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Hospital consultants and their pay deal

realitykeeper

I hear hospital consultants negotiated a pay deal which included back pay. They also seemed to take issue with being "spied" upon to make sure they were not double jobbing.

Ah yes, political cowardice at it`s most extreme. Rather than demanding the hospital consultants surrender their passports at the nearest Garda station and have them make an immediate and full declaration of all their assets to the revenue, the government caved in. Those consultants should have been sued by the state for breech of contract. There is already ample evidence that the hospital consultants have worked in private practice while on the taxpayers payroll and the never ending waiting lists are a testament in themselves. Even the waiting lists are the tip of the iceberg because so so many who should have been treated, died waiting for a begrudging consultant whose only interest was to get back to his private patients as quickly as possible.

Mind you, I am all in favor of private healthcare but consultants must work for one or the other. It is clear these consultants cannot be trusted and they need a boss with the power to sack them to follow them around and to shout at them for slacking off. Consultants should only be paid for what they do and not by the hour.

Finally, hospital spending (like government spending) should stop and every demand for payment scrutinized for value in order to end waste. If a hospital overspends, the claimants should only be allowed claim from the individuals responsible and their personal estate. Am I wrong?

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draiochtanois

This post has been deleted.

Mikenesson

draiochtanois wrote: »

No there isn't - the existing ones just need to work a regular week with regular holidays ...

Here we go..

Students like their holidays too you know

Berserker

Graces7 wrote: »

Given the dire state of the health service,it would have been a deeply meaningful and appreciated gesture to forgo this pay increase.

Meaningful in what way and appreciated by whom?

Dr Brown wrote: »

Most of the consultants I've met are rip off merchants.

Care to expand on this?

Grayson

Graces7 wrote: »

Given the dire state of the health service,it would have been a deeply meaningful and appreciated gesture to forgo this pay increase.

Consultants aren't really the problem there, it's middle management.

I know a consultant pretty well. He's an A&E doc so his private hours are pretty limited. I lived with him in his 30's. He'd arrive home every evening and study. At weekends there'd be a bit of study. He'd started studying when he was doing his junior cert and pretty much hasn't stopped since. He'd one of the very best at what he does and it's because of study.

Yes, consultants get paid a lot but they put the work in.

There's many things wrong with the health service but most can be traced back to the HSE and not the frontline staff.

CrabRevolution

I've worked in hospitals before and sat in at meetings involving consultants and surgeons. One thing that always struck me at every meeting was how they were always looking to fit in more work, more scopes, more procedures more patients etc. (all if this was public so its not like they made more money).

They'd offer to come in earlier, swap days etc. Just to squeeze one more patient in a week.

In the end it was always staff shortages, lack of beds, decontamination delays etc. That blocked this from happening. It was the total opposite of the stereotype of the golfing consultant who occasionally visits the hospital.

EdgeCase

The issue I see here is that there isn't a 'system'. There's a whole load of unconnected parts, all trying to do their jobs, with little or no coordination and support.

What I observe is tons of administration and very little visible management. The two are completely different concepts. One is intelligent and analytical, the other is bureaucratic and just rule following.

You need excellent administrators too, but they are not necessarily managers.

The medical staff, be they doctors, nurses or anyone else are not managers. They're technical professionals with expertise in their areas of medicine. They shouldn't be expected to be good managers. It's not part of their training or even necessarily their interests.

Also, the failure to understand the difference between 'management' and 'administration' is actually insulting to the whole concept of management as a profession. Management is a hugely complex, highly specialist skillset that involves an ability to coordinate and design organisations and make them run smoothly. It's a mixture of system design, psychology and an ability to think incredibly strategically.

What the HSE does *all the time* is put forward bureaucratic administration as management. It's not and it never will be.

You also can't necessarily 'train up' all your administrators to be good managers. Some people simply don't have the aptitude for it anymore than they have for carrying out cardiac surgery. Likewise, cardiac surgeons shouldn't be attempting to manage complex organisations. They should be supported by excellent managers.

To me, that's where Ireland's healthcare utterly falls into a shambles.

It's also not just the public sector, I've seen similar abysmal management in private healthcare here too where everything's focused on administration.

There's also an unwillingness to change those bureaucratic structures, even when they're falling apart and clearly not serving the function they were intended to perform. It's a mixture of empire building and some kind of organisational fossilisation and sclerosis that develops in old organisations like hospitals. Things have been done 'this way' for years and any change is a massive challenge to the system and its various components who resist it.

Blaming a single minister on all of that won't solve it. We've a health service problem that spans decades and multiple administrations from different political parties and ideologies. The problems are actually so chronic that they predate the birth of the current minister for health!! They've all attempted to fix it and none have succeeded.

That's why I think it has to go into a cross party approach to just tackle healthcare head-on as a national crisis issue. I don't think any of them have the monopoly on the solutions to this but they need to stop various actors from playing politics with a system that is impacting people's lives and get on with some kind of approach that can finally start to get the system to work as a proper system.

it's beyond political football or ideological divides. We need public system that works and can ultimately be evolved into a single tier system that's as effective as any of our northern European peers' systems.

The excuses are getting tiresome. We have the resources, we have the skills, we have the people and we have the imagination to sort this out. We need to tackle the problems.

Dr Brown

Berserker wrote: »

Care to expand on this?

Here is just one example.

A consultant called me in to discuss the results of my MRI.

The consultant did not have the MRI results which he had ordered.

Yet I was sent away and I was charged 200 Euro for a 5 minute visit in which nothing was discussed because he didn't have my MRI results.

I could go on but that was not the only time I was ripped off by a consultant.

EdgeCase

You get good and bad example of that kind of behaviour.

I went to an ENT consultant and he only charged €100 fee and refused to take payment for multiple follow ups and even physical treatment, as he felt he wasn't really doing anything. Others will charge you for every time they say hello to you.

Most in my experience are somewhere in the middle.

It is an area where you could do with more regulation and an obvious complaints process as at the end of the day, private consultants are basically sole traders and individuals who vary a lot. It's hard to just make a sweeping statement.

Dr Brown

Topgear on Dave wrote: »

The state made a contract. Then broke their side of it.

The consultants took them to court and the state settled.

But I know its popular to kick the consultants because (a) they are very well paid (b) they are small enough in number to provide an easily kickable group without political blowback.

The government can fight them but lets face it these folks have about 10 years of specialised expensive training, huge responsibility in a lot of cases, and many could walk out tomorrow and work anywhere in the world.

And we are short of them already.

All public sector workers had their pay slashed yet there wasn't the same "hoo-ha" when their pay was cut.

A few years ago the country was on its knees yet all consultants cared about was trying to defend their already massive salaries.

Dr Brown

EdgeCase wrote: »

You get good and bad example of that kind of behaviour.

I went to an ENT consultant and he only charged €100 fee and refused to take payment for multiple follow ups and even physical treatment, as he felt he wasn't really doing anything. Others will charge you for every time they say hello to you.

Most in my experience are somewhere in the middle.

It is an area where you could do with more regulation and an obvious complaints process as at the end of the day, private consultants are basically sole traders and individuals who vary a lot. It's hard to just make a sweeping statement.

Another area that has to be looked at is the fact that a lot of consultants will only accept cash.

I very much doubt they are declaring their full income to the taxman.

SEPT 23 1989

Don't some consultants own the car parks at hospitals or take a cut from them?

VinLieger

Dr Brown wrote: »

A few years ago the country was on its knees yet all consultants cared about was trying to defend their already massive salaries.

So you think they make too much? Funny considering we already have a shortage of consultants fleeing us to other countries due to better pay and conditions.

See the problem with your argument is lets for the sake of the argument say we do pay them too much, would you prefer we had even less than we already do which would happen if we slashed their wages or just the bottom of the barrel who cant get jobs anywhere else?

Dr Brown

VinLieger wrote: »

So you think they make too much? Funny considering we already have a shortage of consultants fleeing us to other countries due to better pay and conditions.

See the problem with your argument is lets for the sake of the argument say we do pay them too much, would you prefer we had even less than we already do which would happen if we slashed their wages or just the bottom of the barrel who cant get jobs anywhere else?

They should let more people become Doctors at the moment its like a cartel.

If Cuba can have a world class health system with little or no money there is no reason why Ireland can't.

ohnonotgmail

Dr Brown wrote: »

They should let more people become Doctors at the moment its like a cartel.

If Cuba can have a world class health system with little or no money there is no reason why Ireland can't.

you mean cuba where they pay their doctors a pittance? Best of luck with that.

VinLieger

Dr Brown wrote: »

They should let more people become Doctors at the moment its like a cartel.

How do you suggest we do that? Reduce the entrance criteria and difficulties of the exams? Yeah that deffinitely sounds like a good way to solve a health care crisis.....

EdgeCase

Dr Brown wrote: »

Another area that has to be looked at is the fact that a lot of consultants will only accept cash.

I very much doubt they are declaring their full income to the taxman.

I genuinely find that bizarre.

The single worst incident I've ever encountered was with an elderly relative who couldn't get a particular fairly operation done in reasonable time on the public system. We did a bit of a 'whip around' amongst the family to pay for her in a private hospital without insurance. It was a few thousand Euro but it was better than leaving her for several years waiting and she needed the quality of life.

We paid the consultant by card, which was all quite normal. Paid the hospital by card, again quite normal. The anaesthetist, however, was expecting payment in cash and offering a cash discount and actually asked her for money in the operating theatre!!! It's was extremely unprofessional and just weird. The fee wasn't huge as it wasn't a particularly complex procedure but, we didn't pay him on the day as we couldn't even locate him afterwards.

I paid him by cheque as I am damned if I'm having someone dodge tax.

Revenue need to come down like a ton of bricks on this stuff. It's utterly ridiculous.

It was actually embarrassing and quite frightening, as she was concerned she was going to end up getting the operation without an anaesthetic or something.

Quite honestly I felt like it was something you'd expect in a developing world country. A doctor asking a patient for cash in the OR. How does that even happen.

Wow. Just wow.

I'm still shocked by it months later.

I had surgery myself a good few years ago too and the consultant asked for post-dated cheques in the amounts of the fees above and beyond what was covered by my (quite hefty) VHI plan.

I think though you can't generalise - but it needs to be regulated properly. It's a business like anything else and one that also needs to be a lot more robustly regulated than others as people are often in quite weak and vulnerable positions too.

Anita Blow

Dr Brown wrote: »

All public sector workers had their pay slashed yet there wasn't the same "hoo-ha" when their pay was cut.

A few years ago the country was on its knees yet all consultants cared about was trying to defend their already massive salaries.

This was in addition to the FEMPI pay cuts.

This revised contract significantly reduced the income of consultants and entailed more public hours, less social working hours. Consultants agreed to it as they understood the economic situation the country was in. Then after consultants implemented these changes, the HSE reneged on their part of the deal and never paid them the money they were contractually owed.
This was followed by a 30% pay cut in 2012. So consultants were significantly financially worse off after this and lied to by their employer.

Hence our health service is in the state it's in. We can fill almost no available consultant posts and we are haemorrhaging current public consultants to private practice or abroad. The HSE does not pay astronomical money and Ireland does not exist in a vacuum. Medicine pays far better abroad

Dr Brown

VinLieger wrote: »

How do you suggest we do that? Reduce the entrance criteria and difficulties of the exams? Yeah that deffinitely sounds like a good way to solve a health care crisis.....

No need to reduce the entrance criteria they just need to open up more places for people to become Doctors like they are doing in the UK.

Also working as General Practitioner is far from rocket science.

ohnonotgmail

Dr Brown wrote: »

No need to reduce the entrance criteria they just need to open up more places for people to become Doctors like they are doing in the UK.

Also working as General Practitioner is far from rocket science.

I would suggest that you dont know much about either if that is your opinion.

EdgeCase

Dr Brown wrote: »

No need to reduce the entrance criteria they just need to open up more places for people to become Doctors like they are doing in the UK.

Also working as General Practitioner is far from rocket science.

Which would just result in Irish public universities training more doctors to work in the private system in the USA and in systems in Australia and Canada and so on.

People are reporting that they're leaving Irish positions due to poor career path options, lack of support, ridiculous hours and so on. It's not due to lack of supply. We are exporting trained and skilled doctors to better managed healthcare systems.

It's not a simple supply and demand curve. There's a whole load of things making working in Irish healthcare unattractive.

We have lost and continue to lose loads of Irish graduates in those professions because they're not addressing the reasons why they're leaving.

VinLieger

Dr Brown wrote: »

No need to reduce the entrance criteria they just need to open up more places for people to become Doctors like they are doing in the UK.

Also working as General Practitioner is far from rocket science.

So your response to loads of our doctors leaving once they are fully trained because pay and conditions are so bad is to pay to train more who will leave when they are fully trained because conditions are so bad......

Dr Brown

EdgeCase wrote: »

I think though you can't generalise - but it needs to be regulated properly. It's a business like anything else and one that also needs to be a lot more robustly regulated than others as people are often in quite weak and vulnerable positions too.

I would generalize because I have met a lot dodgy people in the medical profession and literary nothing would surprise me when it comes to the behaviour of Doctors.

EdgeCase

Dr Brown wrote: »

I would generalize because I have met a lot dodgy people in the medical profession.

It's not so much the profession as you've a load of people working on the basis of casual self employment, without any structure.

I'd suspect it's as dodgy as any other scenario like that as they humans just like the rest of the population.

There should be strong regulations put in place to ensure good conduct of business rules apply. I think that's particularly essential in the medical and paramedical world as you've people often in very vulnerable situations with a sole provider of a service who has them very much over a barrel.

It would be utterly naive to assume that any profession is beyond the need for regulation.

Anita Blow

I will predict the standard response to that question which is instead of making working conditions better, let's force them to stay because we apparently pay hundreds of thousands to train them (which is incorrect, department of health figures demonstrate <20% of medical school funding comes from the exchequer and we pay no more than an arts graduate to train medics)

Dr Brown

ohnonotgmail wrote: »

I would suggest that you dont know much about either if that is your opinion.

You must think that Doctors are some sort of Gods who know everything and are never wrong.

VinLieger

Dr Brown wrote: »

You must think that Doctors are some sort of Gods who know everything and are never wrong.

No I think you are confusing that with how you view yourself

Dr Brown

EdgeCase wrote: »

It's not so much the profession as you've a load of people working on the basis of casual self employment, without any structure.

I'd suspect it's as dodgy as any other scenario like that as they humans just like the rest of the population.

There should be strong regulations put in place to ensure good conduct of business rules apply. I think that's particularly essential in the medical and paramedical world as you've people often in very vulnerable situations with a sole provider of a service who has them very much over a barrel.

The difference between them and the general population is that most people don't have a Superiority complex and look down on people who are not in their profession.

Pugzilla

Chicks, money, power and chicks

Glass fused light

Anita Blow wrote: »

I will predict the standard response to that question which is instead of making working conditions better, let's force them to stay because we apparently pay hundreds of thousands to train them (which is incorrect, department of health figures demonstrate <20% of medical school funding comes from the exchequer and we pay no more than an arts graduate to train medics)

Re-read the first post, why do you think the OP would want to force the removal of passports.

Dr Brown

VinLieger wrote: »

So your response to loads of our doctors leaving once they are fully trained because pay and conditions are so bad is to pay to train more who will leave when they are fully trained because conditions are so bad......

More Doctors in Ireland would mean better working conditions so they would be more likely to stay.