Saving lives, losing respect: how 'consultant' became a dirty word

Different strokes: What are the two consultants' organisations doing?

The Irish Hospital Consultants’ Association was formed in 1988 as a rival to the established Irish Medical Organisation. Set up initially because of unrest among consultants over tax and waiting-list issues, it appointed the former Fine Gael general secretary Finbarr Fitzpatrick at the helm and quickly established itself as a forceful voice in health and pay debates.

The IHCA claims 1,800 members; the IMO says 800 of its members are consultants.

In the current dispute, Minister for Health James Reilly’s proposals would give clinical directors significantly increased powers to roster consultants to maximise patient throughput and to increase the presence of senior clinicians in hospitals across the day.

Some consultants would continue to work on a Monday-to-Friday basis, across a day running from 8am to 8pm. Others would be rostered on any five out of seven days, including weekends. They will continue to receive on-call allowances.

The IHCA has declined to attend the Labour Court, arguing that it did not need to do so as the issues under discussion were not covered by the Croke Park deal.

The IMO has attended in relation to two specific points of difference. These relate to plans by the Health Service Executive to cut rest-day entitlements and reduce payments to psychiatrists for providing second opinions.

Both organisations object to the Government’s plans to cut starting salaries for new consultants, but Reilly says it plans to go ahead with this change anyway.

Reilly has warned that if consultants do not co-operate with a Labour Court recommendation they could lose the protection of the Croke Park agreement and face possible pay cuts.

Pay and conditions: How much do consultants earn?

A bewildering array of contracts applies to consultants working in the public service, but in general the older the contract the better their terms. Some consultants work exclusively in the public sector; others have contracts allowing them to perform both private and public work; a third group works exclusively in private hospitals.

Most of the 2,500 consultants in public hospitals are on contracts that allow them to treat private patients in addition to the 37 hours a week they must devote to the public system.

About 80 per cent of consultants are on contracts negotiated in 2008 that vary in the amount of private practice allowed.

Type A contracts, for which the salary ranges from €166,010 to €173,243, is public-only practice.

The most popular contract, type B, involves salaries ranging from €156,258 to €158,400 and allows consultants to perform 20 per cent private practice in the public hospitals in which they work.

Type C, with salaries of €136,620 to €145,617, allows consultants to treat private patients outside the public hospitals.

The Government now intends to cut the entry-level grade for newly appointed consultants from €166,000 to €116,000.

Consultants are also paid overtime for weekend work and are entitled to on-call and call-out payments. Allowances are paid to the masters of the three Dublin maternity hospitals and to clinical directors.

Consultants’ public salaries are in many cases augmented by significant private earnings. The VHI says that the average fees paid to consultants for private work in 2011 was €86,000.

Fifty per cent of consultants earned less than €50,000, and 71 per cent earned less than €100,000. One per cent earned over €500,000. In 2010 about 1,800 consultants shared €386 million in fees for treating privately insured hospital patients in the year to the end of June. This averages out at more than €214,000 per consultant.

Case notes Why one doctor feels forced out of Ireland

The Government’s decision to lop €50,000 off starting salaries for new consultants will most affect midcareer doctors in their 30s.

Many of them are making plans for their last stage of their overseas training before, they had hoped, returning to take up consultant posts back in Ireland.

Not any more. People like “Beth”, a final-year specialist registrar about to take up a training post in Australia, are seriously considering one-way tickets.

“My time abroad was always planned with a view to returning home, but now I’m thinking I might stay over there. The salary cut was the final straw on top of a health system that is going from bad to worse.”

In Australia she will work a 43-hour week with no overtime and earn as much as she does in Ireland for working more than 60 hours a week.

“Beth” isn’t alone in her outlook; friends from her old class have already moved to Boston and Toronto, and others, even those with families, are looking.

“The old idea was that you acquire new skills internationally and bring them back to Ireland. You might go somewhere where you’d work hard, but it was only for a few years. But people are now planning their overseas assignments for the long term. It’s, say, Toronto rather than Ohio.”

Her parents don’t like the idea of her travelling to Australia, and she worries about not being around as they grow older and about the standard of care they will receive.

After six years at medical school, and 10 further exams, she says she’s unwilling to come back to Ireland and be treated as a second-class citizen relative to longer-established consultants. “It’s also the fact the doctors are being singled out when other well-paid people are not.”