Consultants: dissatisfied with cut backs
Figures from an unpublished survey carried out by the Irish Medical Organisation show that over ¼ of consultants are thinking of leaving the public health system, that many of them are upset about cuts to services and their own pay. This survey carried out by the IMO – the biggest representative body for doctors in Ireland – with consultants got 407 responses, about one sixth of the entire consutalnt workforce (of 2400). It found that 27% of those surveyed are thinking of leaving the system, while 33% of those under 49 are thinking of leaving and just under 1 in 3 of female consultants are contemplating leaving. 40% of consultants would consider resigning their HSE contract, a figure that rises to over 50% of consultants under the age of 50.
So what are the main reasons for their dissatisfaction? 93% say that ‘cut backs are having very negative effects on the level of treatment and support services for patients’ while close to 70% of consultants name cuts leading to bed and ward closures as particular concern.
Consultants feel they are unable to do their jobs, with levels of discontent very high – ‘over 50% of consultants claim that necessary medical equipment is not of a standard to meet clinical requirements’ and 77% believe that there are not sufficient ‘non medical’ support i.e. secretarial/ administration support to meet needs.
Our growing, ageing population with increased chronic diseases is this impacting on consultants’ work load with 72% of those surveyed saying that the complexity of consultations with patients has increased over last five years and over half of them think that the inability to access other disciplines (e.g speech therapy) has a negative effect on their relations with patients. And nearly half the consultants said that waiting times are having a negative effect on their relations with patients. This is supported by recent HSE figures which show there are more people waiting for care and fewer beds in the system.
Consultants are frustrated they can not do their job on a day-to-day basis. But they are also disgruntled that they earn significantly less now than when they signed the new consultants contract.
When consultants signed the new contract in Spring 2008 they were promised two pay increases and only one of these was delivered late in January 2009, they maintain that not delivering the second part of that is a 15% cut and on top of that new levies and pay cuts mean they are 30-40% worse off. so if they were meant to be earning €200 then, now they are earning €160k.
And yet we are still paying Irish consultants more than others (starting salaries in the UK are £70,000 in northern Europe €70,000), although it depends on where you compare them to. But consultants working public only starting salary is €166,000 but can earn up to €208,000 if they become a professor with a public only consultant.
Those on Type B contracts which allows public and private work start at €156,000 but can earn more, if they take on additional roles. The HSE say these are highly competitive rates compared to UK or Northern Europe. IHCA say they are not.
So are the rates of pay a deterrent to getting and keeping consultants in the public system? The IMO and the IHCA say yes it is. The HSE say they have had no problem filling increased numbers of posts – 500 new consultants posts since HSE was established, although the Hanly (Medical Manpower) report in 2003 recommended 3625 consultants in place by 2013 to meet population needs and that was before the real growth in population. So while consultant numbers have increased, they have not increased at the pace expected. However the increase in consultant numbers is incontrast to most other areas where staffing numbers are stagnant or going down.
Also new information gathered for the Drivetime health slot reveals that up to now the type of contract given to a consultant was up to the discretion of the hospital ie whether it was a public only or public/private contract. The correspondence I have seen shows a recent directive from HR director Sean McGrath instructing HSE and HSE funded agencies to issue Type A – public only contracts and that Type B – public and private – ‘should only be issued in exceptional circumstances’.
This is a significant change in HSE policy and of particular worry to some consultants who see their public income cut but also this prevents them from earning privately…
The Type A only contracts are in effect as of that letter in early March and may or may not influence how the new contract is negotiated as committed to by new minister Jams Reilly.