Public consultants doing private work

Every system will be unfair to someone, the way things are now are far fairer than the way we are going as those who can afford it have the choice. You don't have to be wealthy person to afford it currently - it's mostly normal people on averages salaries who go private. I know far wealthier people than us who went public and I know people who would be in a worse position financially than us who went private as it was something they saw as a major priority.

I don't think some realise how big a deal this is to many women which is why I find it funny how they think they know "best".

Why is it fairer for you to be able to get priority from a doctor who is on a public shift? The scenario you're describing might also be very meaningful to a woman who can't afford it. So that's fairer on that woman?

The approach you want to maintain runs the constant risk of being to the detriment of other patients.

It was around 5k for us (out of our pocket plus whatever small contribution from the health insurance). We are in the south east though rather than Dublin so I’m sure there is a cost difference.

Edit: I should add that it can go against tax also so the true cost is less.

I am not missing the point I am talking more in general about the fact that the legacy contracts that allow consultants to have both public and private patients are no longer being issued so eventually there will be no option for private care for expectant mothers which is totally wrong.

I will reiterate again the vast majority of care a private patient of a consultant gets once they enter the hospital to give birth is actually through the public system not private. The consultant attends the birth and sign the patient out (maybe visits briefly on his rounds if he is on duty) but everything else you are a public patient with all care provided by public staff as is your right as a tax payer.

By far the largest part of being a private patient is the significant increased level of care in the lead up to the birth which is done in the consultants private clinic with his own staff and nothing to do with the tax payer.

How have the Voluntary hospitals failed?
Most of our centres of excellence lie within the voluntary hospital sector.

The public system will never be able to offer the level of indivadualied care you get privately. Seeing the same consultant (or even seeing a constulatnt rather than a midwife) for scans, having scans weekly in some instances but at the very least regullary vs. a hand full during pregnancy, being on the end of the call any time of the day or night to discuss a worry or issue, planning the best delivery method well in advance for the monther and many more things.

This makes a very real difference to many 100's and 1000's of women and they will never get this through the public system no matter how well resourced it is it will never be that well resourced. Even the fact this is in the media is stressing women - I can see it in my wife she is disgusted with the way women's choice of better care is bring removed.

What other types of employment is this outlawed? Not in most public sector jobs anyway for sure as teachers, nurses etc often take on private work on top of their public job and certainly not in most private sector jobs as they have little say in what you do on your own time once it's not working for a competitor.

It isn't outlawed, it isn't forbidden, illegal or anything else. You can get whatever level of care you want ….. BUT you have to pay for it. The problem with Obstetrics is that you CANNOT pay for it, because insurance premiums make it financially unviable. You want private care but you want the public to pay for it. That's not fair, why should I (or any other taxpayer) pay for your private care? We shouldn't and we won't.

In any case the issue at the Rotunda has nothing to do with public v private. It concerns a public consultant violating the terms of their contract. And it's only one consultant AFAIK. He/she should be sacked and he would be in the private sector.

The legacy (type B?) contracts that allow mixed public/private work is a different issue and one that will hopefully wither away over time. It is beyond crazy to offer 'piece' work to salaried employees. It would be like allowing teachers to give private grinds in school, during the school day.

Let's see 'I can spend the next hour doing the public job I'm paid for or I can see private patients and ear an extra grand?. What will I do?'

I'm all for the private system but it MUST stand on its own two feet and not be subsidized by state facilities & money. Plenty of private hospitals out there.

And the problem arises as soon as you start using the resources of the public system including doctors who are on shift putting a private patient ahead of the queue.

In terms of other jobs with such scenarios, I can't really think of any but contracts can and do prevent holding a second job. In this case, safety is a pretty legitimate concern as a justification.

The problem is that medicine is a numbers game. You have to get high numbers to reach competency. While the old model of 72 hours on call and vomit on the way home from the sheer fatigue was neither right for the patient nor sustainable, the only thing that it meant was that the actual numbers of cases the trainee had when they came out the other end was incredible. One of the problems with the UK model and moving to shift-work pattern is that doctors will take 12 years+ to reach a level of competency for independent practice, they will not reach the same level of exposure. When they reach the end, they just don’t have the same breadth of experience to back up their practice as the old-timers. You cannot deal with a really sick patient if you have never dealt with that type of illness before. And if your shift is over at 5pm on the dot, there is a loss of ownership of the case. People see shifts and not patients. This is to the detriment of patient care. Medicine is a numbers game and the only way of becoming competent is doing

If the public system cannot give you what you need then go private. No one is stopping you.

However do not expect taxpayer facilities, time or staff to subsidise it on your behald whilst taking resources of others.

That is selfish and ignorant.

But the person is a taxpayer and they are availing of the public services as they are entitled to as also outlined by the previous poster. The point really is not getting through that a private patient of a consultant IS a public patient of the maternity ward also and fully entitled to all the services and staff the same as anyone else.

Would you have any idea of what kind of hours would your average consultant be working across a 7 day week, in total? I'd genuinely be interested to hear. I know there are junior doctors who routinely work 60-70 hour weeks. I know I did 85-90 hour weeks (behind a bar) many many years ago and I can only imagine the difficulty in making live or death decisions with that level of work put in per week.

Absolutely agree and SlainteCare fully endorses that choice, outside the public hospital setting. The issue is that providing both in the same setting only provides additional benefits (ie pay) to the doctors without additional burden. That leads to moral hazard and inappropriately allocated resources. The true cost if private care would be much higher.

The problem here being that their employer is colluding with them to vitiate the essential point of the contract.