Making medical specialists cough up

With the debate on consultants’ pay back in focus, some doctors complain they are being made the whipping boy for other failures…

With the debate on consultants' pay back in focus, some doctors complain they are being made the whipping boy for other failures, writes PAUL CULLEN,Health Correspondent

‘CONSULTANTS’ PAY is to the health service what Anglo Irish Bank was to the banking system,” declared one GP during an outbreak of the recurring debate about medical specialists’ pay last year.

That debate – and those kind of sentiments – have returned with a vengeance this year following the recent talks on pay and conditions between the Department of Health and the consultants’ representative bodies.

It is clear, for example, from their letters published in this newspaper over the past weeks, that consultants increasingly feel that they are being made the whipping boys for the failings of the health service and the country as a whole. All the long years of training and long hours of hospital rounds seem to count for naught as the search for scapegoats intensified within our fractured society, they argue.


For the rest of the population, though, consultants rank as the privileged few among public-sector workers, a group which has taken but a fraction of the financial pain endured by others and which, it has been claimed, could give a lot more.

Some consultants work exclusively in the public sector, others have contracts allowing them to perform both private and public work while a third group works exclusively in private hospitals and falls outside the current negotiations and the surrounding debate.

Most of the 2,600 consultants working in public hospitals are on contracts allowing them to also treat private patients.

Last March, the outgoing human resources director of the Health Service Executive, Seán McGrath, shone a light on consultant pay and conditions in an interview with The Irish Times.

He revealed that one hospital consultant received more than €400,000 from the public health service, while up to 500 senior doctors were earning more than €200,000.

He claimed some consultants were able to complete their 37-hour commitment to public hospitals by Wednesday lunchtime and to devote the rest of the week to their private practice, while receiving additional allowances for being “on call”.

According to Mr McGrath, there are more than 100 salary rates for hospital consultants, based on various contracts, ranging from €130,000 to €185,000. On top of salary there are “very generous allowances”. Clinical directors receive €46,000 in allowances and there are also on-call, call-out and continuing education payments.

No one questions the high standard of training and performance of Irish consultants, but critics repeatedly claim that the private work of specialists in Irish hospitals is assigned a higher priority than public work. Many saw as telling a passing remark made by a consultant in a fitness-to-practise hearing last month, during which he said in relation to the two-year-old child he was treating that “if I was aware the patient was private, I would have done the procedure myself”.

Irish consultants are well paid by international standards, various reports seem to show. In Britain’s National Health Service (NHS), for example, consultants earn a basic salary of €85,569-€115,335 depending on experience, as well as clinical excellence awards which can range from just under €3,445 up to €87,048.

A 2010 report found that Irish consultants earn six times the average wage, compared with 2.5 times in Denmark and Finland, and this was before private fees were considered.

Last year, an OECD report said consultant pay in Ireland was by far the highest of the 20 countries surveyed. This was based on 2008 data, and salaries have been cut since, but it’s no secret that this report is dog-eared from reading by troika officials overseeing our bailout.

However, Pat Plunkett, writing in The Irish Times, argues that consultants here are not paid excessively compared with the “real pay” of specialists in other countries. He points out that the NHS has a longer incremental pay scale, the top of which is better than in Ireland.

The Irish Medical Organisation also points out that Irish doctors, for obvious linguistic reasons, tend to emigrate to other English-language countries rather than the EU. It argues, therefore, that comparisons of pay within the EU are of little use, when the main financial lures for highly qualified consultants lie outside Europe.

Little enough is known about consultants’ private earnings but it was alleged last year that one specialist received €1 million in fees from the VHI and that 138 others received more than €300,000 each.

Last week it emerged that 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.

The sum, which was given by Dr James Reilly, Minister for Health, in answer to a Dáil question, includes only what consultants receive for treating patients admitted to hospital and does not cover the fees for outpatient clinics and private rooms. This was the first time all three health insurance companies have disclosed the sum they pay to hospital consultants.

The programme for government advocates a cut in consultants’ salaries but Dr Reilly changed tack some time ago in favour of extracting longer hours and greater flexibility. The group who will pay the highest price are new recruits, whose starting salaries is now likely to be cut by about €50,000 to €116,000.


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


per consultant. And that’s on top of their public salaries