Q&A: What’s the issue with hospital consultants’ pay?

Why are hospital consultants considering strike action in the autumn
Senior medical specialists represented by the Irish Medical Organisation (IMO) are planning to ballot for strike action over pay and staffing issues. In essence, the doctors argue that as a result of pay cuts introduced for medical consultants appointed after 2012, Ireland has become an unattractive working location and as a result hundreds of posts are unfilled.

How many consultant posts are vacant?
Official Health Service Executive figures show that at the end of June there were nearly 520 consultant posts unfilled on a permanent basis. These included more than 40 in anaesthesia and over 100 in different medical disciplines and in various branches of psychiatry. Last week, the hospital group overseeing paediatric services had to further restrict the opening hours of the new urgent care centre for children at Connolly Hospital in Blanchardstown due to the shortage of consultants. There are fears that other new hospital facilities due to open in the coming years, such as the €140 million national forensic mental health service at Portrane in north Dublin and the €1.7 billion national children's hospital, could face similar recruitment challenges. Consultant posts in Ireland were traditionally in great demand. What has happened?

Medical organisations contend that government decisions to cut pay for hospital consultants over recent years has led to Irish medical graduates – who traditionally spent a period training overseas – opting to remain abroad and not to return to take up posts here.

Does the Government accept this argument?
Minister for Health Simon Harris for the first time on Friday acknowledged that the two-tier pay system – whereby those consultants recruited after 2012 were paid less – was "unfair and it is having an impact on recruitment and retention of highly-skilled doctors".

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Are hospital consultants not among the best paid in the Irish public service?
Hospital consultants are the largest group of high earners in the Irish public service. However, for the past decade there has been controversy over their pay. After five years of talks, in 2008 the government agreed a new contract with hospital consultants which included salaries of up to €240,000. However the ink was barely dry when the then minister for health Mary Harney said that due to the economic crisis the second phase of increases under this deal could not be paid.

Hundreds of consultants initiated legal action which was finally resolved last summer as part of an agreement that cost close to €200 million.

In the interim the government in 2012 had cut pay for new-entrant consultants by 30 per cent. This reduction was subsequently rolled back in part. Ironically the deal to resolve the High Court cases over the Harney cuts actually widened the gap again between those appointed after 2012 and those in place before then.

Medical organisations say that those appointed after 2012 can earn about €50,000 less a year than longer-serving colleagues. Consultants in Ireland can still earn between €150,000 and more than €200,000 in the public system, with many having lucrative private practices on top.

Why then would Ireland be an unattractive place to work?
Ireland competes in the English-speaking world for senior doctors, and medical organisations contend that salaries in the US, Canada and Australia are far higher than those available here. Critics frequently maintain that senior doctors in northern Europe earn less than their Irish counterparts. However there is no great tradition of doctors from these countries moving to Ireland. After the 2012 pay cut the then minister for health James Reilly spoke of consultants from Belgium or the Netherlands taking up posts in Ireland. They never came.

What about Sláintecare? How will this affect consultant recruitment?
One of the key elements of the Sláintecare reform programme is the removal of private medical practice from public hospitals. Hundreds of consultants have contractual rights to treat fee-paying patients and any change in this regard will, undoubtedly, involve a contract renegotiation.

Access to potentially lucrative private practice has been a selling point in the past when attracting consultants to take up posts in Irish hospitals. How the Government intends to encourage specialists to take up positions in Ireland while at the same time ending private practice rights, presumably without significantly increasing public salaries, remains to be seen.