Hospital consultants and their pay deal

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

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.

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 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.

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.