Sir, – I must accept, with regret, Ellen McCafferty’s feelings of nausea at consultants’ pay rates (September 25th). I am, however, grateful that she accepts we are entitled to be paid for our skills and qualifications. It is indeed, a long hard road, but I question just how much, if any, is subsidised by the Irish taxpayer, above the third- level education we strive to provide for the children of the nation?
Most consultants have spent significant periods of time in the health services of other countries, rather than in Ireland, gaining knowledge and expertise to bring back to this country. All of those in post-graduate training are paid to provide service to the patients. They work hard and then go home or to the library to study more. They are paid for the service element of their jobs, but not for the self-directed learning. Understandably, trainees are paid at rates less than fully-trained specialists.
I was taken aback to be told by an intern yesterday that she earns less as a medical doctor than she did when working as a healthcare attendant, for the same number of hours worked. My eldest daughter, five years out of college, is paid more as an IT person than the senior medical trainees who wrote to your paper recently (September 20th).
One of the main reasons consultants in my specialty are remaining in Ireland is the tie of family and mortgage commitments. It is certainly not the working terms and conditions, which are deteriorating day by day. That tie is much weaker for our trainees. The risk, iterated in your paper last week by those same senior trainees, who represent the future of the health care provision in the Irish health service, is that they will not feel so bound by family and financial ties. Indeed, they may find it better to go abroad to pay off their Irish debts at a pay-rate, and professional conditions, much better than in “the ould sod”. This is particularly so if the suggested new pay rates are introduced for new consultants. It would be a huge loss of talent for our country.
It may come as a surprise to those who listen to the propaganda and self-serving “leaks” from the Health and Finance departments, but Irish consultants are not paid excessively when related to the real pay of specialists in other countries. We are not the best paid in Europe, unless one is extremely selective in choosing one’s comparators.
When compared to the NHS, where the starting pay is lower, but the incremental scale is much greater, the final outcome, for consultants at my level of seniority is much better in England. The NHS top pay-rate is euro-equivalent to the rate of pay agreed for the 2008 Contract in Ireland, but reneged on by the Minister of the day “ere the ink was dry”, being 19 per cent higher than I am paid at present. Her Majesty’s Revenue Commissioners and the NHS pension scheme withhold a much smaller proportion than here in Ireland. It is less than the package offered for a consultant in Australia and also less in gross terms than the Gulf States, where the salaries are tax-free, and benefit from added accommodation and travel expenses, making the net outcome much greater.
The control of consultant appointments in Ireland lies entirely in the hands of the HSE, Department of Health and Department of Finance. I have personal experience of trying over periods of many years to persuade the Department of Health and HSE that more consultants were needed. There is no closed-shop of consultants trying to ensure a small group hold all the benefits. If one looks at the private sector, consultant numbers have increased in Ireland, but almost all are in full-time private practice, at an income significantly in advance of those in the public service. Many of our new orthopaedic surgeons are now in full-time private practice, as working conditions in the public hospitals deteriorate.
The consultant body has striven for years to improve health care in Ireland. We fought to keep the “advocacy clause” in our contract, in order to ensure we could speak out in public against a system where patient care is threatened by inefficient use of resources. The inequality in healthcare provision is a feature of a two-tier system, superimposed on a collapsing economy. This is not the responsibility of the consultant body, but is national political policy. Where is the much-vaunted universal health insurance cover that James Reilly proposes to introduce? Perhaps he’s too busy fighting off his political allies. – Yours, etc,