then again you may want to weigh up how long you'll be stuck on lower grade pay scales before you can even get a senior post.
• Make sure you fully cost everything and talk to an accountant. I did this before establishing a sole trader and ltd company a good few years ago and it was really well worth it. I got some really good advice about how best to use pension contributions and directors loans etc. My experience was that they offer you the advice without charge with the understanding that you'd go to them to do your books, but that might no longer be the case. Don't make some of the common errors with things like writing expenses off on tax that some colleagues have done in the past (e.g. you earn €100k and your expenses are €20k. Your tax bill on €100k is about €40k so some people read tax write-offs for expenses as meaning you can deduct your €20k expenses from the €40k tax and only pay €20k tax. That's not how it's done. You deduct €20k expenses from your total income of €100k and pay income tax on €80k).
• Based on experiences of colleagues who I've spoken with about going private, make sure you respect your knowledge and charge fairly for it. Colleagues initially felt bad charging appropriate fees for private work and undersold themselves. You have your expertise and you are entitled to charge for it.

Best of luck with your decision. I've a lot of respect for anyone who takes the plunge to go out on their own, so wish you well if you go for it!

longtimelistener

Thank you, redsheeps, such a helpful reply especially as it seems we likely work in similar fields.

Do you plan to make a mortgage application any time soon?

No, thankfully we're just on the other side of that. Our mortgage repayments are high though, as we're aiming to pay down quickly so that's a factor. We budgeted with my current salary in mind, but any increase in salary would be really helpful for savings etc.

Do you find you like the team work from a social point of view and not just work support. 

I do, but it's more about the work support. I have 4-5 colleagues who I'd happily spend some time with socially and would seek out if I was having a bad day, but the majority are more "I can tolerate having lunch with you but I might still eat alone in my office". I suppose being quite new still, and joining during covid, means I haven't embedded socially as much as I could have.

Are you eligible for more senior grades now or have you more time to do before becoming eligible? 

I'm eligible, but I've just missed out on a senior panel due to a technicality (part of my frustration with the system!). If a new panel opened tomorrow, I'd be eligible. There wouldn't be huge movement either, people in the more desirable posts tend to stay put, and there's almost nowhere for them to go upwards either.

How often do senior panels come up for your discipline? 

Very infrequently. National panels, huge competition. Best case scenario, they're annual but it could be 2/3 years between panels forming. Due to just missing this one, I have no idea how long I'd be stuck at this grade for (unless I go through a backdoor system of temporarily back-filling a senior post, but that would end in time).

Make sure you fully cost everything and talk to an accountant.

Good thinking, I definitely need to sit down with someone and look in more depth at the financial aspect.

You have your expertise and you are entitled to charge for it.

This definitely makes me wonder if we're in the same field! My field is notorious for under-valuing themselves. I'm already unsure what I'd charge, so I've costed an "acceptable" hourly rate and a "actually reflects my expertise" rate just for comparison!