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Hospital consultants - milking the system for their own benefit!

Roger_007

I watched the Prime Time programme last night ,(Prime Time 21/11/2017), and was shocked at the extent to which the senior medical staff in our public hospitals are milking the system for their own financial benefit.
They are paid a six-figure salary to provide a minimum number of hours caring for their public patients. Yet many of them seem to be paying far more attention to their private patients and doing far less than their contracted hours in the public system.
If anyone was in any doubt about why there are such long waiting lists in the public system, a large part of the answer was provided last night. The consultants are, by keeping waiting lists long, forcing their public patients to go into the private system to get private treatment .
I'm also amazed that there seems to be no political fallout about this scandal.

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exaisle

Roger_007 wrote: »

I watched the Prime Time programme last night ,(Prime Time 21/11/2017), and was shocked at the extent to which the senior medical staff in our public hospitals are milking the system for their own financial benefit.
They are paid a six-figure salary to provide a minimum number of hours caring for their public patients. Yet many of them seem to be paying far more attention to their private patients and doing far less than their contracted hours in the public system.
If anyone was in any doubt about why there are such long waiting lists in the public system, a large part of the answer was provided last night. The consultants are, by keeping waiting lists long, forcing their public patients to go into the private system to get private treatment .
I'm also amazed that there seems to be no political fallout about this scandal.

What they didn't tell you was that the reason that SOME consultants don't work their full allocation of hours is that some hospitals don't have sufficient funding from the HSE to provide facilities (eg Operating Theatres, theatre staff etc) which would allow them to work full hours.

Nor did they mention that the hospitals use the money obtained from private patients to fund themselves, which is why HSE and the government turn a blind eye.

It's all very well to say we should only allow public patients to use public hospitals and that private patients can use private hospitals (or, indeed, that private patients' use of public hospitals should be restricted). The other side of that coin is that you have to fund and staff the public hospitals adequately, and as far as I can see, we don't have the resources to do that.

SEPT 23 1989

did i hear correctly that one scrounger was only doing 13 hours a week for their 200k a year?

Rodin

The show left out a lot if information which would make the picture more complete.
The spies in the car park didnt seem to be there after hours or on a weekend.
Personally I often go in at the weekend to do admin work. Its often the only quiet time to do it and it is very productive.
Also none of these consultants appear to have been on call or been called in out of hours.
To think the 39hours should all be between 9 and 5 Monday to Friday fails to address that much work in medicine happens on an emergency out of hours basis. Something the spies in cars did not appear to be present for.

Being in a private hospital when meant to be in a public clinic/theatre is shameful however.

LeinsterDub

The entire system is a mess . We need a Single-payer healthcare designed from the ground up.

Anita Blow

Working 13 hours a week is disgraceful, but I've worked with many consultants in the Dublin hospitals and I can assure people that such low working hours are an outlier rather than the norm. Most if not all I have worked with would work beyond their contracted hours and were beyond frustrated with the system they work in. Much of their work is hampered by HSE funding. In one week we saw about 10 patients who required a particular procedure that the HSE will only fund once per week.

Wanderer78

LeinsterDub wrote:

The entire system is a mess . We need a Single-payer healthcare designed from the ground up.

Completely agree, but there's little or no political will to do so. Two tier it is!

arctictree

I don't see many other jobs where you are allowed run your own business on the side. Even worse, using your employers premises and equipment!

seamus

arctictree wrote: »

I don't see many other jobs where you are allowed run your own business on the side. Even worse, using your employers premises and equipment!

This is really the primary issue and it needs to be broken out. By all means allow doctors to double-job, but on their own time and in another hospital. This abuse of public money has been going on for decades.

My mother was a nurse in Crumlin Children's in the 70's and 80's. Back then the nurses were responsible for drawing up the surgery schedule for the following day. It was noted on a patient's chart if they were public or private patients. And the consultants "required" that their private patients were scheduled first every day. Patients who are scheduled later in the day are more likely to miss their slot because of earlier overruns or unexpected emergencies. And you couldn't discommode a private patient - they might go to another consultant!

So if there were five surgery slots that day and four private patients, then only one public patient was getting their surgery tomorrow. And the day after that. And the day after that.
Every now and again a consultant would intervene and direct the nurses to schedule a public patient earlier in the day. After that patient's parent had provided an "incentive" to get their child bumped up the surgery list.

You can be sure the same bullsh1t takes place in public hospitals to this day. I have no problem with people paying privately to avoid the queue - provided that "avoiding the queue" means going to a private hospital.

Lock it out, say from 2019 that there will be no private surgeries or consultations permitted in public hospitals, and then let the market sort it out.

suicide_circus

^^^then watch a further flight of consultants from Ireland to countries where they can make the big bucks. This ludicrous system we operate is probably the only thing keeping some of them in the country

velo.2010

Treatment should be based on the level of need and not the level of income. There should be no private healthcare other than someone wanting a private room with Netflix.

Newly qualified consultants must be contracted to work in the state for a certain number of years as the public effectively funds their training throughout.

Anyone with the money and who wants to have less serious varicose veins treated, before someone else with a worse case, can go abroad.

Harsh, but healthcare and education must be the top priority and all parties should strive to reach a common consensus on both. They can argue over other areas like transport, energy etc.

seamus

suicide_circus wrote: »

^^^then watch a further flight of consultants from Ireland to countries where they can make the big bucks. This ludicrous system we operate is probably the only thing keeping some of them in the country

Fine, let them go. Plenty of others to fill their spaces. Thousands of medical staff from overseas dying to get work in western country.

Since the majority of consultants are 35+ with families and interests in Ireland, I can guarantee you very few of them will magically up sticks and go overseas.

A big chunk will get together to form their own independent hospital groups.

The majority - especially those up-and-coming, will stick with their six figure salaries in the public system.

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njs030

There's never any expose about the really good hard working consultants is there?!

I had been waiting to see one and on the day had to rearrange as my child was sick. A week later I had a call from my GP to go in, the consultant had reviewed my files in my absence and written to my GP with suggestions for my care until my next appointment came round!

That's really good care. Why isn't that level of care mentioned in these programmes to offset the bad ones?

(When I did get to see him he spent about 30-40 mins with me talking through my illness and what he would suggest to help. No rush whatsoever.)

Rodin

arctictree wrote: »

I don't see many other jobs where you are allowed run your own business on the side. Even worse, using your employers premises and equipment!

And in doing so, securing extra cash for the public system without which it would not be able to cope.
The dirty secret is that without supplementation from private income, things in the public sector would be much worse.

Rodin

velo.2010 wrote: »

Treatment should be based on the level of need and not the level of income. There should be no private healthcare other than someone wanting a private room with Netflix.

Newly qualified consultants must be contracted to work in the state for a certain number of years as the public effectively funds their training throughout.

Anyone with the money and who wants to have less serious varicose veins treated, before someone else with a worse case, can go abroad.

Harsh, but healthcare and education must be the top priority and all parties should strive to reach a common consensus on both. They can argue over other areas like transport, energy etc.

Should all those who have their education paid for bu the state have an obligation to repay the state by working in the public sector or do you want a special rule for doctors?

LeinsterDub

Rodin wrote: »

And in doing so, securing extra cash for the public system without which it would not be able to cope.
The dirty secret is that without supplementation from private income, things in the public sector would be much worse.

We already spend a fortune on Health care. Heath care needs new processes not more money

http://www.finfacts.ie/Irish_finance_news/articleDetail.php?Ireland-second-highest-OECD-health-spending-poorest-outcomes-506

fly_agaric

Rodin wrote: »

Should all those who have their education paid for bu the state have an obligation to repay the state by working in the public sector or do you want a special rule for doctors?

IMO Ideally they would have to work in public sector for a time after training but seems to me the medical training system (as well as the health service) in this country is malfunctioning, but no one really wants to change it.

Too many of the places taken up by rich foreigners whose huge tuition fees sustain the system (would it collapse if it depended on state funding alone??).

In a normal situation, expensive medical education would be considered a critical/strategic area for a country, and most places in state funded universities would be locked off for citizens/locals only who would mainly end up working in the local health service (i.e. not for sale to rich foreigners).

Anita Blow

fly_agaric wrote: »

IMO Ideally they would have to work in public sector for a time after training but seems to me the medical training system (as well as the health service) in this country is malfunctioning, but no one really wants to change it.

Too many of the places taken up by rich foreigners whose huge tuition fees sustain the system (would it collapse if it depended on state funding alone??).

In a normal situation, expensive medical education would be considered a critical/strategic area for a country, and most places in state funded universities would be locked off for citizens/locals only who would mainly end up working in the local health service (i.e. not for sale to rich foreigners).

To clarify, the HSE doesn't really pay for postgraduate training. Training is funded by the doctors themselves who must pay their membership fees to the colleges, pay for participation in their courses and pay for their examinations. Training is through the colleges, not the HSE.

With regard to medical education, undergraduate is majority funded by foreign tuition fees while 50% of our Irish medical graduates fund their tuition themselves to the tune of 60k so there is no basis for forcing graduates to stay in the Irish system. Not least because it would be extremely damaging to the quality of care in the Irish system as we are a small country and are absolutely reliant on people training abroad.

Anita Blow

seamus wrote: »

Fine, let them go. Plenty of others to fill their spaces. Thousands of medical staff from overseas dying to get work in western country.

Since the majority of consultants are 35+ with families and interests in Ireland, I can guarantee you very few of them will magically up sticks and go overseas.

A big chunk will get together to form their own independent hospital groups.

The majority - especially those up-and-coming, will stick with their six figure salaries in the public system.

I can assure you this will not be the case. You will see established consultants go fully private and younger consultants go abroad. Regardless of people's personal feelings towards senior medics, the quality of their training is second to none. Look at any random consultant's bio and you will see most will have trained in many prestigious places in the States, Australia etc. They earn far far more there (even with private work here), have a far better work/life balance and work in a system which isn't completely dysfunctional where they are free to do what they think is best for the patient without financial or bureaucratic restriction. For some reason they come back to Ireland out of some misplaced feeling of loyalty but if their pay is eroded further and they continue to be vilified by the public here I'm sure most registrars will just not bother coming back.

If working in the public system was so lucrative and sought after by foreign medics we wouldn't have such a critical shortage of consultants with the highest number of vacant posts in the history of the HSE.

Sue Pa Key Pa

velo.2010 wrote: »

Treatment should be based on the level of need and not the level of income. There should be no private healthcare other than someone wanting a private room with Netflix.

.

I agree with that principle. However, I have to play the only game in town and I will make sacrifices elsewhere to afford the health insurance that allows me to leapfrog my fellow citizens in my time of need. Not ideal, but I make no apology for taking care of my personal situation

velo.2010

Rodin wrote: »

Should all those who have their education paid for bu the state have an obligation to repay the state by working in the public sector or do you want a special rule for doctors?

We train Gardaí to serve in the state and we train the defence forces to do similar. Its possible to expect doctors and nurses to stay at home and serve the country for a period.

seamus

Anita Blow wrote: »

For some reason they come back to Ireland out of some misplaced feeling of loyalty but if their pay is eroded further and they continue to be vilified by the public here I'm sure most registrars will just not bother coming back.

You see, I'm not talking about eroding their pay. Simply restructuring how they earn it.

We have an intractable problem which needs to be solved. And is going to require some short-term pain for long-term gain.

There is no universe in which it makes sense that we have huge public waiting lists and consultants carrying out private appointments and surgeries in public hospitals. If private work was to be allowed in public hospitals, then only after all public patients have been treated.

It may require higher spending in health, and locking consultants into "public-only" contracts that are expensive. But if it gets us some of the reforms we need, then it's worth spending.

It's worth noting that it's a symptom of a poorly put together health system, it's not the cause of it. The entire thing is structured on geography rather than population dispersal. This results in far too much administrative overhead, too much money spent on day-to-day care rather than acute care, and acute care resources spread far too thinly.

And that comes back to stupid policies that allow national politics to be influenced by local matters. This is why we have wastes of money like a major hospital in Ballinasloe, when there's a perfectly good major hospital in Galway. Because if they proposed closing Ballinasloe and making it A&E only, local politicians would be wailing and gnashing, and TDs worrying about the next election.

Red_Wake

velo.2010 wrote: »

Rodin wrote: »

Should all those who have their education paid for bu the state have an obligation to repay the state by working in the public sector or do you want a special rule for doctors?

We train Gardaí to serve in the state and we train the defence forces to do similar. Its possible to expect doctors and nurses to stay at home and serve the country for a period.

Neither the Gardai nor the Defence Forces have a qualification which can be used abroad. Your example is very flawed.

velo.2010

Sue Pa Key Pa wrote: »

I agree with that principle. However, I have to play the only game in town and I will make sacrifices elsewhere to afford the health insurance that allows me to leapfrog my fellow citizens in my time of need. Not ideal, but I make no apology for taking care of my personal situation

I understand that completely.

The problem is, even if you have private only hospitals, I think you'll still have an overlap with public hospitals, which is not acceptable IMO.

I also have a problem with those entering the medical profession purely for personal financial enrichment. I always thought of the medical profession as a deservedly well paid but, ultimately, vocational pursuit. Watching last nights programme tells me this is not the case with many.

The only solution I can see is to completely differentiate private medical training and private medical care with public training of doctors and provision of public healthcare.

Allow private medical training colleges to cater for those who ultimately wish to practise in a private only setting, ie, the state would not be funding the entry of publicly trained doctors into the private sector. Hospital training for those doctors would be done abroad. Many trainees come from a family background of doctors and are financially secure - they can afford to train privately. This may open up public training spaces for those who have a real passion for biology/medicine but because of socio/economic reasons may not normally be able to pursue a career in medicine.

Allow foreign private medical providers to set up here. Any overflow would be dealt with by sending patients to their other medical centres abroad. That way you just may get a complete separation of the public and private healthcare system in Ireland.

At the moment there is no separation and many are suffering needlessly because of it, as we saw last night.

mountai

Whilst we have a system that nurtures conflict and cover up we will never make progress . Top managers seem to think that they have a right to be unquestioned in their jobs , OBrien , Woods et al . The hard working consultants are being dragged down by by the minority of leeches who are greedy and fraudulent who could be whipped into line by simply making them CLOCK IN . Not rocket science really . of course Harriss will wring his hands and promise to "Look at it" . **** .

jonon9

The HSE is a cesspit of overpaid and under worked people, there is secretaries for secretaries far too many pencil pushers in the administration side of the HSE it need complete reform or disbandment. The amount of money wasted is disgusting and the hospitals are just getting worse.

fly_agaric

Anita Blow wrote: »

To clarify, the HSE doesn't really pay for postgraduate training. Training is funded by the doctors themselves who must pay their membership fees to the colleges, pay for participation in their courses and pay for their examinations. Training is through the colleges, not the HSE.

With regard to medical education, undergraduate is majority funded by foreign tuition fees while 50% of our Irish medical graduates fund their tuition themselves to the tune of 60k so there is no basis for forcing graduates to stay in the Irish system. Not least because it would be extremely damaging to the quality of care in the Irish system as we are a small country and are absolutely reliant on people training abroad.

I was thinking of the undergraduates when I posted that; didn't know so many of the Irish students were paying such large fees too? It would be unworkable + unfair to force people to work in public sector after qualification with the way the education system is setup now but if it were organised differently (not relying on fee payers) than it would be reasonable imo.

velo.2010

Red_Wake wrote: »

Neither the Gardai nor the Defence Forces have a qualification which can be used abroad. Your example is very flawed.

What qualification they have is beside the point. We train guards, teachers, doctors, nurses etc. with the expectation to work in the public service - because we have a public service which need such people.

Anita Blow

seamus wrote: »

You see, I'm not talking about eroding their pay. Simply restructuring how they earn it.

We have an intractable problem which needs to be solved. And is going to require some short-term pain for long-term gain.

There is no universe in which it makes sense that we have huge public waiting lists and consultants carrying out private appointments and surgeries in public hospitals. If private work was to be allowed in public hospitals, then only after all public patients have been treated.

It may require higher spending in health, and locking consultants into "public-only" contracts that are expensive. But if it gets us some of the reforms we need, then it's worth spending.

It's worth noting that it's a symptom of a poorly put together health system, it's not the cause of it. The entire thing is structured on geography rather than population dispersal. This results in far too much administrative overhead, too much money spent on day-to-day care rather than acute care, and acute care resources spread far too thinly.

And that comes back to stupid policies that allow national politics to be influenced by local matters. This is why we have wastes of money like a major hospital in Ballinasloe, when there's a perfectly good major hospital in Galway. Because if they proposed closing Ballinasloe and making it A&E only, local politicians would be wailing and gnashing, and TDs worrying about the next election.

I agree entirely with your appraisal of the health system. Every village expects its own centre of excellence but the public fail to realise that outcomes and expenditure would be so much better if we centralised services into major regional centres.

The problem of waiting lists however is not down to consultant hours. It's a confluence of factors. As I said above, my consultant (Harvard-trained and absolutely outstanding) was frustrated beyond belief that he would see 10 patients a week needing a certain procedure that the HSE would only fund once per week. That's a waiting list that's growing by 9 people per week in one hospital alone. It isn't his fault that he can only use that theatre once per week, if he had it his way he would be banging through 20 public patients a week.

Another example- I've a family friend who is a consultant surgeon. He would say how he would arrive in to work to find out that his public theatre list for the day has been cancelled by the hospital due to unavailability of theatres/staff. So he would have to go home because there's nothing else to do outside of operating that day. Rightly or wrongly, he would be a bit angry that he had lost out on a days work that he could've scheduled patients in a private hospital for (which I don't think is unfair).

The HSE has a million problems, the biggest being the bureaucracy and complete mismanagement of casework and misallocation of resources. But consultants are a simple scapegoat Harris can for the public to beat them with and deflect from the actual problems in the service which government has no appetite to address (firing scores of admin staff and reallocating that money to frontline services).

It also ignores the fact that consultants would simply move abroad or to full-time private work if forced into a public contract only. They have no onus to be locked in to such a contract and given the examples above why would they? Imagine being locked into a contract that pays you substantially less than you get now, and then being faced with turning up to work on a regular basis where theatre is cancelled and you've to sit twiddling your thumbs all day?