Extravagant government equal pay offer to hospital consultants panders to their workers co-op mentality

Patslatt1

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Taoiseach Varadkar,formerly a doctor, recently announced a pay increase with equal pay of $250,000 for all hospital consultants who will work for public patients only with no option for private practice. This equal pay offer is inherently extravagant and panders to the paradoxical workers co-op mentality of rich doctors. The offer is extravagent because to attract the scarcest consultant specialties in what is to an extent an international market in the English speaking world, the pay of all Irish consultants must match the pay of what would be the highest paid when influenced by that market. That results in maybe 80% of the consultants being paid a lot more than necessary given the big international pay differences between specialties.
The American market in medical care which has a lot of local oligopolies not subject to antirust law illustrates such huge pay differences going by the 2019 pay report by www.medscape.com The report surveyed 20,000 doctors in over 30 specialties.Annual pay levels were Orthopedics $482k, Cardiac $471k, Anesthesiology 392, General Surgeon 362, Oncology 359, Ob/Gyn 303, Psychiatry 260, Internal Medicine 243, Pediatrics 225. Under the Irish equl pay system, the Pediatrics pay would be 482 instead of 225, a colossal waste of money.
In practice, the Irish system has failed to pay enough for the scarcest specialties going by shameful hospital waiting lists,even for critical but simple cataract operations to prevent blindness.
Another failure is that equal pay fails to send a market signal to doctors to make a career in the scarcest specialties, prolonging scarcity.
 


wombat

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It appears that consultants vote with their feet, if wages are not high enough here, they can work in the U.S. or elsewhere. It shows how f..d up our priorities are when we talk about greedy consultants but dedicated nurses.
 

Dame_Enda

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If we don't increase their pay, consultants will continue to leave the country for Dubai, Australia etc.
 

Orbit v2

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Yes, but I think Pat's question stands, and it's odd nobody else is talking about it. You can't substitute an orthopaedic surgeon for a psychiatrist. They might as well be different professions from a supply and demand perspective.

A profession that I've become a bit more familiar with recently is teaching and they make the same kind of arguments about collegiality and same pay. They don't want a situation where one teacher is competing against another for pay resources. But, then teachers are more substitutible (well more so at primary level at least). So, I think the argument is different.

Simon Harris was on there earlier and said his proposed pay levels will be the highest in the EU and other than the US, comparable with the other non EU English speaking countries like Canada and Aus.

I suppose for Pat's point to be valid you would have to see shortages in particular specialties here, but then again maybe the ability to do private work has masked this issue. Which specialties are more likely to do private work (orthopaedics more than psychiatry?) and the present government plan will only expose this problem gradually over time?
 

Baron von Biffo

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The 'Public patient only' contracts are a perfect example of cutting off our nose to spite our face.

""Over 500 consultant posts are unfilled. This will deteriorate further due to the Government's proposal which perpetuates the discrimination against consultants who we need to retain and recruit," it said. The organisation also said it would create a €650m black hole in funding for public hospitals over time as private income would be lost.

Commenting on this loss of private income, Mr Donohoe said the Government's expectation is that from 2021 the cost per year to the State in forfeiting private medical fees will be between €16m and €25m. He said this would have to be considered as part of the Budget process."


It will do nothing to fill the outstanding vacancies and will take at least €25M out of the health system but it's still not enough to silence the begrudgers.
 

Uganda

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If we don't increase their pay, consultants will continue to leave the country for Dubai, Australia etc.
Who do the consultants think they are - RTÉ “personalities’ earning 500k for a few hours work a week?

sorry, for “earnings” please read ”paid”
 

Dame_Enda

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Who do the consultants think they are - RTÉ “personalities’ earning 500k for a few hours work a week?

sorry, for “earnings” please read ”paid”
RTE positions are not life or death issues unlike doctors.
 

Orbit v2

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Certainly consultant skills are more marketable. That's not to say that the likes of Graham Norton isn't worth whatever he earns in the UK, but you won't know what a media personality is worth until they take the plunge, and maybe then only after a few years of building a career, whereas consultants have a fair idea what they will earn in any country.

That said, doctors do owe us to an extent for the very expensive training they get, and there should be some claw back for doctors who emigrate just at the point where they become useful to the health system here. Part of the reason why they earn so much in the US is that they all have enormous student loans to pay back (several hundred K$ often).
 

Baron von Biffo

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Certainly consultant skills are more marketable. That's not to say that the likes of Graham Norton isn't worth whatever he earns in the UK, but you won't know what a media personality is worth until they take the plunge, and maybe then only after a few years of building a career, whereas consultants have a fair idea what they will earn in any country.

That said, doctors do owe us to an extent for the very expensive training they get, and there should be some claw back for doctors who emigrate just at the point where they become useful to the health system here. Part of the reason why they earn so much in the US is that they all have enormous student loans to pay back (several hundred K$ often).
This idea that we should recover the cost of medical training crops up from time to time but I've never seen it thought through. Some obvious questions come to mind.

Would this recovery of costs be confined to doctors or would it extend to all medical disciplines?

How could we justify charging medical students but not others for their degrees?

If it's only for medical courses wouldn't students opt for other professions?

Wouldn't the need to pay for this see medical salaries rise?

If salaries didn't rise would it not cause an even greater loss of doctors as they emigrated to get better salaries to pay off their debts?
 

wombat

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Unlike RTE "personalties" the consultants can get work in other countries. Work with better salaries and conditions than are available here.
Medical consultants provide an essential service. Regarding introducing differentials, would the savings be significant enough to outweigh the need to constantly adjust them to market conditions. Surely the idea of working in the PS is that you trade security for potential earnings? Given the choice between being kept in comfort in hospital or being treated by an arrogant pr1ck who can cure them, patients will choose the latter.
 

Baron von Biffo

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Medical consultants provide an essential service. Regarding introducing differentials, would the savings be significant enough to outweigh the need to constantly adjust them to market conditions.
Indeed. And of course the adjustments would themselves serve to distort the market leading to unintended shortages in the specialities that don't get the higher salaries after a review.

Surely the idea of working in the PS is that you trade security for potential earnings?
Well that used to be the case but it was a gentleman's agreement. Lenihan put an end to that sort of thing.

Traditionally PS workers had lower salaries but a somewhat better pension than the OAP. It operated as a deferred income system. Then during the boom private salaries advanced well beyond those in the PS and the OAP was also rising so that they were losing out at work and in retirement.

Benchmarking went some way towards addressing the problems but it was used unscrupulous politicians and dishonest media as a stick to beat PS workers.

When the recession hit they were subjected to pay and pension cuts as well as being forced to work longer hours under threat of job losses as theirs is the only employer who can change the law to impose whatever conditions it wants on staff.

They're now in the worst of all worlds. They still have the low PS pay but without the security and they're legally forced to pay into a pension scheme whether it's the best they can get or not.

Given the choice between being kept in comfort in hospital or being treated by an arrogant pr1ck who can cure them, patients will choose the latter.
With more than 50 years experience of hospitalisation and treatment by dozens of medics I've seen massive improvements. There's a lot more respect for patients nowadays but, no more than any other profession, not every doctor will win a charm award.
 

Uganda

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Indeed. And of course the adjustments would themselves serve to distort the market leading to unintended shortages in the specialities that don't get the higher salaries after a review.



Well that used to be the case but it was a gentleman's agreement. Lenihan put an end to that sort of thing.

Traditionally PS workers had lower salaries but a somewhat better pension than the OAP. It operated as a deferred income system. Then during the boom private salaries advanced well beyond those in the PS and the OAP was also rising so that they were losing out at work and in retirement.

Benchmarking went some way towards addressing the problems but it was used unscrupulous politicians and dishonest media as a stick to beat PS workers.

When the recession hit they were subjected to pay and pension cuts as well as being forced to work longer hours under threat of job losses as theirs is the only employer who can change the law to impose whatever conditions it wants on staff.

They're now in the worst of all worlds. They still have the low PS pay but without the security and they're legally forced to pay into a pension scheme whether it's the best they can get or not.



With more than 50 years experience of hospitalisation and treatment by dozens of medics I've seen massive improvements. There's a lot more respect for patients nowadays but, no more than any other profession, not every doctor will win a charm award.
Your narrative regarding ps pay is disingenuous.

benchmarking was a scam dreamt up by “social partners” to inflate ps salaries in a process which was secretive. The basis behind the average pay increase of 8.9% was never disclosed as it was shrouded in secrecy, decided by a group, all of whom had a vested interest in a “positive” outcome.

all the crash did was to reverse the scam

and as for the threat of job losses in the ps, let us not forget that at least 350,000 private sector employees were forced out of their jobs on foot of the crash

how many were forced out in the ps?

was it none, not a single one, or zilch?
 

Florence

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This idea that we should recover the cost of medical training crops up from time to time but I've never seen it thought through. Some obvious questions come to mind.

Would this recovery of costs be confined to doctors or would it extend to all medical disciplines?

How could we justify charging medical students but not others for their degrees?

If it's only for medical courses wouldn't students opt for other professions?

Wouldn't the need to pay for this see medical salaries rise?

If salaries didn't rise would it not cause an even greater loss of doctors as they emigrated to get better salaries to pay off their debts?
Students on the graduate medical programme (where they have a first degree in anything but medicene) do pay for their 4 year medical course and can get no grant help whatsoever. They pay 15k-17.5k pa in fees. The end up with a minimum of 100k debt, more if they had to pay market rents while training. This is why so many leave on qualification to earn more abroad to pay the debts. My brother in law qualifed on the graduate programme aged 31; he also had a degree in physiotherapy plus experience. His starting pay was c.32k gross, less than a Luas driver. Many of his collegues on the graduate programme wanted to do medicene from school (they were nurses, physios, radiographers etc) but you need 600 points to be sure to get in, and there aren't enough places at that stage as many places are sold to wealthy foreign students. My brother in law only got about 530 points in his leaving so he didn't get medicene where he would have paid whatever the registration charge was then. He got his no.2 choice physio.
 

roc_

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We need to address the work conditions for new consultants too.
 

paulp

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I think Pat makes a valid point.

Only question I'd have is where does it end.
eg. in rural parts where GP contracts are not filled, should the state offer more?
 

cobhguy

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but you need 600 points to be sure to get in, and there aren't enough places at that stage as many places are sold to wealthy foreign students.
They leave the bulk of places to non eu students to offset the cost of the degree.

Non Eu students pay €55,000 at the RCSI for each academic year.
 

Baron von Biffo

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Your narrative regarding ps pay is disingenuous.

benchmarking was a scam dreamt up by “social partners” to inflate ps salaries in a process which was secretive. The basis behind the average pay increase of 8.9% was never disclosed as it was shrouded in secrecy, decided by a group, all of whom had a vested interest in a “positive” outcome.

all the crash did was to reverse the scam

and as for the threat of job losses in the ps, let us not forget that at least 350,000 private sector employees were forced out of their jobs on foot of the crash

how many were forced out in the ps?

was it none, not a single one, or zilch?
What public services did you want to have shut down in order to give you the joy of seeing PS Workers lose their jobs?
 

Baron von Biffo

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I think Pat makes a valid point.

Only question I'd have is where does it end.
eg. in rural parts where GP contracts are not filled, should the state offer more?
Are you trying to push some in the media over the edge entirely?

They're still not recovered from the shock of the broadband plan providing infrastructure outside of Dublin so sending more money beyond the M50 could finish some of them off.
 


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