Analysis: Shortage of top doctors forces rethink on consultant pay scales

A medical brain drain and problem recruiting to key posts has triggered a review of policy

Minister for Health James Reilly: fresh talks after Easter on pay for hospital consultants. Photograph: Gareth Chaney/ Collins

Minister for Health James Reilly: fresh talks after Easter on pay for hospital consultants. Photograph: Gareth Chaney/ Collins


The announcement by Minister for Health James Reilly yesterday of fresh talks after Easter on pay for hospital consultants is the first indication that the Government will probably have to revisit the significant cuts it imposed nearly two years ago.

The Coalition came into office hospital-consultant pay firmly in its sights. In autumn 2012, the Cabinet acted on the programme for government commitment and unilaterally introduced a 30 per cent pay cut for senior doctors taking up such posts from that point.

Following that cut the salary for new entrants ranged from €95,000 to €116,000 depending on the type of contract.

However, for the Government the unintended consequence was that it made these positions much less attractive at a time when Irish-trained medical graduates were in high demand abroad.

Over the past year or so, medical representative bodies such as the Irish Medical Organisation and the Irish Hospital Consultants’ Association (IHCA) argued that a brain drain was effectively under way. They maintained that Irish-based consultants and senior non-consultant doctors were opting to leave while those abroad were choosing to remain overseas.

It emerged in January that the Public Appointment Service had received no applications in relation to four recruitment campaigns last year in the areas of paediatric intensive-care medicine, geriatric medicine and radiology.

In January The Irish Times reported health management had received a report that recognised problems were emerging concerning retention of senior doctors and that that the HSE had suggested to Dr Reilly that the pay issue be reconsidered.

The HSE proposed a revised scale for newly appointed consultants with greater experience or who had additional training.

Yesterday a strategic review group came to the same conclusion – that the lower pay rates in place for new consultants appointed after 2012 were acting as barrier to recruitment.

Haddington Road caveat

process on pay for new-entrant consultants is expected to be in train within weeks, with an aim of completion by July. However, one potential sticking point is that the proposed talks will take place within the context of the Haddington Road agreement to which the IHCA has to date declined to sign. If a change of heart is not forthcoming it may not be invited to attend.

Hospital consultants are some of the highest-paid staff in the public service. But it is not only those appointed after autumn 2012 who have seen their salaries reduced. Pay cuts were imposed on other consultants under the Haddington Road pact last year.

It remains to be seen whether any revision of pay rates and the introduction of other proposed reforms proposes by the working group will be sufficient to make Irish hospital positions more attractive for young doctors.