Second Opinion: Are health professionals paid too much or not enough?

Doctors’ salaries have been in the news several times lately. Medical organisations in Ireland claim salaries are now so low that it is impossible to fill vacant posts.

Health professionals are leaving the country in droves to get better jobs elsewhere. By contrast, Health Statistics 2014, from the OECD, show that consultants and nurses working in Irish hospitals earn more than those in most other European countries.

Consultants earned an average of €170,000 in 2013 compared with €71,791 in Italy and €64,424 in Spain. Nurses earned €51,200 compared with €43,785 in Belgium and €38,000 in Germany.

Ordinary citizens are a little bemused and perceive health professionals as being over-paid.

Are they well paid or not? How do their salaries compare to those of employees in the private sector with equivalent qualifications and experience?

Salary variations

The November 2013 HSE pay scales show that some employees are extremely well paid whereas others barely earn a living wage, recently calculated by the Vincentian Partnership for Social Justice to be €11.45 an hour for a 39-hour week or €23,220 per annum.

Salaries of administrators and managers vary enormously.

Clerical officers – the ones who answer the phones, greet you at reception, and type up reports – work for four years before they earn a living wage.

Their salary ranges from €21,358 to €37,341 after 15 years. Senior managers are another ball-game altogether. National directors earn between €136,282 and €160,470 and their assistants earn more than €90,000.

Lower paid

Home helps, who can keep older and disabled people out of expensive residential care, are paid somewhere between €24,000 and €30,000 a year.

Hospital cleaners, porters and mortuary attendants earn about €28,000. Staff nurses, including midwives, are paid between €27,000 and €43,000after 13 years.

Therapists of various kinds, such as speech and language therapists, physiotherapists, and chiropodists, who make a big difference to people’s lives, helping with mobility and communication challenges, earn between €34,000 and €50,000 after 13 years.

Psychologists are paid between €50,000 and €80,000 and social workers, who have to deal with difficult family situations, €32,000 to €57,000.

Salaries of environmental health officers, who carry out food safety inspections and monitor the smoking ban, range from €36,000 to €57,000.

Consultants’ pay for new entrants has dropped dramatically, from €184,000 in 2010 to €116,207 in 2014.

Most of the above HSE salaries are roughly comparable with those of employees in the private sector of similar experience and number of years in third-level education.

Salary guide

The

CPL Salary Guide 2014

, which lists average earnings for a whole range of private sector professionals, shows that receptionists are paid between €20,000 and €40,000 and medical secretaries €24,000 to €45,000.

A newly qualified solicitor earns between €35,000 and €58,000, rising to €100,000 after five years. Consultants on contracts in the private sector are paid any amount from €130,000 upwards.

How are salaries for health professionals, managers and administrative workers calculated? Are they based on number of years spent in third-level education, usefulness to society and patients, or what the various groups and their unions think they are worth?

Price of knowledge

Professional groups put a price on their knowledge and skills which often has no relationship to how useful these are to health and society. Patient outcomes should influence how much professionals are paid.

Unfortunately they do not. Psychiatrists treating patients for depression for 20 years with no improvement in mental health are paid three times more than chiropodists who provide instant relief and better mobility.

Significant pay gaps adversely affect team performance when services are as interdependent as they are in the health sector.

Now that the economy is improving, some health professionals and top management are campaigning for higher salaries. The pressure must be resisted at all costs.

Most HSE employees, including consultants, are now earning about the right amount.

The gap between salaries of different professional groups is narrowing, leading to less hierarchical and more patient- focused workplaces. This is all good.

Gap too wide

However, the gap between salaries of lower administrative and managerial grades and top managers is still much too wide. Those in the upper echelons of the HSE, and outside agencies and hospitals funded by the HSE, think they are worth huge salaries. They are not.

There is convincing evidence that chief executive and top management pay is heavily influenced by peer-comparison data and has little to do with patient outcomes, quality of services, or work complexity.

Any spare funding allocated to health in the next budget should be spent recruiting more frontline workers on modest wages.

Dr Jacky Jones is a former HSE regional manager of health promotion and a member of the Healthy Ireland Council. drjackyjones@gmail.com