Consultants pay and conditions in the Republic – Patrick Plunkett of St James Hospital, Dublin 8

Last week I told you readers here that the new pay rates and contract
would empty Irish hospitals of Excellence and it with workmanlike pros
from midfield. I have told Nora Owen, Stephen Mulvanny and a few
others that this will inevitably happen. I am 99% certain of this. It
makes me sad and angry. MUPPETS etc comes to mind. Below I reproduce
the Plunkett letter from the Irish Times.
Bill Tormey

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,

PATRICK K PLUNKETT,

FRCSEd, FRCSGlas, FRCPI,

FCEM,

Clinical Director/Consultant in

Emergency Medicine,

Department of Emergency

Medicine,

St James’s Hospital,

Dublin 8.