Consultants frustrated over cutbacks to services and pay

Figures from an unpublished survey carried out by the Irish Medical Organisation (IMO) show that over a quarter of consultants are thinking of leaving the public health system, and that many of them are upset about cuts to services and their own pay. By Sara Burke

The survey of consultants carried out by the IMO - the biggest representative body for doctors in Ireland - got 407 responses, about one sixth of the entire consultant workforce (of 2,400).

It found that 27 per cent of those surveyed are thinking of leaving the system - for those under 49 the figure is slightly higher, at 33 per cent. 40 per cent of consultants would consider resigning their HSE contract, a figure that rises to over 50 per cent for consultants under the age of 50.

So what are the main reasons for their dissatisfaction? 93 per cent say that "cut backs are having very negative effects on the level of treatment and support services for patients", while close to 70 per cent of consultants name cuts leading to bed and ward closures as particular concerns.

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 per cent believe that there are not sufficient 'non medical' supports - i.e. secretarial/administration support - to meet needs.

Our growing, ageing population and the increased prevalence of chronic diseases is impacting on consultants' work load, with 72 per cent of those surveyed saying that the complexity of consultations with patients has increased over the last five years. 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. Almost half those surveyed 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 the spring of 2008 they were promised two pay increases. Only one of these was delivered late in January 2009. They maintain that not delivering the second part of that is a 15 per cent cut; on top of that new levies and pay cuts mean they are 30-40 per cent worse off - so if they were meant to be earning €200,000 then, now they are earning €160,000.

And yet we are still paying Irish consultants more than others (starting salaries in the UK are £70,000, in northern Europe they are €70,000), although it depends on where you compare them to. For consultants working in the public system only the starting salary is €166,000 but they can earn up to €208,000 if they become a professor whilst a public-system-only consultant.

Those on Type B contracts (which allow public and private work) start at €156,000, but they can earn more if they take on additional roles. The HSE say these are highly competitive rates compared to the UK or Northern Europe. The Irish Hospital Consultants Association (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 they are. The HSE say they have had no problem filling an increased numbers of posts – there have been 500 new consultants posts since the HSE was established, although the Hanly (Medical Manpower) report in 2003 recommended 3,625 consultants should be 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 in contrast to most other areas where staffing numbers are stagnant or going down.

As well as this, new information gathered for the Drivetime health slot reveals that up to now the type of contract given to a consultant - that is, whether it was a public only or public/private contract - was up to the discretion of the hospital. The correspondence I have seen shows a recent directive from HR director Seán 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. 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 James Reilly.