Consultants excluded from 15% voluntary pay cut….

Posted in Blog by saraburke on June 25, 2011

It was reported in the Irish Times (24 June 2011) that hospital consultants and or their representative bodies lobbied the minister for health, James Reilly, so as not to be included in the 15% voluntary pay waiver announced by Minister of Public Expenditure and Reform on Wednesday last (22 June 2011). This was refuted by both a spokesperson for the Minister of Health and the Department of Public Expenditure and Reform (known as PER). So why are consultants excluded and who earns what in the public health system?

It is impossible to get a figure from the HSE as to how many people on its payroll of just under 106,000 staff earn over €200,000, an extraordinary fact in itself. It is some what explained by the fact that there are still 17 different pay roll systems in the HSE but also that many of these 106,000 are not direct staff of the HSE but people who work for voluntary hospitals or large voluntary agencies. Why on earth seven years into its existence the HSE has not managed to merge the pay roll systems remains an unanswered question.

However, it would appear that not very many of the 106,000 workforce earn more than €200,000 from the public purse. Lets start outside of the HSE with the Minister, as a result of various different pay cuts, he now has a salary of €169,000.

Michael Scanlon, the secretary-general in health, as a result of the most recent voluntary cut (on top of the previous pay cuts) is now paid €200,000 exactly, although he will still get his pension at his previous rate – see article linked to earlier. And according to the Department of Health no one else in the department or in any of the agencies directly funded by them is paid over €200,000.

HSE chief Cathal McGee  took up post last year with a €322,000 basic salary, with no bonus, but a car allowance of €13,800. Yesterday, he confirmed he was happy to take the 15% voluntary reduction which leaves him with a salary  of €280,000, signficantly above that of the minister. According to the HSE none of the National Directors earn over €200k ( the highest band starts at €183k).

And again according the the HSE, most consultants don’t earn over €200k FROM THEIR PUBLIC WORK – an important distinction as many earn significantly more than this when their public and private earnings are combined. Pay for consultants on type A contract on which they can only work in the public system ranges €176-196,000, while those on Type B who are allowed to work privately their sarlaries start between €146-158,000 however they  can earn multiples of that from their private work – see below.


Tracey Cooper, HIQA CEO, earns around  €170-180k. The CEOs of the voluntary hospitals earn less than €200,000 from the public purse according to the pay scales but some receive top up payments from the ‘research fund’ of their hospital.

Jimmy Tolan – the current VHI CEO, is the super high net earner in the health sector – his “total remuneration including pension paid to CEO to December 2010 amounted to a salary of €411,420 and performance related pay of €37,500”. That means he was paid the bones of €450,000 last year. He opted out of a bonus for 2011 (all semi state CEOs were asked to by government). When asked was he taking 15% waiver, I was told he already has taken a 40% pay cut from his original package worth €665,320 including pension and bonuses – he resigned in May but is in post til November. His salary is a multiple of the current minister. Figures published by PER yesterday say the starting salary of the new CEO to be recruited to replace Tolan will be €191k, a fraction of its predecessor’s.

So why is it so hard to know how much hospital consultants earn? 70% of those who work in the public system are allowed to work privately – with a cap of 20-30% of their workload although a minority far exceed that ratio. And while it is hard to get actual figures on their public salaries, it’s impossible to get definitive figures on their private incomes.

HSE figures released for this article say that “27 non academic hospital consultants earn more than €250K”, these are often clinical directors who maybe towards end of career, so they get an additional €50k for the clinical director post and would usually be on quite a high salary scale due to years of service.

The HSE could not give a figure for the numbers of consultants paid more than €200k. Many of the academic posts eg a professor in a university and a consultant could earn over €200k but it might be €180K from HSE and however more from the university.

Incredibly, the consultants earning over €200,000 are not included in the 15% voluntary waiver introduced this week. James Reilly spokesperson said the matter was “still being brought to cabinet table” and “still in discussion as part of Croke Park”. The response from the Dept of Public Expenditure and Reform was similar but different, “The same objectives are being pursued by minister Reilly in relation to hospital consultants through a separate process which is ongoing”.

But there was general consternation that consultants were not included in the waiver as they are the highest earners in the health sector. And rumour abounded that the Minister had been lobbied by consultants to that effect. There was a rare and surprising silence from bodies representing the consultants on this issue.

So can we estimate consultants’ total income – their public and private earnings? No one has those figures except Revenue but in order to get a ballpark figure for Type B contracts who are allowed to practice publicly and privately, one would need to add up their public salary, money paid to them by insurance companies and money paid directly to consultants by people out of pocket for private care. And there is no way of collating that.

When asked how much they paid to conultants, the VHI said it was commerically sensitve and released a statement on this saying that ‘We pay fees to over 2,300 consultant of which the average payout in 2010 was approximately €98,000 per consultant . 70% of consultants were paid less than €100,000 and 6% (138) paid more than  €300,000. But that does not include their public income nor what they get from other insurance incomes plus money paid out of pocket and other earnings eg evidence in legal cases etc..

And earlier in the week news broke that some of these consultants who work privately and publicly are in trouble with the HSE for far exceeding their private workload as agreed in their contract.

The background to this is that a new hospital consultant contract was agreed in 2008 and is in place since 2009. Under this contract for the first time consultants are measured for public and private work. For the last two years, the HSE has been working with consultants carrying out  more than 50% private work to reduce it, to verify the measurement tool and if not reduced the HSE issued a fine to these consultants.

Now, it is the end of the long two year process and this week 17 letters have been issued telling the worst offenders that as of 16 September that “their private practice will be suspended with effect of that date (16 Sept) and we will withdraw the clinical indemnity provided in respect of your private practice”.

And although those numbers exceeding the 20/30% private practice is not widespread, it is extremely significant that the HSE is taking them on in an attempt to level the playing field for public patients. We do not know much about who they are, what type of specialities, where they are except that many are in Limerick and Cork.

The IHCA on behalf of the consultants reject the HSE measurement  of their public and private work, several attempts were made to contact both consultants’ representative bodies (IHCA and the IMO) today and their silence is deafening.

2 Responses

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  1. Marcus De Brun said, on October 27, 2011 at 10:18 pm

    Irish Independent:
    Wednesday October 12 2011

    •There are few occasions in my career when I feel compelled to ask myself whether medicine was the right choice for me.

    Today was one such day, one where I not only question myself as a member of the medical profession, but also as a citizen of Ireland.

    Tom is 40; he and his wife Kate are the kind of soft-spoken, gentle, introspective people who make general practice a meaningful place to work. Two weeks ago Tom came to see me, complaining of a tingling sensation down his left arm with occasional stiffness in the wrist. This he attributed to his working on the computer at his office.

    There was an initial suspicion of carpal tunnel syndrome, so Tom was referred for physio.

    However, matters came to a head the following weekend when Tom noticed that his speech was becoming slurred.

    Of an anxious disposition, he presented to a nearby Swiftcare clinic and after being examined he was informed that he may have had a “slight stroke” and was advised to go to A&E.

    He endured the six-hour wait in A&E, where he was examined, reassured (that a stroke was highly unlikely) and allowed to drive home.

    The following Monday Tom was at my practice once again with an unresolved and unexplained slurring of speech and persistent tingling in the arm. Fortunately, Tom has VHI.

    I referred him to a neurologist at a private Dublin hospital.

    During the week Tom went to see the neurologist, who organised an MRI scan and recommended that he have some bloods done “there and then”.

    Tom was requested to pay €350 for his 20-30 minute consultation with the doctor and was then told that his blood tests would be an additional €300.

    When he informed the receptionist that the cost was “a bit too much” and that he would rather have the bloods done at his GP’s, he was informed that one of the tests was “a special test” that could not be done at his GP’s.

    When he asked if he could have just the “special test” done and have the remainder at his GP’s he was informed that this might be possible but that he would have to “go through the public system to get the remainder of his results” and that this would greatly complicate things.

    Tom acquiesced and left the rooms of the neurologist after paying out some €650 for his 30-minute visit.

    On Thursday Tom had his MRI scan (covered by VHI) and on Friday his wife called to say that Tom was quite unwell and that she was very worried on his behalf.

    It is important to reiterate here that Tom and his wife don’t complain and don’t present to the doctor’s unless there is something wrong.

    Once again, this time on a Friday evening at 5pm, Tom and Kate are in my office.

    On this occasion Kate is in tears and Tom has a hard time holding back his own tears.

    Tom has an envelope with his MRI films inside, he is pale and upset since he saw the neurologist. After I examine him, he asks me to look at his MRI scan which I do, while warning him that I am neither a radiologist nor a neurologist.

    I do the decent thing and say I can see nothing wrong with the MRI scan, that we will have to wait on the formal report.

    I ring the private hospital on the off chance that the MRI might have been reported on — but of course the world of private medicine has gone home for the weekend.

    I give Tom the only remaining tool in my medical arsenal of impotence in the form of a letter to A&E should his speech become worse over the weekend. I also give him my mobile number.

    My refusal to take a consultation fee has the apparent effect of deepening Tom’s sadness, for which I also give him a short-term script for some anxiety pills.

    Now for the bills: first presentation to me, €50; two visits to the physio, €80; visit to Swiftcare, €125; return visit to me, €30; visit to the consultant, €350; bloods, €300; total, €935.

    Tom has been out of work for two weeks. If we count the cost of his medication and the fees I have waived, Tom’s symptoms have cost him almost €1,000, of which he is entitled to a €60 refund from his VHI.

    Tom and his wife will spend the weekend worrying, awaiting the diagnosis which they most fear.

    The professionals, like myself, who have treated Tom will sleep quite soundly, oblivious to the pain of Tom and Kate, oblivious to their fears and the financial burden that has been placed upon them.

    This is the establishment of medicine in Ireland, this is the predatory nature of the relation between the ‘noble profession’ and decent, tax-paying, hard-working people.

    Dr Marcus de Brun
    Co Dublin

    Irish Independent

  2. saraburke said, on November 13, 2011 at 10:03 pm

    A very powerful and poignant illustration of the unfairness and nonsensical nature of the Irish health system. Thanks Marcus


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