Intern/SHO Salary

ThatDrGuy · 06-03-2013 09:04PM

I would have to say personally Irish medical training is god awful. Its only the vast volumes of patients you see combined with the dangerous out of your depth but no support so go to do it situations that lead to learning. I learned to use CPAP on a severely hypoxic patient by googling it. I was working for a professor of resp medicine at the time! You see people coming out of SHO schemes unable to treat Afib but who can strip and rebuild a broken printer in 2 minutes. Training is the dirtiest word in the HSE vocabulary. The ships surgeon on the space shuttle, head of medicine at nasa, associate prof of neurology : he hasn't spent 13 years training! Not to say Irish medics and surgeons are bad at what they do. It just takes an unacceptable amount of time ( and personal sacrifice ) to get to that stage: for 4,500 ish a month and a 20% chance of a job its downright lunacy. If I was doing it again I would have headed straight to OZ and never looked back.

take everything · 06-03-2013 09:24PM

ThatDrGuy wrote: »

You see people coming out of SHO schemes unable to treat Afib but who can strip and rebuild a broken printer in 2 minutes.

Brilliant.

his_dudeness · 06-03-2013 09:34PM

dissed doc wrote: »

Bizarrely, the HSE contracts forbid the doctor from working privately even on their own time. It's 24/7 obligation to the HSE so no chance of even earning extra money to pay off the loans.

Am I wrong in saying that the new contracts with their "rostering" arrangements maxes out at 40hours - and in any case, EWTD appplies to consultants too.

If/when I finish and get consultancy, I'll be taking my 100k and clocking out at my 40 hours. Might actually get a bit of a life (albeit at a standard considearbly less than I would have expected) **** for paying off student loans but could bring around a new breed of less private practice driven consultants.

It'll make **** of patient care and patient continuity though....

Forklifted · 06-03-2013 09:43PM

Looks like this has sparked a good debate, thanks for all the replies. There are many more in my situation so this is a worthwhile conversation (p.s. we seek no pity as we got ourselves into this).

I'm beginning to understand that I will still be under qualified post-Internship or even after one or two years of SHO to consider locuming under an LLC.

Like many early GEMs I have the full €100k however some of the financial advisors who have commented will be appalled to know that I do not have a guarantor for it - just life insurance. I suppose they can always kill me if I'm struggling to pay it back!! This puts the ball in my court on graduation (somewhat!).

For those who wanted the details, the loans are at 4% with no repayments for the four years, leaving you with about €106k on graduation. Then the loan reverts to a 15 year term at the same interest rate but with an understanding that it will be paid in 10 year based on the assumption that you will make more in the later years. There is also an interest only option for intern year which would be around €400-500 per month. Nobody will be paying €1500 per month, its just not possible for the initial 4/5 years.

I suppose my initial question was really seeking to find out if the overtime/call adds up. One poster mentioned that inters might get as little as €8k for that but even after tax that roughly amounts to my (interest only) loan payment for the year. This makes a huge difference to me if true.

Too · 06-03-2013 09:48PM

It depends on:
1 what speciality (unrostered OT)
2 whether hospital pays unrostered overtime
3 if you work the day post call or not
4 frequency of call

In surgery you will double your gross with OT in most jobs but your net is only about 47% of this. In medicine your gross is less and in micro path etc there is no overtime.

This does not take into account croke park II. Deduct another 10% off your gross.

Nor does it take into account the effect of the "NCHD spring". Many interns only work 48 hrs on average and it looks like this will be extended up through the ranks so SHO and reg income will dramatically reduce.

I echo the comments above. In my experience, Irish training (for those who work hard, are copped on, take the initiative and basically put in the time and effort) is excellent and Irish trained doctors are sought the world over. However knee jerk implementation of EWTD onto the beurocratic unionised chaos that is the Irish system will, in my opinion, result in alot of very poor, badly trained and disillusioned doctors.

I would not like to be starting out again in medicine in Ireland today. If you want to stay then do but make sure your eyes are open and your goals are realistic. however after your intern year is a good time to consider moving. The US if you have the drive and the pedigree but otherwise consider Australia or Canada.

dissed doc · 06-03-2013 10:04PM

Too wrote: »

It depends on:
1 what speciality (unrostered OT)
2 whether hospital pays unrostered overtime
3 if you work the day post call or not
4 frequency of call

Personally I think they will introduce the EWTD at 48hrs/week max, and that will be all you can get paid for then. But, you will still end up doing the 70hrs+/week like 15 years ago, but unpaid. Nothing will actually change except a reduction in the overtime bill through a box-ticking EWTD-compliant rota.

dissed doc · 06-03-2013 10:11PM

ThatDrGuy wrote: »

I would have to say personally Irish medical training is god awful. Its only the vast volumes of patients you see combined with the dangerous out of your depth but no support so go to do it situations that lead to learning. I learned to use CPAP on a severely hypoxic patient by googling it. I was working for a professor of resp medicine at the time! You see people coming out of SHO schemes unable to treat Afib but who can strip and rebuild a broken printer in 2 minutes. Training is the dirtiest word in the HSE vocabulary. The ships surgeon on the space shuttle, head of medicine at nasa, associate prof of neurology : he hasn't spent 13 years training! Not to say Irish medics and surgeons are bad at what they do. It just takes an unacceptable amount of time ( and personal sacrifice ) to get to that stage: for 4,500 ish a month and a 20% chance of a job its downright lunacy. If I was doing it again I would have headed straight to OZ and never looked back.

Yeah but it's denial and only way to work through the "cognitive dissonance" of spending so long in what is meant to be training. Studies say that specialists are at their best if they get out into practice in their 30s. So Irish grads get posts in their 40s and somehow "okay" it in their heads, but the research says that they wasted their time, because specialists in the US, UK, Netherlands are out as consutlants 5-6 years from graduation but spending 14yrs+ in training in Ireland makes you somehow better? BS. Complete horsesh1t, TBH.

irish grads are not sought after; this is historic due to previous ties with the UK which are now rapidly fading due to bridges being burned by our dear leaders (.eg., Pakistan recruitment drive). They speak English and have cost nothing to train; Aus or Canada gets a "free" specialist that can communicate. That is what is sought after. Ego and self-delusion over a decade and a half in training are not.

As an aside, the HSE and DoH have effectively implemented what is being planned in the UK with consultants and "super-consultants". 90% of the consultants will have limited incomes and no bonuses and 10% will have access to extra financial awards, etc., . Right now, this will take only 5-10 years to implement in Ireland as consultants on higher contracts dwindle in number and more people take up the regular contract. None of these things are things that the IMO or any doctor can fight against as it is being completely unilaterally imposed.

his_dudeness · 06-03-2013 10:20PM

The interns will always be the first to be brought in line with EWTD, they're just an easier grade to organise and for the most part dont cover ED so its only ward work that'd have to be changed.

An option to maximise your OT is to pick a smaller hospital where doctor numbers are too small to fully implement the 48hour working week, hospitals like Roscommon, StnJohns in Limerick, Wexford.youll end up working more, and it'll probably be quieter, and cost of living at these smaller hospitals tends to be less too, so better take home pay. Cn do the same at SHO too, pick a medical scheme that has you manning Ennis and Nenagh. It'll be soul destroying but technically "training" and prob best bet to maximise take home pay. I did 6 months in Roscommon as an intern three years ago on a 1 in 5 rota doing 28 hour shifts and made a packet.

The private hospitals take on RMO staff at pretty competitive rates too, without needing too much experience. I have a lot of friends working in a certain private hospital in the west while they're doing research and seem to be doing okay out of it.

Bella mamma · 06-03-2013 10:20PM

RobFowl wrote: »

Also the days of non GP's doing GP locums are gone as the MPS and Medisec will no longer cover non vocationally trained docs for GP work (they changed this about 2 years ago for anyone looking for cover from then).

About 6 months ago (no less), I asked The Medical Council about this as you are correct in that The MPS etc will not cover for GP work if you are not a GP. It's listed as one of the 6, or so, exclusions including Cosmetic work, OBGYN etc. The reason I asked is twofold: SHOs who don't get on the GP training scheme (a common occurrence) don't want to stay on in hospitals AND I know a doctor who did their 2 years of SHO training (BST) and has been working in a GP office since, which is 3 years since they finished SHO training and did The MRCPI. They work full time in 2 practices in Dublin, 4 days plus 1 day. They were unable to get on the scheme x 3 and did not apply this year in case fast-tracking comes in next year. The Medical Council were very clear in telling me that any doctor could work in a GP office as long as they did not "mis-represent themselves as a GP". They agreed that patients would think such a doctor was indeed a GP, but as long as the doctor didn't say they were a GP, it was fine. This doctor is also on the list for the national cervical smear taking programme. Surely there must be more non-GPs doing GP work and using the term 'assistant' if patients ask? (Though patients would never ask). What will happen to these doctors now? And most importantly, how are they covered insurance wise??

OP: How much per year are GEM fees? Are they €13k x 4 years and the remainder for living expenses? I agree with around €8k in overtime payments, €12k max. SHO is not much better, at a salary of €38.8k plus that overtime. Sadly if you don't really want to, you will be in a much better position to emigrate and do all your training abroad. You can do GP in England too.

Chanste: Why would you think that your loan could be written-down, are you equating it with negative equity write-downs? That's completely different. It can be re-structured. You have earning potential but there is no way they will reduce it.

chanste · 06-03-2013 10:57PM

Bella mamma wrote: »

Chanste: Why would you think that your loan could be written-down, are you equating it with negative equity write-downs? That's completely different. It can be re-structured. You have earning potential but there is no way they will reduce it.

TBH although I know I don't have a mortgage, I guess I was thinking that for a loan this big there ought to be some kind of wiggle room. If personal insolvency systems can allow someone to write off part of the negative equity of a house, I'm not sure exactly why I shouldn't be able to do the same. People who bought property and then got stung by the recession aren't so different to me having got a large student loan of €100k with what was at the time looking like a much more stable proposition, then because of the recession and cut backs its far more difficult to earn significantly. When I got the loan I also did not need a guarantor, but I also didn't require life insurance (at least I don't remember getting any - but I'm certain about the guarantor).

For the record, I am not planning on defaulting on my loan or anything of the sort, but I think that the only way I could manage to pay this loan would be interest only, and because this would prohibit me from ever getting a mortgage having a loan this big with capital that isn't reducing, what could be worse about defaulting? It is in the banks interest to make me see why paying it is a better option, and the best way I can think of doing that is to either prolong the reduced interest rate which I was on as a student or to write down a chunk of the loan.

chanste · 06-03-2013 11:13PM

Just thought I'd draw attention to this for people who end up struggling with med loans. This is from the personal insolvency act of 2012. If I understand it correctly (and please do correct me before this starts giving me undue hope) a "Debt Settlement Arrangement" (DSA) will allow a person to apply to have unsecured loans above the value of €20,000 paid off within 5 or 6 years taking into account their means.

The page is well worth a read for anybody with money worries.
http://www.citizensinformation.ie/en/money_and_tax/personal_finance/debt/personal_insolvency/personal_insolvency_options.html

Forklifted · 06-03-2013 11:43PM

Bella mamma wrote: »

OP: How much per year are GEM fees? Are they €13k x 4 years and the remainder for living expenses? I agree with around €8k in overtime payments, €12k max. SHO is not much better, at a salary of €38.8k plus that overtime. Sadly if you don't really want to, you will be in a much better position to emigrate and do all your training abroad. You can do GP in England too.

They started out at €13k but they've risen to €15k now. Looks like it could rise another €1k each year at the moment as the Higher Education Authority keep cutting their contribution to the overall fee.

I need to decide what it is I want to do. GP seems like the best route considering age, lifestyle etc in Ireland. But I don't know what the jobs market is like here in Ireland for qualified GPs?

Personally I don't mind going abroad to train (be it to the US for Internal Med + a fellowship or to the UK for GP) but I know there will be many in my position who don't want to or can't leave.

Forklifted · 06-03-2013 11:45PM

chanste wrote: »

Just thought I'd draw attention to this for people who end up struggling with med loans. This is from the personal insolvency act of 2012. If I understand it correctly (and please do correct me before this starts giving me undue hope) a "Debt Settlement Arrangement" (DSA) will allow a person to apply to have unsecured loans above the value of €20,000 paid off within 5 or 6 years taking into account their means.

The page is well worth a read for anybody with money worries.
http://www.citizensinformation.ie/en/money_and_tax/personal_finance/debt/personal_insolvency/personal_insolvency_options.html

I know that they have similar measures in the UK but if you go before the judge as a qualified doctor he'll throw it out immediately based in future earning potential alone. I think the reality is that it will have to be paid!

etymon · 07-03-2013 06:50PM

Dug out my loan agreement from 2010 which is interesting. 100k over 4 years, 25k each year, no life assurance, no security, no repayment schedule AT ALL. The duration of the agreement is year to year i.e. 2010 - loan amount = 25,000 repayable by 23 September 2011 in one instalment. 2011- loan amount is now 50,900 repayable by 24 September 2012 in one instalment. Obviously I didn't pay that and now i am up to 75k plus but what is to stop me from paying them 200 quid a month for the rest of my life? Apart from the obvious i.e. the debt never goes away. Meh, I've lived with debt long enough. I could handle it.

Forklifted · 07-03-2013 07:47PM

etymon wrote: »

Dug out my loan agreement from 2010 which is interesting. 100k over 4 years, 25k each year, no life assurance, no security, no repayment schedule AT ALL. The duration of the agreement is year to year i.e. 2010 - loan amount = 25,000 repayable by 23 September 2011 in one instalment. 2011- loan amount is now 50,900 repayable by 24 September 2012 in one instalment. Obviously I didn't pay that and now i am up to 75k plus but what is to stop me from paying them 200 quid a month for the rest of my life? Apart from the obvious i.e. the debt never goes away. Meh, I've lived with debt long enough. I could handle it.

At the moment, there technically isn't much to stop you doing that. But in reality they will make life more difficult than it should be. Constant letters, phone calls, the odd court appearance to start with. The prospect of renting for most of your life due to a poor credit rating. Plus every time you acquire an asset they'll chase it.

I don't think its worth thinking about the option of not paying it as it'll have to be paid.

HeadPig · 07-03-2013 09:37PM

I feel physically ill reading about the mistreatment and exploitation of Irish doctors. Disgusting. Wish we had the power to strike.

his_dudeness · 07-03-2013 11:21PM

HeadPig wrote: »

I feel physically ill reading about the mistreatment and exploitation of Irish doctors. Disgusting. Wish we had the power to strike.

We do.

drzhivago · 08-03-2013 08:20PM

Forklifted wrote: »

Looks like this has sparked a good debate, thanks for all the replies. There are many more in my situation so this is a worthwhile conversation (p.s. we seek no pity as we got ourselves into this).

I'm beginning to understand that I will still be under qualified post-Internship or even after one or two years of SHO to consider locuming under an LLC.

Like many early GEMs I have the full €100k however some of the financial advisors who have commented will be appalled to know that I do not have a guarantor for it - just life insurance. I suppose they can always kill me if I'm struggling to pay it back!! This puts the ball in my court on graduation (somewhat!).

For those who wanted the details, the loans are at 4% with no repayments for the four years, leaving you with about €106k on graduation. Then the loan reverts to a 15 year term at the same interest rate but with an understanding that it will be paid in 10 year based on the assumption that you will make more in the later years. There is also an interest only option for intern year which would be around €400-500 per month. Nobody will be paying €1500 per month, its just not possible for the initial 4/5 years.

I suppose my initial question was really seeking to find out if the overtime/call adds up. One poster mentioned that inters might get as little as €8k for that but even after tax that roughly amounts to my (interest only) loan payment for the year. This makes a huge difference to me if true.

Coming to this late but have significant experience of hospital earnings and potential and also locum earnings and potential

I note the contribution from a few financial advisors and this looks worrying for anyone intending to study GEM in the next few years

FACTS

No Guarantee of job on graduation from college = Quite a number of graduates will have to emigrate at this point
2nd Year post grad = SHO - Most jobs at this level now attached to some sort of training scheme (even if only in name without the actual training as some have alluded to) which means person is on Trainee register which PROHIBITS working outside your hospital - SO ILLEGAL TO DO LOCUMS
SHO Earnings are quite low if paying rent/living expenses you might not even be able to afford that years interest on the 100+K accumulated debt at that point
SHO PAID HOURS are reducing in line with EWTD, WORKING HOURS MAY NOT actually reduce but paid hours will
Moving from SHO - REGISTRAR = competitive application process and not always enough jobs for applicants which means more years on lower scale as SHO in NON training job with potential to do locums or EMIGRATE
SPR very competitive to get on to and if proceeding to this point it will be at least 10 and more likely 12 years post UNIVERSITY that you will complete SPR and get CCST (Certificate of Completion of Specialist training) which allows you to apply for consultant job but no guarantee of same -- AS SPR you wil earn more than SHO BUT you will have higher outgoings through exams conferences reserach etc that you will have to pay yourself so ability to pay back on laon may actually decrease in these years also as there are the exam fees/courses etc
NEW CONSULTANT SALARY = 109-116k NET POSITION again means probably will only be able to afford small payments off loan
IN REALITY your first job as an intern has salary of 30K, IF you asked for a mortage in that year which is a 20+ year term loan then you would be unlikely to get more than 75K in current climate and YET you will have graduated with a loan 33% more to be repaid ina shorter time --

Taking all of above into account TBH looks like writing is on the wall for graduate entry medicine unless schemes of refunding are put in place with debt forgiveness for working in certain areas/hospitals/specialities

I wish you luck as I do not see a way out of this

Regarding your question on earnings as an INTERN, I think you have to figure in the 48 hour maximum and dont expect any more earnings than that in INTERN year, if you do i fear you will be disappointed

This is an issue that you shoudl take to USIT / IMO / Local politicans to show you cant afford to work after paying for this education unless they structure things differently

drzhivago · 09-03-2013 11:16AM

Have had an interesting chat with a financial person

He knows career path for docs in Ireland and also the gaps ie not enough jobs at various levels

One option he has suggested is
Intern in Ireland
Move to UK for SHO job for 2-3 years
When ;and in UK declare bankruptcy (a la what we read in newspapers except you would actually be based there and not juts on paper)

Bankruptcy in UK does not affect GMC registration unless you become bankrupt because of the method of running your medical practice or unethical behaviour

at this point we cant find the relevant data/legislation related to how this would affect your Irish registration if you maintain such while you go to UK, there are some constraints in irish Veterinary registration related to undischarged bankrupts but cant seem to find similar for docs

So in essence Go East young men and girls would seem to be the answer to your massive debts, in particular if you dont get intern job here but can secure Foundation job in UK

briankirby · 09-03-2013 01:20PM

dissed doc wrote: »

Sorry, that is nonsense. Consultant salaries are currently around €4.5k/month and set to drop to the a target net income of €4k within 5 years. You will *never* pay off that debt.

In Ireland, doing a few years hospital rotations and then doing GP locums is th best route. Training schemes in aireland are complete BS and a complete waste of time IMO. You are takki g about salaried positions which is never ever going to make a dent in that level of debt. You need to get active and work.

To answer the above question, yes its normal for people to work through their own LLC in the UK. NHS will not contract directly so you go through agencies, who will bill you out for 15% higher for example.

Hey dissed doc,
When u say the agencies will bill you for 15% what do u mean exactly?Is it that they take 15% of your pay?Working 50 hours a week as an sho locum in the UK as u mentioned you could be making £8000 a month gross.If u set up an LLC that a tax rate of 21%.Your hospital accomodation will be paid for and through the LLC u can claim back for petrol and food if you are travelling every 4-6 months. Anybody who is worried about debt should just do this or do as drzhivago suggested and declare bankruptcy.This would be 75000 net a year excluding malpractice and all that.Im sure there are ways of getting the effective tax rate lower than 21% as i bet many are doing.

Traumadoc · 11-03-2013 11:05PM

Ryder wrote: »

Relatively smooth...intern 1 year
Sho 2 years. Reg 1/2 years. Spr - specialist registrar, is on a training scheme 5 years, plus one or two years abroad on fellowship. Cardiology is currently very competitive so if you really want it, try to get some research done during term/ summer...talk to a sho/reg...always looking for help.

If working in Ireland is important to you (as a consultant) I would advise training here

I would advise the opposite ...(as a consultant )

Ryder · 11-03-2013 11:49PM

Traumadoc wrote: »

I would advise the opposite ...(as a consultant )

That just depresses me...when the consultants tell you to go, all hope really is lost.

nerrad01 · 12-03-2013 12:03AM

what depresses me most is the only option of a decent life is to have to move to the uk and declare bankruptcy....im just hoping and praying that there will still be jobs in oz in a few years so i can work and be able to pay off my loan as its certainly not an option here!

lexa · 12-03-2013 12:17AM

Student loans are not discharged if you are declared bankrupt in the UK so that's not an option. Otherwise all UK students would declare themselves bankrupt when they finished college.

nerrad01 · 12-03-2013 12:22AM

lexa wrote: »

Student loans are not discharged if you are declared bankrupt in the UK so that's not an option. Otherwise all UK students would declare themselves bankrupt when they finished college.

i thought our loan is just classed as a personal loan as opposed to the type givin out by the government backed student loans company in the uk??

I dont think it would be an option many would chose to go down anyway even if it was available....but its just a horrible situation to be faced with

Forklifted · 12-03-2013 12:41AM

nerrad01 wrote: »

i thought our loan is just classed as a personal loan as opposed to the type givin out by the government backed student loans company in the uk??

I dont think it would be an option many would chose to go down anyway even if it was available....but its just a horrible situation to be faced with

That's correct. The student loans that the lexa is referring to are from the Student Loans Company which is specially set up by the govt and therefore they are not discharged in bankruptcy (its the same in the US).

We don't have such a system, rather we get the equivalent of personal loans from the high street banks. They call them student loans due to the rate and repayment options but they're the same as consumer credit in a court of law.

Forklifted · 12-03-2013 12:42AM

Traumadoc wrote: »

I would advise the opposite ...(as a consultant )

Can you elaborate on this a little? It would be nice to hear a consultant view on this.

Traumadoc · 12-03-2013 06:08AM

Better training, shorter hours, no vilification - ( remember respect?), structured teaching , more opportunity, work life balance, paid for all hours worked, better pay, better work conditions, better resources, more consultants, being trained , not just providing a service, happier work environment , training courses paid for by hospital, consultant provided not led services, shorter training,........I could go on.

opinion guy · 12-03-2013 08:32AM

Traumadoc wrote: »

Better training, shorter hours, no vilification - ( remember respect?), structured teaching , more opportunity, work life balance, paid for all hours worked, better pay, better work conditions, better resources, more consultants, being trained , not just providing a service, happier work environment , training courses paid for by hospital, consultant provided not led services, shorter training,........I could go on.

Choose life. Choose a job. Choose a career. Choose a family. Choose a ****ing big television, Choose washing machines, cars, compact disc players, and electrical tin can openers. Choose good health, low cholesterol and dental insurance. Choose fixed-interest mortgage repayments. Choose a starter home. Choose your friends. Choose leisure wear and matching luggage. Choose a three piece suit on hire purchase in a range of ****ing fabrics. Choose DIY and wondering who the **** you are on a Sunday morning. Choose sitting on that couch watching mind-numbing spirit-crushing game shows, stuffing ****ing junk food into your mouth. Choose rotting away at the end of it all, pissing your last in a miserable home, nothing more than an embarrassment to the selfish, ****ed-up brats you have spawned to replace yourself. Choose your future. Choose life . . . But why would I want to do a thing like that? I chose not to choose life: I chose something else. And the reasons? There are no reasons. Who needs reasons when you've got the HSE?

Forklifted · 12-03-2013 11:08AM

Traumadoc wrote: »

Better training, shorter hours, no vilification - ( remember respect?), structured teaching , more opportunity, work life balance, paid for all hours worked, better pay, better work conditions, better resources, more consultants, being trained , not just providing a service, happier work environment , training courses paid for by hospital, consultant provided not led services, shorter training,........I could go on.

Where can we realistically train outside Ireland?

I'm doing the usmle but I know the health care systems are vastly different which might present problems when returning.

I presume its possible to get on a training scheme on the UK. What about oz/nz? I've looked into it but it looks complex with visas and preference for home students.

Intern/SHO Salary

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