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Doctors' pay - time to end the gravy train
[ by Niall Hunter, Editor www.irishhealth.com]
The election campaign has thrown up a plethora of claims and counter-claims between the political parties about what is wrong with our health system and the best way to fix it.
The average punter at this stage must be bamboozled by the rain forest of manifestos and policy documents and angered by the rationalisations of the outgoing Government that, when it comes to health service reform, has confused spin with reality.
Thankfully, sometimes a salient point emerges that tends to put things into perspective if you are looking for a thumbnail sketch about what is wrong with our health system and what needs to be changed.
Two figures are relevant here. Firstly - €136,000. That's the amount a (presumably exhausted) junior hospital doctor earned last year in overtime payments alone. That's on top of his or her normal salary of around €60,000.
Secondly - €201 million. That's the amount you and me handed over to the HSE last year in overtime payments for junior hospital doctors. With 4,700 juniors working in hospitals, this works out at an average overtime payout of €43,000.
There would be wide variations in overtime levels between different junior doctors in different specialties, but some can earn six-figure sums in overtime alone, albeit for working well in excess of 70 hours per week.
This €201 million payout, the HSE tells us, was after recent (obviously limited) reductions in junior hospital doctor hours under EU law and following recent contractual changes which cut back on overtime pay.
I'd hate to know, you might say, what it was before these reforms. Well here it is - the total payout in junior hospital doctor overtime was actually nearly €250 million in 2008.
There are issues here that will need to be addressed urgently by the next Government. An obvious one is how safe can it can be for either patient or doctor to have medics working such long hours. The health authorities obviously don't regard this as too urgent an issue, as they presided over such a dodgy system for years when it was an easy option for them.
The second is, why are there such long working hours for juniors?
Some senior consultant trainers will still claim that junior doctors need the long hours in order to be trained properly. In other words: "I did 100 hours week and look at me, so why can't they do it?" This contention is hotly contested by many.
But, and here is the real crux - this type of health and safety Russian roulette in our hospital system was supposed to have been sorted out some time ago. We are still having the same debates today about what is wrong in the hospital service that we were having in the 70s, 80s and 90s.
We have been told for many years past that the old system of juniors, supposedly trainees, doing excessive amounts of service work, leading to huge levels of overtime, was going to end.
Also, we were told the system would be changed so that consultants would deliver, rather than direct , the service on the ground to ensure more senior doctor decision-making for public patients.
We had the Government-sponsored Hanly report nearly 10 years ago, which promised that in order to give us consultant-provided care, consultant numbers would double from around 2,000 to nearly 4,000 and junior doctor numbers would be halved, with less reliance on costly overtime.
We were told that an expensive and long drawn-out consultant contract review process would provide for more flexible consultant working and equal access for public and private patients to hospital care, and would facilitate consultant-provided care in public hospitals.
We were sold a pup.
Consultant numbers were not doubled. The HSE said last week only 500 additional consultants have been appointed to the system since 2005 and during that time, junior doctor numbers have only been reduced by a few hundred.
Mary Harney threw millions at consultants to get them to accept a new deal. Among the benefits of the new contract promoted by the former Minister was that it would allow for equal access for public and private patients to hospital diagnostics.
Waiting lists for diagnostics and outpatients at some hospitals stills stretch from months into years. Attempts to remove the distinction between public and private patients on these lists is meaningless when there is still poor access to care.
Nearly everyone on public hospital waiting lists, whether for diagnostics, an outpatient appointment or inpatient care, is a public patient. Private patients are not gloing to languish on a public list if they can pay for quicker care elsewhere.
The 'perverse incentive' system , whereby private medicine will thrive as long as public care is inferior in terms of access, is continuing.
Also, the new consultant contract has yet to implement an effective system that will control excessive levels of private practice in public hospitals by a minority of consultants.
All these inequities in our healthcare system may or may not be sorted out by universal health insurance plans from a Fine Gael/Labour Government. They may even say, after March 9, that "the financial situation is worse then we thought" and then long-finger their reform plans.
However, doing nothing is not an option, as Mary Harney used to say, usually before she did something that didn't change anything very miuch.
But if the next Government does nothing else it will be thanked by many for finally tackling the sometimes excessive earnings of doctors.
James Reilly's promise that the days of consultants earning €180,000 or more in public pay and a further €300,000 or more in private practice pay will end when it is in Government will strike a chord with people who might not necessarily be rabid blueshirts.
Many would also feel the good doctor could also do something too about a system that allows hospital doctors who are effectively trainees, although admittedly they are unfairly lumped with too much service work, to be paid six-figure sums.
You do not need to be seething lefty Provo to believe that such a system is wrong, especially in the current economic meltdown.
It should go without saying, but it often doesn't, that our medical personnel are of a high standard and work very hard. A cynic would say this should be axiomatic given the amount they are paid, which is higher than the rates in most other developed countries.
But that's probably being a bit too cynical. Medicine is a tough job deserving a fair rate for the work done - it's a question of what Government and society should determine to be a fair rate.
And like many others, doctors have had pay cuts recently. But then again, everything is relative. A newly-redundant construction worker about to emigrate will shed few tears for a professional having his or her six figure income cut by 10% - 15%.
To be fair to the medical community, it has not shown the same untrammelled economy-damaging avarice that continued among members of some other professions even after the recession set in.
However, most reasonable people nowadays would agree that a consultant getting paid €500,000 or more for public and private work is unjustified, a 26-year old trainee GP getting €80,000 a year is unjustified; a hospital trainee potentialy earning more than his consultant boss does from his public salary is also unjustified.
Surely such payouts are no longer sustainable in view of the state of our public finances and the rising costs of private insurance.
Questions must be asked too about the taxpayers' return on this investment. Surely we can get a better service, and a better system, without having to pay some people working in it quite so much.
You could argue too, in terms of moving to a more socially cohesive and equitable health service, with a proper sense of public ownership and staff buy-in, that we need a more level playing field in terms of earnings.
And excessive earnings for some doctors can potentially have detrimental effects too on manpower planning and unmet needs in healthcare.
Take, for example a doctor in his or her late 20s who has enjoyed a very generous salary while still in training. How enthusiastic is he or she going to be about the prospect of earning a more modest sum initially in, for example, an deprived inner-city general practice, or a rural hospital post with little opportunity for private practice, once they are fully qualified?
There is considerable anecdotal evidence that some senior GPs simply cannot meet the salary expectations of recenty-qualified GPs they might want to take on in their practices, so accustomed have some trainees become to high earnings.
Despite all the political promises, we have still not moved away from a health system that in many respects suits those working in it more than those using it.
The bottom line is that in order for the public to take true ownership of the health service it pays for, it is anomalous to have some within it earning the pay of high court judges, the Irish Taoiseach, the US President or even Irish bankers.
The country, the economy, society and the health service can no longer afford it.
|Tommy KT Posted: 04/03/2011 21:30|
regarding pay - most news articles / comments are about the 6 figure sum. and yes indeed - quite a few doctors earn €100k. however - most i suspect - if asked - would prefer to work less, and earn less.
pay scales for doctors are easily accessible and can be viewed by all:
you will see that an intern, having gotten > 575 points in the leaving cert, studied for 6 years in medical school - earn €16.52 per hour, or €33,619.30 per year.
An SHO - who is usually the first person to deal with A&E patients - earns about €5000 more a year.
An SpR who is usually the most senior person to deal with A&E patients - earns between €60,400 to €76,000 depending on seniority (between say, ~ 4 to 10 years post graduating). And s/he is the decision maker for MOST decisions on a day to day basis and overnight - referring to their consultant's opinions in difficult cases.
"Medicine is a tough job deserving a fair rate for the work done - it's a question of what Government and society should determine to be a fair rate." i think this is a very fair and reasonable statement indeed - and Government and society, the people of Ireland, should endeavor to reach and agreement - and then proceed.
|Anonymous Posted: 07/03/2011 15:04|
The answer would seem to be obvious, employ more junior doctors to get the work done, thereby cutting their hours down to normal and reducing the overtime spend.
|badger5079 Posted: 08/03/2011 16:26|
The basic wages of NCHDs start at 33,619 Euros per year. NCHDs are then required by their employers to do excessive amounts of overtime against our wishes. The article here seems to imply that NCHDs all want to continue doing 90 hour and 100 hour weeks as happens in many hospitals even today. This is not true. Anyone who "walks in my shoes" will soon know why.
If you ask a third year primary school teacher (whose basic wages are the same as that of an intern) or any other public servant to do 90 or 100 plus hours per week they will end up earning as much as NCHDs. Anybody who works 90-100 hours per week will end up earning a large proportion of their wages as overtime - the alternative is to ask doctors to work overtime for free.
The problem is not excessive earnings by NCHDs - it is excessive mandatory hours required by consultants and personnel managers in direct contravention of the EWTD. Nobody would expect to be forced to do 90 or 100 hours per week and not get paid for those hours as Mr. Hunter seems to suggest. Of course you could always try to make NCHDs do overtime for free and then you may get a consultant-provided health service by default because all of the NCHDs will emigrate.
NCHDs don't want to do overtime - but if they are forced to do it, they should certainly be paid for it.
Salaries for NCHDs have in many cases dropped by 20-25%.
Anybody who envies NCHDs their job security is welcome to achieve close to maximum points in the Leaving Cert, complete a 6 year medical degree and commit to a lifestyle where you are forced to move house every 6-12 months, forced to endure 90 and 100 hour weeks and 28-36 hour shifts against your wishes, work in a ridiculously inefficient hospital system which is immune to reform while listening to every butcher, baker and candlestick maker throughout the land who ever bought a couple of apartments in Bulgaria tell you that you are corrupt and greedy for merely doing your job (a job that saves lives) and being paid a normal overtime rate for the excessive hours you are illegally required to work.
Don't forget that over 50% of my wages are taken at source to help keep the bankrupt state afloat.
I also feel that the age of an employee is no reflection on their competence or professionalism. The employee either is competent and skilled in the role that they are employed to perform or they are not and should be paid appropriately. This is perfectly in line with free market principles. If this simple principle applied across the public sector, we would prevent a lot of waste as talented young newly qualified professionals are forced to go overseas while some mediocre employees occupy jobs by coasting through, secure in the knowledge that incompetence or laziness will not result in dismissal; perhaps a reassignment at worst.
The fact that one is a trainee doctor until one is a consultant or a GP cannot be denied. It is also undeniable that hospital medical care in this country is largely provided by these NCHDs or trainees and that guidance from the consultants is not always readily available. We simply do not have enough consultants at present to have a consultant-provided healthcare system. (Many consultants are primarily concerned with their private patients and let the public portion of their contract "run itself" that is to say, let it be run by trainees.)
Even in hospitals where NCHD posts were reduced and consultant posts were increased, there have been instances where consultants have resigned in frustration as the hospital managements have not provided them with any medical staff of even an office to work from. There seems to be no plan to prepare for a consultant-provided healthcare system. So the NCHD numbers have risen again.
I believe that we need a 24/7 shift system in Irish healthcare and that this should be provided by consultants and GPs with assistance from NCHDs and allied health professionals. Some universal model of healthcare is likely to be the most cost efficient model since it will reduce the waste associated with duplication of services for private patients.
Ideally, NCHDs should be trained to be consultants in a much shorter time frame. In Ireland, it often takes 10-15 years if not more to become a consultant as there are too few consultant posts. Training has become relegated to the back burner due to the primacy of coping with service requirements in our besieged healthcare system. As a result, many of the jobs that NCHDs have to do are non-medical which wastes NCHD training time. If an NCHD spends 50-60% of their time doing non-medical tasks such as cannulation, phlebotomy and first dose IV medication administration on the red-eye part of a 28 hour shift as I currently do, then there is less time for patient examination diagnosis and treatment. These tasks need to be done, but should be shared with nursing and midwifery staff. We need all hands on deck but these extra hands need to be untied first.
Doctors will always be expensive to pay relative to many other professionals. One doesn’t get to avail of the services of a specialist who can repair one’s aortic aneurysm or diagnose one’s critically ill child if that person is receiving the same income as everyone else as would happen in a communist system – unless one is prepared to commit to the broader consequences of implementing a communist society. Doctors invest a lot of time and expense in their own education. Having a vocation is not synonymous with being taken for a fool.
We need a healthcare system that focuses on making the best use of NCHDs' time so that the patients' interests and the taxpayers' interests may best be served. This would also facilitate a more rapid training process so that we could move to a more efficient consultant-provided model of healthcare.
|bhj Posted: 09/03/2011 10:59|
Sir in relation to GPs salery, the average fee being charged by GPs is 60.00 euro if one has to come back to see his/her GP for the same complaint they will be charged another 60.00euro and so on. Surely this practive should be abolished after all you are paying for a diagnosis if it is not the correct one you should not have to pay for subsequent diagnosis for the same complaint it is the same when you have a priscription if the first one does not work you will not only have to pay the Doctor again you will also have to pay for the medication again the chemist wil not accept returns. Both Doctors and Chemists are gaining on the double.
|Anonymous Posted: 09/03/2011 13:54|
Badger I am also compelled to do overtime by my employer - for free! I, like so many others, have never been paid overtime in my profession. No, no-one is suggesting doctors should be made go down this route and that is certainly not the only alternative. The alternative is simply to employ more people to do the work - what are NCHDs not suggesting that? ? The difference with primary school teachers on their third year of employment is that they are fully qualified but junior doctors are still undergoing training are they not? I sincerely hope your attitude as a doctor when helping any "butcher, baker and candlestick maker" throughout the land is considerably bettter than the attitude you display while complaining on here. After all, similar to your suggestion, you were welcome to train for a different profession. No one forced you to become a doctor, you made that decision yourself. Of course age is a reflection of competence. You cannot get experience without it and no amount of training will give you that. A shift system should be ideal in theory but would result in consultants being paid a shft premium in line with other sectors - 15 - 20% which would still be costly. Aas for certian tasks being "non-medical", how on earth is cannulation, IV meds and phlebotomy non-medical?? What on earth else would you call those tasks except medical? They are hardly admin or catering and they can certainly constitute part of treatment. The very fact that you say they should be shared with nursing makes it perfectly obvious that they are medical tasks. Certainly doctors invest a lot of time and expense in their own education - as does the the taxpayer.
|badger5079 Posted: 10/03/2011 07:10|
@ANONYMOUS, why not implement a system where NCHDs are forced to do overtime hours up to 90+ hours per week?
Go ahead. Leave NCHDs on a salary that starts at 33,000 euros per year and ask them to work 90+ hour weeks for that salary with no overtime.
The free market for doctors might result in doctors deciding to emigrate. The consequences of treating NCHDs like cannon fodder are already here for all to see.
Any NCHD who has a medical degree is fully qualified as a doctor. However, it is clear that training is a lifelong requirement for a doctor since the field of medicine is so vast that it can never be mastered, unlike many other jobs such as "butcher, baker or candlestickmaker". You can argue that a "junior teacher" (notice how we never hear that phrase?) is still in training in the same way as ongoing training is also a requirement for teachers but nobody would propose making junior teachers work overtime for free.
It is clear that a consultant doctor has more training than an NCHD and they receive higher wages as a consequence but all registered doctors are fully qualified. I won't stand for this point to be muddied by some anonymous blogger.
I treat all patients with professionalism and courtesy, you may be interested to hear. Even those who, like yourself, may secretly despise me for doing my job and trying to improve conditions for frontline doctors and the safety of the patients under their care.
Age and competence do not always go hand in hand. Indeed many of the most imcompetent buffoons I have ever met are older workers. Age generally brings experience which is a great asset for any doctor or worker but it is not a guarantee of competence.
I chose to become a doctor and I do not regret it. I am merely pointing out that NCHD training and conditions are being eroded enormously and patient care is suffering as a result as competent NCHDs emigrate. This is an enormous loss of investment for the taxpayer also.
Regarding your comments on what is a non-medical task I would simply state that a doctors job is to examine, diagnose and treat patients. There are many tasks that NCHDs are forced to do because there is nobody else to do them and we do our best under difficult circumstances. However, I am pointing out that nurses and midwives could share these tasks with doctors on-call so that patients are not waiting so long to be seen by a doctor.
If you think it is more efficient to leave all cannulation, phlebotomy and first-dosing to one doctor on-call when it could be shared with nurses and midwives then you obviously don't grasp the importance of getting doctors to increase the proportion of time spent on medical tasks such as diagnosing and treating unwell patients. I never said those tasks were administrative tasks or catering tasks but they are no less nursing or midwife tasks than they are medical tasks.
Any nurse from outside this jurisdiction will have the skills of cannulation or phlebotomy and are quite skilled at it. It is a great skill for nurses or midwives to maintain nad most of them want to embrace it. This concept of "it's not my job" is redundant in this new era of recession and cutbacks and NCHD shortages when all hospital workers need to push for efficiency reforms so that patient care does not suffer. What is prefectly obvious to me is that you are biased against doctors and are happy to see the health service limp on without the kinds of simple efficiency reforms that I am proposing in the patient's interests.
Regarding consultants getting a shift premium - I think that consultants' basic pay is too high in the first place. Shift work for consultants is the only way to get a health system where consultants provide the care which is a vital reform that the health system in Ireland needs.
Finally, I am pretty confident that you, (the anonymous private sector worker who thinks that NCHDs deserve to be treated like crap) are not paying as much tax as I am. Don't try to browbeat me in your position of exalted taxpayer as I too am a taxpayer and my taxes are taken before I receive my paycheck, unlike many private sector workers who are on the fiddle.
|Anonymous Posted: 10/03/2011 15:59|
Badger, where EXACTLY did I say that we should implement a system where NCHDs are forced to do overtime hours up to 90+ hours per week??????? You will see if you read my post that I suggested somethimg else entirely which you have conveniently glossed over.
There is no such thing as a "junior teacher" - you simply made that up. Once a teacher is qualified they are qualified. Teacher training is an ongoing factor for the life of the teacher's entire career once they are qualifed - not the first 6 years like junior doctors. Teachers ould tell you thjat the homework they correct, school sports and concerts they coach are overtime for free. Many sectors in the proivate sector also do overtime for free.
The name "badger" is no different to being anonymous and this is not a blog.
Where exactly did you manage to imagine that I despise you for doing your job and trying to improve conditions for frontline doctors and the safety of the patients under their care You have one heck of an imagination and clearly do not know the first thing about my thoughts
Yes nurses can share the "not-your-job" tasks which again proves that they are medical tasks, just as diagnosing and treating are. And the"it's not my job" concept is exactly the one you are displaying there. If you manange to imagine from my post that I am "biased against doctors and are happy to see the health service limp on" you are clearly exhibiting strong symptoms of paranoia.
As for "thinking that NCHDs deserve to be treated like crap" - delusional imaging on your part. No I am not paying as much tax as you - how could I. I am not being paid for 50+ hours overtime - or any overtime for that matter, per week. And like all PAYE worker,s my taxes are also taken before I receive my paycheck, so cut your silly little bits of unsubstantiated nonsense implying that people are "on the fiddle".
|buzz Posted: 11/03/2011 11:34|
Badger I hope you are more courteous with your patients than you are to other bloggers I mean posters
|badger5079 Posted: 12/03/2011 02:36|
Your alternative suggestion of getting more NCHDs employed to do the work is not possible due to the recruitment embargo by the HSE. Even when doctors are unwell, they are generally not replaced due to unwillingness by the hospitals to employ locums. NCHDs suggest that more NCHDs are needed all the time but our warnings are ignored.
The term "junior teacher" is just as valid as "junior doctor". A doctor is professionally qualified once they obtain their degree just like a teacher. Training is a lifetime endeavour for a doctor, just as it is for a teacher but you don't hear the phrase "junior teacher", do you?
I see that you say that doctors only train for the first 6 years of their careers unlike teachers who train all their lives. However in your previous post you say that:"The difference with primary school teachers on their third year of employment is that they are fully qualified but junior doctors are still undergoing training are they not?" So if teachers are fully qualified in their third year of their careers, then why do they need training? If you are accepting that a professionally qualified person may also be a trainee, then you must accept that an NCHD is also a professionally qualified and that ongoing training endeavours by any doctor should be commended instead of being used to belittle them as juniors who do not deserve a professional wage.
Now that I have exposed how you have twisted logic in an effort to belittle NCHDs as undeserving of respect as fully qualified professional doctors who have ongoing training requirements, it is clear that you are biased against NCHDs.
In the , U.S. cannulation and phlebotomy are often done by nurses and technicians as well as doctors. Here, the culture of "not my job" means that the group with the least powerful voice in the frontline of the healthcar system, the NCHDs, are stuck doing these tasks alone when it would be more efficient to share them with nurses and midwives as happens in other jurisdictions. The doctor can't be everywhere at once and this lack of flexibility is affecting patient care. You seem to ignore this point however. The not my job concept is exactly what I am fighting here. I am not proposing that NCHDs stop doing cannulation and phlebotomy - I am proposing sharing these tasks with allied health professionals as they do in other countries to the benefit of patient care.
The concept of doctors having to give all IV first doses has been acknowledged as ludicrous. Many hospitals have done away with this policy but the practice often continues regardless due to an inertia regarding reform. The General Secretary of the INMO stated that nurses should of course be allowed to give IV first doses.
I said that many private sector workers are on the fiddle regarding their taxes. I did not say that PAYE workers are on the fiddle. I suggest you check with the Irish Revenue regarding this widely-known problem.
How much overtime do you do in a week? Would you be happy to do treble your basic hours and only get paid for your basic hours? Now imagine spending those hours doing medicine. Is that your solution for the health service? I know what will happen if such a system is enacted.
|Anonymous Posted: 15/03/2011 14:27|
Badger, the existing situation is not legal. the option for junior doctors to do unpaid overtime is not acceptable - so what do you suggest? If employing moe junior doctors is prevented by the recruitment embargo - then it is this which docotes need to change and you will find they garner far mor support in this tahn they would by making 3 times their salary and then complaining about it.
The term "junior teacher" does not exist - you just made it up. There are "student teachers" who are undergraduates in teaching (tho graduates from their degree / Masters) who have not yet graduated in that disciple and there are fully qualified teachers. A junior doctor is not qualified as a conmsultant - hence the term.
You are now attempting to twist my words, which I would hae thought beneath you.Teachers are fully qualified in their third year of their careers (or sooner) but undergo periodic upskilling in accordance with changing curricula and professional requirement - unlike junior doctors who undergo consistent training for addtional years in order to qualify. Where exactly did I belittle any profession and say they do not deserve a professional wage? Read the posts before you go shooting off at the mouth please. It is you who are arguing (and quite rightly) against compulsary overtime. I on the other had provided suggestions for change. i
Any evidence of "bias" is clearly in your imagination.
Did I say anywhere that cannulation and phlebotomy, as medical tasks should not be shared with other medical professions??? Shared, absolutely no argument. But it is you display the 'not-my-job' concept.
As the Revenue comissioners (your referring to them as Irish Revenue makes me wonder where you're posting from) will attest to, it is near impossible for P.A.Y.E. workers for fiddle their taxes without some extremely skillful fraud.
Badger, where exactly did I suggest that you do treble your basic hours and only get paid for your basic hours?????? This is a paranoia of your own imagining. I choose not to go into medicine - you did, so I have to need to imgaine the delusion that you and you alone in this, seem to be suggesting. If you read (for the third time) my post you will have no need to repeat yourself asking whether this is my solution for the health service.
|badger5079 Posted: 15/03/2011 20:46|
A junior doctor is fully qualified as a doctor but they don't have the experience of a consultant. A student teacher is fully qualified as a teacher but they don't have the experience of a headmaster. You are happy to use the term junior doctor as you say that it is appropriate becasue junior doctors are not fully qualified consultants. Then why not call us junior consultants? After all, our qualifications as fully qualified doctors are not in question. The reason I made up the term junior teacher is to get people to realise the discrepancy in calling a newly but fully qualified doctor "junior" while not applying the term to a newly but fully qualified teacher.
Howver in both the case of a newly qualified teacher and a newly qualified doctor, each has much that they can learn throughout their careers. Why are the public happy to call fully qualified doctors juniors but we feel uncomfortable with calling newly qualified teachers "juniors"? It is because it is acceptable to undermine NCHDs as not fully qualified in some way so that it seems acceptable to deny them their full wages.
One of the main things that can reduce the need for NCHD overtime is to stop using NCHDs as the person that is called when it is nobody else's job. They are still being forced to do all cannulas and phlebotomy and in many cases give all IV first doses in hosptals around the country when in other countries, the nurses and midwives are allowed to help out with these tasks to improve patient care. I f you agree with my call for urgent reform in this area then we are in agreement as I never said that this was not my job an I accept that NCHDs need to do these tasks - just not alone.
Private sector workers often evade tax if they are self-employed.
When you were talking about doing overtime for free yourself I believed that you were about to make some sort of justification for bringing this in for NCHDs. It might be a good idea as it would leave Ireland without NCHDs and then we would have consultant-provided healthcare by default. It's not paranoia to believe that the HSE and hospitals country-wide have systematically tried to defraud NCHDs out of part or all of their overtime pay on many occasions. Most hospitals try to do it on the sly and the consultants condone it by saying that in their day, the would do a 120 hour shift for a thrupenny bit and a glass of warm milk.
|Anonymous Posted: 18/03/2011 11:45|
Again Badger, there is no such thing as a "student teacher", you just made it up as you've admitted. There are undergraduates in teaching who are studying to become teachers and there are fully qualified teachers. .
As for thinking that it is acceptable to undermine NCHDs so that it seems acceptable to deny them their full wages - that is an imagining which is entirley your own.
I have no problem with nurses doing cannulation and phlebotomy. as well. Indeed in many cases nurses who come to work here foo overseas who are not qualified to do cannulation will do a course in it to enabvle them to do it.
It was not the self-employed I was referrign to, but the vast majority of private sector worker, who are P.A.Y.E
No, your belief was just that - your belief. In any professional occurpation as people becoe exprienced, there will be a certain amount of overtime required in many cases this is unpaid. That however does not make it a justification across the board.
Perhaps consultants attitudes are part of the problem as they beleive as they went through the same system and qualifed and it "didnt do them any harm" so therefore it should be acceptable for anyone comign up through the system now.
|badger5079 Posted: 18/03/2011 20:46|
I meant that we don't hear of the term junior teacher for newly qualified teachers or teachers in their early careers but it is acceptable to refer to doctors in their early careers as junior doctors. Why the difference? Both groups are fully qualified. My use of the term "student teacher" was an error - I meant "junior teacher" to mean a teacher who is in their early career. I am not advocating the use of the term "junior" for either teachers or doctors as it undermines them in their professional capacity.
As an NCHD who does not want to be forced to do stupid amounts of overtime, I reject the term gravy train. It implies that NCHDs are complicit in maintaining the status quo in Irish hospitals whereby they are forced to work over 90 hours per week. The vast majority of NCHDs would refer to have more doctors sharing the workload or to share the workload with allied health professionals such as nurses but when we speak out in the hospitals, nothing is done and when we speak out in the media we are threatened with sanctions under our contracts.
Perhaps some investigative reporter would care to take a ride on this "gravy train" to discover that it is actually a "blood, sweat and tears train"
|Anonymous Posted: 22/03/2011 10:01|
The difference Badger is that junior doctors or whatever you prefer to call them are still undergoing ongoing trainging to become fully qualified in their specialised field, whereas teachers are not. So there is no such thing as a "junior teacher".
Why is it that when you (as a group) speak out in the media about an espect of your work which is essentially, illegal, you are threatened with sanctions under your contracts.
An investigative report is an excellent idea. Perhaps PrimeTime would be interested. They have investigated a number of scandals in our health service already.
|iknow.imgood Posted: 31/03/2011 12:37|
I think its absolutely criminal that doctors are still charging 50-60 euro for consultations now.These prices soared in the boom days and now that people have taken huge pay cuts, well why havent their fees been cut too in line with everyone elses pay packets (20-40% reductions). Its utterly shameful that children under twelve dont have cheaper rates to ensure they get medical attention when needed. I see so many families that are unable to afford to bring their sick children to doctors. The current Minister for Health is taking about reversing the medical card levy. Thats a genius intervention. The medical card levy did an amazing u-turn on peoples waste whereby people became vigilant. When people passed away, we saw boxes and bags of unopened+unused medicines before the levy-hundreds and sometimes even thousand of euro for disposal. Now, that has become a very rare sight which is wonderful. Even the people with medical cards, were very supportive of the levy as it was a small contribution to a the states medical bill and they saw less waste themselves because suddenly they were having to think about not wasting their money on the levy and now we get told what they dont need this month 'as i have 4 boxes of those already at home'! I dont see at any level, people not taking their medicines due to the levy as we did a survey and not one customer stopped taking their medicines due to the cost of the levy. They just said they dont collect from the pharmacy what they dont need so why would the minister have that be reversed? The mind boggles. Why doesnt Dr Reilly put his energies where more people can access the medical system and get GPs to reduce their prices - more people would go and im sure they would see more private patients coz then they could afford 30 euro but 50-60 is plain greedy.
|Anonymous Posted: 01/04/2011 15:16|
Good points I know but perhaps James Reilly's aim in removing the prescription charge from medicla card holders is to relieve the burden on families who need perhaps 6, 8, or 12 items every month - 6 euro can be the difference between putting a dinner on the table and your family going hungry.
|badger5079 Posted: 01/04/2011 21:06|
Anonymous; a teacher in the first years of their career does not generally know as much as a teacher with 20 years of experience. Same thing for doctors, generally speaking but such teachers do not get hit with the "junior" tag.
If people have a problem with "junior" doctors getting paid enormous sums of money due to overtime, they need to remember that NCHDs are used as the donkey of the Iirsh medical system. If somebody else doesn't feel comfortable, then it's the NCHDs job. Hence the massive overtime and the massive waits to be seen by an NCHD training doctor. There should be more consultants and less NCHDs but then who would do all the cannulas, first IV doses, tracking down radiology reports, spending hours interceding with radiologists to get scans that you know are not necessary or cost-effective for the patient in many cases, chasing up old notes, taking blood tests on-call and clerking up all the patients who pile into the Emergency departments? Because, it sure doesn't seem like the consultants will do these jobs and they are probably right. They are trained to diagnose and treat patients using their hard-won skills and knowledge. It is hte NCHD who has to mop up all the in-between jobs and when we are doing 40 hours overtime per week, it gets expensive. Just as it would for anybody doing the same hours and getting overtime rates.
|Anonymous Posted: 04/04/2011 10:08|
Badger, we have been over this ground before, no a teacher in the first years of their career does not generally know as much as a teacher with 20 years of experience. However a teacher in the first year of theior career is a filly qualigfied teacher, a junior doctor is still undergoing training to qualify as a consultant.
As I think I made clear, the problem is that NCHDS - or however you wish to be called are doing vastly more hours than is legal or fair. I have ALREADY agreed that I have no problem with other meidcal personel such as nurses doing cannulas - which many already do, first IV doses, tracking down radiology reports and communicating with radiologists to get scans - which nurses also do. But if you that they are not necessary for the patient in many cases - why do you waste hours tracking them down - surely this only contributes to the overall problem. Nurses spend plenty of time chasing up old notes and clerking up patients which they could argue takes from the time they should be doing what they are trained and paid to do - Nurse.
|badger5079 Posted: 04/04/2011 18:31|
Anonymous: Are you saying that a doctor is not fully qualified in their first year of their career? He or she has a medical degree and are working as professional doctor but you seem to want to deny that they are fully qualified whereas you have no problem saying that a newly qualified teacher is fully qualified, regardless of ongoing teacher training needs.
You just don't want to admit that NCHDs are fully qualified. The discrepancy seems to reveal your bias.
Nurses do not track down radiology reports in any public hospital I have worked in. Name one hospital where this occurs. I don't think you are directly experienced in this area. I have worked at the frontline of public healthcare in Ireland for over 7 years and I have never seen a nurse do anything like that.
In my own hospital, the ward sisters are variable in their attitude to first doses. If they feel like it, they can allow the hospital policy to be implemented. If they don't feel like it they can complain that there nurses are not ready based on a whim...and they can get away with it.
You recognise that nurses need to spend more time nursing...I agree...but you castigated me for daring to suggest that doctors would better serve their patients by being allowed to spend more of their time on treating and diagnosing patients as opposed to non-medical tasks such as IV first doses, phlebotomy and IV cannulation. In the U.S. You don't need a doctor to do all of these tasks. You just need somebody take charge and train a larger pool of people to share these jobs so that they can they done more efficiently, whether the job is done by a doctor, nurse or midwife is not as important as the safety and efficiency with which it is done.
That is my opinion as a trainee doctor. I do not know what job you hold and whether you work within the health service but I know that you are happy to leave cannulation, IV first doses and all phlebotomy to the one or 2 medical doctors on-call who are covering all the wards while goiing out of your way to make sure that the nurses and midwives don't have to help out so that they can focus on nursing/midwifery. I suspect that you are a nurse. You see the NCHD's role as general a dogsbody who must be used to mop up any job that nurses, midwives, porters etc don't want to do. You seem to forget that a doctor's job is to treat and diagnose patients and we are thin on the ground. You are prepared to ignore calls for reforms that I have suggested that will make a huge difference to patient care, safety and waiting times. I have met many of your sort.
This is the same mentality that had nurses prepared to go on strike for a 10% pay rise and a 35 hour working week in 2007. While the NCHDs (so disparagingly referred to as junior doctors - again, you never hear of junior nurses even though the term is just as valid) were working 2 to 2 and a half times these hours weekly as a routine matter.
|badger5079 Posted: 04/04/2011 19:19|
I also have never seen or heard of a nurse chasing up old notes. Not once in 7 years of work at the frontline. Never. After all, it's not their job. (Fair enough - but it falls to the doctor).
If a consultant tells his/her NCHD to book a scan and the NCHD debates the need for it, that NCHD will be labelled as argumentative and may get a bad reference. That could mean the difference between getting a job with decnet conditions and hours and one where you have to go to a godforsaken outpost where training is extince and the hours are 90 plus per week.
You seem to be bluffing your way through this discussion. You are quite lacking in knowledge of the facts of how thing work at the frontline of Irish hospitals but happy to bluff it out.
|Anonymous Posted: 05/04/2011 11:58|
Badger, we have been over and over the the use of the term junior doctor and I have explained it to you several times. If you are still confused read my previous posts. I have also explained how occasional brief training periods for teachers differ from the ongoign trainign required for junior doctrs / NHCDs / whatever yoiu want to call yourself, in order to qualified as consultants. These are the facts and the only bias is, yet again, in your own mind.
To my knowledge, nurses do indeed track down radiology reports.
If the ward sisters are variable in their attitude to first doses, then I agree that this too needs to be tackled. There must be consistnecy if the system is to function for the benefit of the patient. If the hospital policy is to allow nurses to administrer fisat doses, then ward sisters should not be allowed to over-rule that without a very good medical reason - not a whim.
I do take your point in relation to debating the need for a scan with a consultant but why complain about it here if no-one is prepared to undertake any action to change it where it mattes - at the hospital?
However, I am perfectly aware of all of the facts I have outlined here thank you.
Where on earth did I "castigate" you? Can you provide examples? I simply pointed out, correctly as a matter of fact, that, IV first doses, phlebotomy and IV cannulation most certainy were medical tasks - you don't see admin or catering staff being qualified to carry them out. The U.S is hardly a good example of how to run a medical system - but if that is where you are coming from, then it does explain your attitude.
Where on EARTH have you picked up the notion that "I am happy to leave cannulation, IV first doses and all phlebotomy to the one or 2 medical doctors on-call who are covering all the wards while goiing out of my way to make sure that the nurses and midwives don't have to help out" READ my posts - properly. You will see that I actually AGREED-WITH-YOU, more than once, that that I have no problem with other medical personel such as nurses doing these tasks and many already do.
You suspect wrong - I am not a nurse. Tho I have the height of respect for nurses as I do for all dedicated hard working medical staff. Where do you get the notion that I see the NCHD's role as general a dogsbody who must be used to mop up any job that nurses, midwives, porters etc don't want to do - that is purely paranoia. AGAIN - I AGREE that A doctor's job is to treat and diagnose patients. How much reassurance do you ned on all these points? What calls for reforms have I ignored? You will find I have suggested reforms in fact. As for you remark that "I have met many of your sort" - of that certainly typifies your attitude and says more about yours than it does mine, I'm sad to say.
I dont know what "mentality" had nurses prepared to go on strike for a 10% pay rise but I certianly did not agree with it, jsut as I do not agree with NCHDs / junior doctors or whatever you prefer, working 80 and 90 hours a week as a matter of course. No you never hear of junior nurses - they are referred to as trainees - or undergraduates now since since nursing became a degree course.
|JamesH Posted: 05/04/2011 12:24|
Anon, and Badger, I have been watching this debate for a while now. Just from the outside, I think you both have decent points. I agree with Badgers point about the term junior doctor. While a lot of NCHDs no doubt aspire to be a consultant, there are only 3000 consultants in the whole country. An NCHD as Badger has argued many times is a fully fledged, qualified and registered doctor in their own right. I assume that some NCHDs never make it to consultant level and so it is demeaning to refer to them as junior doctors (they are fully qualified doctors, just as Badgers example of a teacher is a fully qualified teacher (and not a junior principal)). A trainee nurse is not in any way comparable to a fully qualified doctor, as you yourself point out a trainee nurse is an undergraduate, where as a NCHD is a graduate and fully qualified doctor. Having read Badgers messages I now fully understand and agree it is insulting for you to continue to use the term junior doctor. On the other hand I think Badger that in fairness Anon has many times agreed with you that IVs, first doses etc do not all have to be done by the NCHDs and has supported a lot of your issues.
|badger5079 Posted: 09/04/2011 20:31|
I understood that you thought of IV cannulation and IV first dosing and phlebotomy as tasks that were to be done by doctors only. When you said that these tasks are "medical", I did not understand that you meant that this could also mean that nurses and midwives could do these tasks. So we seem to be in agreement, although I am not used to using the term medical to apply to nurses and midwives, as expert as they may be at heir jobs. (No more than I would apply the term nursing to a doctor).
I assure you that training periods for doctors look like becoming increasingly brief due to cutbacks. Perhaps that may allow us to shed our "junior" titles.
I have been 7 years qualified as a doctor. I have never once seen or herd of a nurse tracking down a radiology report. That entails checking on the computer reporting system for the result (they don't have access to that whch is stupid) or when the report is not on the system, going down to cajole the result out of the radiologist - a nurse would never accept that task and rightly so. It is one of the most frustrating causes of wasted time for NCHDs.
There are many areas of the U.S. healthcare system which are far superior to our own. The problems of access and cost are separate to issues of poor management.
I admit that I am very angry and defensive. I feel I am being forced into emigration despite having a relatively secure job. I fell like my calls for cost-saving reforms are being ignored by mu hospital. I have called for simple reforms in my hospital and nd I have written in the media about it and the response was a threatening letter from the personnel manager.
|Anonymous Posted: 21/12/2011 14:33|
Yes IV cannulation, IV first dosing and phlebotomy ARE medical tasks (they are not orderly or admin tasks for example) as I have said many times, therefore, they can be done by Medical staff - of which there are nurses, midwives and doctors, among others. Or do you not consider nurses as medical staff because they do not have the title Dr. in front of their name? I presume that attitude of snobbery among doctotrs, which considered nurses as some sort of doctors' handmaid, has long since died out.Y es we are in agreement on that. But if the term medical staff doesn't apply to nurses, midwives, radiologists, speech therapists, aneasthetists, physioterapists etc, then what term exactly would you apply to them? Afte rall, the receptionist at the front desk and the records officer (ward clerk) are both admin staff altho their job is different, or would you ascribe different titles to them also?
On the contrary I have seen nurses, in two different hostpital doing that - and it wasn't today or yesterday either. One of them was a ward sister (now called CNM as I understand). .
While research in the states is cutting edge compared to some other countries, I would say that on the contrary, the problems or access and cost in the U.S. are entirely integral - afterall it is of little use having an excellently managed system, if people die waiting to access it or must bankrupt themselves to pay for their treatment.
Your anger and definesiveness is what can unite the public, this is what can get us public on the side off all medical staff (that is nurses, doctors, radiologists etc) who are calling for reform. The public needs to hear about it and needs to hear WHY, most of all. With people on your side, those who make such decisions (aside from those who write threatening letters) can see that medical staff have a stronger voice when backed by those who need their services - patients (not consumers, incidentally).
|Cathriona Posted: 03/03/2013 01:32|
Gravy train?? I work unpaid overtime now, thanks to the lovely whitewash that those above skewed examples have given to doctor's work conditions. Now, there is an extra 10-20 hours of my week that I don't get paid for. Where's my €45,000 overtime? I'm not on €60,000 a year... I'm on €30,000 a year. My average pay per hour worked is about €8 to €10. Non consultants doctors are exploited at present, and still people like to say it's ok to make us work like dogs because we get piles of overtime pay, which... Um, not very many of us get..
Very poorly informed article. Do some non-HSE sponsored research next time. The HSE do not care about doctors.
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