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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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Icemancometh

Rodin wrote: »

The simple solution is to have all doctors clock in and clock out and get paid by the hour.

Now ask yourself why that hasn't happened.

It might be apocryphal, but I believe Tallaght brought in a clock in system for NCHDs, then removed it after a couple of weeks.

Berserker

Rodin wrote: »

The simple solution is to have all doctors clock in and clock out and get paid by the hour.

Now ask yourself why that hasn't happened.

Paying medical professionals by the hour would end up costing the state a heck of a lot more in salaries, I can tell you that. As for clocking in, what would that achieve?

byhookorbycrook

I attend my consultant privately, in a private hospital.She also does some public work. one of her public clinics used to be on a Monday- to make up for missed bank holidays(not paid, obviously) she offered to do an extra Monday(for free) if there were 5 in a month- HSE didn't want her to, as she would see more patients and end up costing the HSE more money if people needed further treatment in the public system.

mountai

Berserker wrote: »

Paying medical professionals by the hour would end up costing the state a heck of a lot more in salaries, I can tell you that. As for clocking in, what would that achieve?

Their contracts are based on the amount of hours they work in the public health system . Clocking in and out would verify time spent in the public hospitals . If you watched the programme , you would have seen a certain MINORITY of consultants abuse the system , this would keep check on the swindlers and fraudsters . Simple

Roger_007

mariaalice wrote: »

Its not the HSE alone its also the media( who can be biased against private medical care ) that want to blame consultants, I had to see a consultant recently and he starts seeing his private patients at 7am the vast majority do work very hard. That consultant do not have oversight as in having a 'boss' the same way everyone else does is wrong though.

Consultants do not have a boss in the way that other workers have. Consultants regard themselves as more-or-less independent contractors. They claim absolute independence in their clinical decisions.
The very fact that waiting lists are many multiple times longer for public patients than for private patients is absolute proof that consultants are prioritising treating their private patients. If they were treating patients based on medical need only the waiting lists would be roughly the same, ( but then who would buy medical insurance?).
I don't know what the solution to the problem is. If any solution is proposed which would negatively affect consultants overall income, they will simply refuse to cooperate. The current two-tier system gives the consultants massive opportunities to earn huge incomes. They would not lightly give that up.

Anita Blow

Roger_007 wrote: »

If they were treating patients based on medical need only the waiting lists would be roughly the same, ( but then who would buy medical insurance?).

This is a ludicrous statement. Cannot fathom how the increase in waiting lists is anything to do with consultants and not gross mismanagement by the HSE. Yet again scapegoated due to some crafty manipulation of the public by the department of health.

Outkast_IRE

To me the whole system seems rigged from the get-go, and it will require a long term solution to correct it.

The numbers of places in college for medicine courses is kept low so demand is always sky high for their services. Is there any reason we couldnt invest in increasing substantially the number of places in medicine and linking it to a minimum amount of years they must remain working in Irish public hospitals. (Under Improved Condiitons & Contracts than Junior Docs Currently Have)

Also the Universities currently offering medicine places seem to be taking in huge amounts of (High Fees) foreign students who will return home after their training is complete - Good for the University - Bad for the Irish Health System

Since as far back as early 2000s we have accepted that we are barely training 1/4 of the doctors we should be. Why is this accepted ?

Boost the numbers coming through colleges, start offering contracts for only working in public system for Fair Money and Fair Condiitons/Working Hours.

Roger_007

Anita Blow wrote: »

This is a ludicrous statement. Cannot fathom how the increase in waiting lists is anything to do with consultants and not gross mismanagement by the HSE. Yet again scapegoated due to some crafty manipulation of the public by the department of health.

The consultants have absolute discretion to decide who they will treat and in what order, and from which waiting list. These are clinical decisions. The inequity in public and private waiting times is absolutely determined by the consultants. They could easily prioritise public over private patients for a period to bring more equity into the system, but, of course they won't do that because they would incur a financial loss.
The point is often made that the HSE also benefits financially from having more private patients in public hospitals. That is absolutely true. But they cannot do it without the consultants playing along, which, of course they are quite happy to do.

Berserker

mountai wrote: »

Their contracts are based on the amount of hours they work in the public health system . Clocking in and out would verify time spent in the public hospitals . If you watched the programme , you would have seen a certain MINORITY of consultants abuse the system , this would keep check on the swindlers and fraudsters . Simple

A clocking system doesn't keep check on swindlers in other industries. Why would medicine be any different?

Anita Blow

Roger_007 wrote: »

The consultants have absolute discretion to decide who they will treat and in what order, and from which waiting list. These are clinical decisions. The inequity in public and private waiting times is absolutely determined by the consultants. They could easily prioritise public over private patients for a period to bring more equity into the system, but, of course they won't do that because they would incur a financial loss.
The point is often made that the HSE also benefits financially from having more private patients in public hospitals. That is absolutely true. But they cannot do it without the consultants playing along, which, of course they are quite happy to do.

How can they do that when the HSE only funds a certain number of procedures? The rate-limiting step here is not consultant willingness to treat people, it's availability and funding for theatre time and clinics.
As I have said twice now in this thread, my particular consultant was seeing 10 new patients a week in clinic that required a particular procedure which the HSE would only fund once per week. That's a waiting list that's growing by 9 people per week in a single hospital, and you believe that's the consultant's fault?
You believe it's the consultant's fault who turns up to theatre on a given day to be told the management has cancelled his list because there isn't enough staff that day?

velo.2010

Restructuring the HSE to resemble something like the Nordic model of health care could be possible, but would need regionalisation of services and the acceptance of local taxation as well as PAYE. However, I think many people would be suspicious of a council tax and be reluctant to pay, as we've seen with the water charges.

Regarding how we rate worldwide, by funding of the HSE, Ireland falls in the middle of the rank of countries by % of health expenditure by government. The Nordic countries dominate the top with the US at the bottom. Just to show how fcuked up the US system is... while the government spend less as a percentage on health costs, as a percentage of GDP they spend more than anyone else in the OECD. Per capita spending is also higher than the other countries. Both figures are roughly 30% more than others. This shows the dominance of the insurance companies in the US healthcare system and how little regulation allows costs to spiral out of control.

NutmegGirl

The HSE wouldn't want drs to clock in and out, because then they'd know exactly how many hours they work, which would be more, they'd have to act on it and the wage bill would soar. Ireland didn't want the working time directive for jr drs to be implemented (48 hr week) because they knew they'd be scr**ed when it was found out that the majority worked far more than that and they'd have to employ more juniors to comply. As it is most hospitals outside of the urban centres struggle to hire and retain juniors, have to rely on locums, so no continuity of care, a system which is far more expensive and potentially dangerous than employing more juniors. It's all very well expecting foreign drs to come and take up the slack, but they don't get onto training schemes here by and large, so eventually if they want career progression they'll move on or go home and also there's something slightly unethical about taking drs from countries that need their graduates to stay and work there, generally poorer countries than us.

Also the public system is subsidised by private patients far more than people realise. If they were completely separated, the HSE would have to make up the shortfall, which would be in tens possibly hundreds of millions, and they have no intention/interest of doing that. The hospitals budgets take into account the level of private practice income brought in.

And as mentioned drs who are told they can't operate because of closed theatres, the HSE would have to employ extra staff of all types, nurses, lab staff, radiology, porters/housekeeping to open theatres on these days and reopen closed beds. The HSE would prefer to keep them closed because again they have no intention of hiring extra staff to reopen beds, or to work weekends, or into the evening like private hospitals do. That would certainly put off consultants in these specialities coming back to Ireland where they'll have heard from their friends/classmates how bad it is, I've heard of people coming back, getting permanent positions and going abroad again within a year once they realise how bad it is here; combined with lower pay for new entrants, which is being changed but only slowly. And I know other public servants like teachers, nurses etc are also suffering with this, and are voting with their feet going to the Middle East, all of a sudden shortages of teachers; nurses not coming back despite risible campaigns expecting to attract them but offering nothing These salary policies may have economically made sense but the government can hardly be shocked when people emigrate and don't want to come back to the same system that relies on workers goodwill to function but doesn't value them in the slightest.

There are always people who take advantage of every situation, and there are some in every hospital milking the system, everyone knows who they are incl management who choose to turn a blind eye. This programme won't have been a shock to anyone in the HSE and I suspect that the HSE is happy about it, hoping it will turn public opinion against consultants, they have legal cases coming up soon with consultants, test cases essentially, where the HSE hasn't complied with the contract that consultants signed and hasn't paid them what was in the contract. If they have to pay what they owe it would be a lot of money which wouldn't be popular so they'd be more than happy that this programme tarnished drs making them all look greedy. The HSE can't really expect people to comply with the new contract when it hasn't complied with its part but they're not going to mention that.
Also slightly disingenuous having NHS people commenting on the programme, it's a completely diff system where public and private are completely separate so you're not comparing like with like.

notsoyoungwan

NutmegGirls post is spot on.

I would love if I could clock in and get paid by the hour! I currently do 50-60 hrs per week, 39 of which are paid. I don't do private practice.

There was no mention of how the HSE are breaching consultants contracts, and underpaying them. There will be high court cases going ahead in new year re this. Also amused by the references to allowances- we had to fight to get them to agree to pay for time spent in the hospital at weekends, despite it being in the contracts, they tried to pay a lower rate than in contract and after eventually getting letter from DG directing appropriate payment, we're still not getting it.

But yeah, those fat cat greedy docs are the bad ones, not the behemoth employer who has the minister on its side and complicit in breaching contracts. No primetime investigates on that.

Oh and btw, patients have a role to play too. I spent 2.5 hrs on Monday twiddling my thumbs. I was at a clinic, in an off-site location. Not one, yes, not one, of the patients turned up for their appointments. One had the decency to cancel but none of the others did. Total waste of my time, and one of the causes of long waiting lists.

enfant terrible

Great work by RTE, shameful how some consultants are treating their public patients.

lawred2

Lots of hand wringing and platitudes with hear no evil see no evil responses from administrators... Nothing will change. The health system serves those on the inside and that's pretty much it.

And it does so using our taxes.

the_syco

enfant terrible wrote: »

Great work by RTE, shameful how some consultants are treating their public patients.

Sh|te work by the RTE, shameful how the HSE is treating it's junior doctors. No wonder they leave when then can.

VinLieger

The more i read about this the more this appears to be an agenda ridden piss poor piece of journalism by rte.

An example that was never mentioned is that consultants similar to junior soctors are not allowed clock in or be paid for more than 37.5 hours a week so the HSEs data to begin with is completely wrong.

Im sure there are doctors not doing their work but ignoring that the hse is simple not paying people for their work is pretty poor and evidence the whole basis for the program was "people dont like consultants lets confirm that bias"

notsoyoungwan

VinLieger wrote: »

The more i read about this the more this appears to be an agenda ridden piss poor piece of journalism by rte.

An example that was never mentioned is that consultants similar to junior soctors are not allowed clock in or be paid for more than 37.5 hours a week so the HSEs data to begin with is completely wrong.

Im sure there are doctors not doing their work but ignoring that the hse is simple not paying people for their work is pretty poor and evidence the whole basis for the program was "people dont like consultants lets confirm that bias"

Also when they mentioned the salary scales they neglected to say that the HSE are refusing to pay consultants what they are supposed to pay them, and they there are many consultants forced to take high court cases to get the HSE to pay them what they are contracted to pay. How many people would put up with that in the private sector?

Roger_007

I don't have a problem with publicly paid consultants earning other income by working in private facilities outside of their working hours, provided they fulfill their contractual obligations.
What I do have a problem with is any employee of any public utility using publicly provided facilities to generate private income on top of their salary. This is what is happening in all our public hospitals. 94% of hospital consultants are on contracts which allow them to do precisely this. These people are using the same (publicly provided), facilities and ancillary services to treat both their public and private patients.
In my view the Prime Time report concentrated too much on what hours were spent on-site or off-site. That is a side issue. The most important issue is why private practice is allowed within our public hospitals at all. It creates a conflict of interest in which the public patients inevitably lose out.
I have yet to hear a convincing argument as to why there can be private patients in public hospitals.

VinLieger

Roger_007 wrote: »

I don't have a problem with publicly paid consultants earning other income by working in private facilities outside of their working hours, provided they fulfill their contractual obligations.
What I do have a problem with is any employee of any public utility using publicly provided facilities to generate private income on top of their salary. This is what is happening in all our public hospitals. 94% of hospital consultants are on contracts which allow them to do precisely this. These people are using the same (publicly provided), facilities and ancillary services to treat both their public and private patients.
In my view the Prime Time report concentrated too much on what hours were spent on-site or off-site. That is a side issue. The most important issue is why private practice is allowed within our public hospitals at all. It creates a conflict of interest in which the public patients inevitably lose out.
I have yet to hear a convincing argument as to why there can be private patients in public hospitals.

Because private patients help fund public hospitals, they could not run without the money private patients bring in

seamus

the_syco wrote: »

Sooo... close all non-Dublin hospitals, and force anyone with an injury to goto Dublin hospitals? [/sarc]

Actually, not sarc, as they're doing that now...!

Not quite as bluntly as that, but you're along the right lines.

You distribute major hospitals based on serving the population.

So if, for example, worldwide best practice is one major hospital per 250,000 population, then you put four major hospitals in Dublin, another four in the leinster region, four in Munster and two in Connaught. And you distribute them in such a way as to minimise the amount of travel based on population distribution.

But some people are going to have to travel huge distances to reach major hospitals, and that's just the way it has to be.

Outside of the major centres, you distribute minor trauma centres, again based on population distribution, that can deal with the bloody noses, broken bones and chest pain before bouncing the emergency cases to the big hospital.

Anita Blow

Roger_007 wrote: »

I don't have a problem with publicly paid consultants earning other income by working in private facilities outside of their working hours, provided they fulfill their contractual obligations.
What I do have a problem with is any employee of any public utility using publicly provided facilities to generate private income on top of their salary. This is what is happening in all our public hospitals. 94% of hospital consultants are on contracts which allow them to do precisely this. These people are using the same (publicly provided), facilities and ancillary services to treat both their public and private patients.
In my view the Prime Time report concentrated too much on what hours were spent on-site or off-site. That is a side issue. The most important issue is why private practice is allowed within our public hospitals at all. It creates a conflict of interest in which the public patients inevitably lose out.
I have yet to hear a convincing argument as to why there can be private patients in public hospitals.

I personally believe they should be fully separated but I think the picture painted by RTE was very misleading. In fact personally I don't think I've ever seen any of my theatre lists changed to place private patients first. Additionally the show made it seem like treating private patients in a public hospital is a daily thing for consultants- I think I've seen maybe 3-4 private patients among a public theatre list over a 3 week period.

Using public facilities is not free- the public hospital generates profit from it which it uses to subsidise public services.

The question is not a problem of consultant work practices, it is why hospital funding has been let fall to such an extent that they are utterly reliant on such practice. Unfortunately the blame for that would fall onto hospital and HSE management and that is a debate neither the public nor the department of health want to have. It's much easier to pick a scapegoat.

Similar to Harris 'declaring war on 55 euro GP fees'. Easy to make a scapegoat of struggling GPs yet the public fail to appreciate that due to government policy, a GP might treat only 3-4 people that day paying 55 euro and about 15 medical card holders who they make a fraction of that off of and have to run an entire practice off it.

People's problem is with the department of health, not frontline staff. But for as long as people are happy to just accept the DoH press releases as gospel we will continue to haemorrhage doctors to other countries where they aren't continually demonised

Anita Blow

seamus wrote: »

Not quite as bluntly as that, but you're along the right lines.

You distribute major hospitals based on serving the population.

So if, for example, worldwide best practice is one major hospital per 250,000 population, then you put four major hospitals in Dublin, another four in the leinster region, four in Munster and two in Connaught. And you distribute them in such a way as to minimise the amount of travel based on population distribution.

But some people are going to have to travel huge distances to reach major hospitals, and that's just the way it has to be.

Outside of the major centres, you distribute minor trauma centres, again based on population distribution, that can deal with the bloody noses, broken bones and chest pain before bouncing the emergency cases to the big hospital.

This is exactly what needs to happen. Ireland has among the highest number of nurses per capita in the OECD, yet the nurse:bed ratio in our major hospitals is awful. Why? Because so many are sitting twiddling their thumbs in hundreds of minor hospitals dotted all over the country which are nothing more than glorified nursing homes requiring no active medical care. They could be closed, capacity in nursing homes expanded and those nurses redistributed to major urban/regional hospitals and the quality of care will improve for everybody

Roger_007

VinLieger wrote: »

Because private patients help fund public hospitals, they could not run without the money private patients bring in

If you check out the HSE annual report for 2016, you will see that private patient income is almost insignificant in the overall cost of the health service. I can't even see why this red herring is used at all.

VinLieger

Roger_007 wrote: »

If you check out the HSE annual report for 2016, you will see that private patient income is almost insignificant in the overall cost of the health service. I can't even see why this red herring is used at all.

Considering how the HSE are proven to be falsiying reporting hours worked i wouldn't believe that for a second

Anita Blow

Roger_007 wrote: »

If you check out the HSE annual report for 2016, you will see that private patient income is almost insignificant in the overall cost of the health service. I can't even see why this red herring is used at all.

HSE accounts cover HSE-owned hospitals only for which they had received private funding of 480 million that year.

It does not include voluntary hospitals who are independent of the HSE and publish their own accounts. Voluntary hospitals include:
Adelaide & Meath Inc. N.C. Hospital Tallaght
Beaumont Hospital
Cappagh National Orthopaedic Hospital
Children’s University Hospital, Temple Street
Coombe Women’s Hospital
Mater Misericordiae Hospital
Mercy University Hospital, (Cork)
National Maternity Hospital, Holles Street
Our Lady’s Hospital for Sick Children, Crumlin
Rotunda Hospital
Royal Victoria Eye & Ear Hospital
South Infirmary Victoria Hospital
St. James Hospital
St. John’s Hospital (Limerick)
St. Luke’s Hospital
St. Michael’s Hospital, Dun Laoghaire
St. Vincent’s University Hospital

May explain why the amount may seem so low when it doesn't include the private income of the 5 largest hospitals in the state as well as all the tertiary maternity hospitals and most paediatric hospitals.

gctest50

NutmegGirl wrote: »

The HSE wouldn't want drs to clock in and out, because then they'd know exactly how many hours they work, which would be more, they'd have to act on it and the wage bill would soar. ..........

Since the drs hours worked would be on record there is probably an additional reason

- when a patient dies/injured due to an error by a doctor, the patients legal team wouldn't be long demanding the records of hours worked

It'd be the same as a truck driver crashing - all there in black n white

NutmegGirl wrote: »

they'd have to act on it and the wage bill would soar

They need to be forced to act on it

This misfortune collapsed, it's like a f*cking concentration camp

Junior doctor collapsed on 60-hour shift

The shattered medic was found unconscious in hospital operating theatre

http://www.irishmirror.ie/news/irish-news/health-news/junior-doctor-found-unconscious-hospital-2351619

Roger_007

Anita Blow wrote: »

I personally believe they should be fully separated but I think the picture painted by RTE was very misleading. In fact personally I don't think I've ever seen any of my theatre lists changed to place private patients first. Additionally the show made it seem like treating private patients in a public hospital is a daily thing for consultants- I think I've seen maybe 3-4 private patients among a public theatre list over a 3 week period.

Using public facilities is not free- the public hospital generates profit from it which it uses to subsidise public services.

The question is not a problem of consultant work practices, it is why hospital funding has been let fall to such an extent that they are utterly reliant on such practice. Unfortunately the blame for that would fall onto hospital and HSE management and that is a debate neither the public nor the department of health want to have. It's much easier to pick a scapegoat.

Similar to Harris 'declaring war on 55 euro GP fees'. Easy to make a scapegoat of struggling GPs yet the public fail to appreciate that due to government policy, a GP might treat only 3-4 people that day paying 55 euro and about 15 medical card holders who they make a fraction of that off of and have to run an entire practice off it.

People's problem is with the department of health, not frontline staff. But for as long as people are happy to just accept the DoH press releases as gospel we will continue to haemorrhage doctors to other countries where they aren't continually demonised

I don't blame you for defending your own position. Everyone does that. But you obviously have a vested interest in the continuation of the present two -tier system. You are a beneficiary of it.
I'm not sure why you are bringing up the issue of GPs . Or is that just another red herring to avoid the central question which I will re-state:- why are publicly provided facilities being used to generate private income for certain employees, (such as yourself).

gctest50

Consultants pay for the use of the place etc
and pay for their insurance

Anita Blow

Roger_007 wrote: »

I don't blame you for defending your own position. Everyone does that. But you obviously have a vested interest in the continuation of the present two -tier system. You are a beneficiary of it.
I'm not sure why you are bringing up the issue of GPs . Or is that just another red herring to avoid the central question which I will re-state:- why are publicly provided facilities being used to generate private income for certain employees, (such as yourself).

I'm not a consultant. I'm bringing balance to the rhetoric that comes out of the department of health that the public eat up because it plays to their perceptions of the profession. The public hospitals allow it because it generates income for themselves too (not just the consultant) to plug holes in their own finances.

I don't think anything I have said suggestions that I'm playing to some vested interest or that anything I have said is wrong. I'm telling you the reality of working in the health service which is at odds with how Simon Harris attempts to portray it. We have over 300 vacancies for consultant posts which cannot be filled, for the first time in the history of the state we have been unable to fill training schemes and the majority of our graduates are now going abroad immediately upon completing intern year. Why is that?

As I have said, I agree that private patients should not be treated in public hospitals. But if you think that consultants not working their contracted hours, or our theatre lists being filled up with private patients and public patients being discommoded is a regular occurrence then I can assure you that you're incorrect.