The number of doctors who are appointed to consultant posts in hospitals around the State is the number that will determine whether the recent talks on a new pay and career deal for senior doctors will prove successful.
Since October 2012, when the Government unilaterally cut the pay of new hospital consultants, the ability of the health service to fill these once-coveted positions in Irish medicine has declined rather dramatically.
The Oireachtas health committee was told last spring that at that stage there were about 250 consultant positions in HSE hospitals that were not filled on a substantive basis, although some were filled by locums.
This represented about one in eight of the positions.
However, as the figures included only hospitals run by the HSE, members of the committee argued that, when voluntary hospitals were taken into account, the real number of vacant positions was probably closer to 300.
Concerns were also raised about whether there had been a falloff in the calibre of consultants appointed. In hindsight it can be argued that the Government’s decision to cut the pay rate backfired spectacularly.
Commitments
However, it also has to be borne in mind that in cutting the pay for new hospital consultants, the then minister for health James Reilly was only implementing a commitment set out in the programme for government agreed between Fine Gael and Labour in 2011.
Hospital consultants are the largest group of high-earners in the public service, and it had been argued by some commentators and politicians that Irish consultants’ salaries were out of line with those internationally.
After the pay cut was implemented,medical organisations contended that this lower salary rate for new entrants, along with other pay cuts put in place for consultants under financial emergency measures, would lead to a brain drain.
They maintained that young doctors would move abroad to work and those overseas would not return to Ireland given the salaries on offer and the failure on the part of the Government to fully honour a contract negotiated in 2008.
The Government argued that consultants in other northern European countries could move to work in Ireland.
However, it quickly became apparent that the medical organisations were correct in their assessment of the impact of the pay cuts.
While Irish doctors operate in a market in the English-speaking world, there is no real tradition of doctors from the Netherlands, Germany or Scandinavia coming to work in Ireland.
In January the HSE acknowledged, on foot of receiving a consultancy report, that there was an issue in relation to retaining senior doctors.
Dr Reilly then asked officials in his department and the HSE to develop new proposals for revised pay structures for hospital consultants.
The minister said that while the starting salary of €116,000 for newly appointed consultants working exclusively in the public system was attractive and higher than in many countries, he said “it is clear that without latitude and under current interpretations, problems have arisen in terms of the movement of well-established consultants”.
In comments to the Oireachtas health committee , the minister said: “When we introduced the reduction it was never my intention that somebody who has spent 10 years working as a cardiologist in Toronto would be expected to return here and commence work at the starting point on the salary scale.
“That, clearly, does not make sense. Whatever needs to be done will be done to address that issue.”
The MacCraith group, which recently looked at career structures for senior doctors, found that cuts to the pay of newly appointed hospital consultants and lack of recognition in pay scales of previously obtained experience were hampering attempts to recruit and retain senior doctors in the health service.
It urged the Government to look again at pay levels for newly appointed hospital consultants.
Talks on the issue eventually got under way in June.
However, not all organisations representing consultants were represented: this is because the Irish Hospital Consultants Association (IHCA) declined to sign up to the Haddington Road agreement and was thus not permitted to take part in the new talks process on a new pay and career structure deal.
The new pay terms effectively reverse the 30 per cent pay cut put in place in 2012.
For consultants working exclusively in the public hospital service, pay rates under the proposals increased from €116,000 to €121,000, and can go up to €175,000 over time.
Pay scale
Perhaps crucially, the proposals allowed consultants with experience to come into the system much higher up the pay scale than the entry level, possibly up to a rate of €155,000.
However, the argument immediately concerned the criteria that would be used to determine the level of experience that would warrant entry at the higher pay rates. Already there has been debate about the merits or otherwise of the new consultant pay and career offer.
However, it will probably be another year or so before we will know whether the pay-review exercise has been successful in reversing the medical brain drain experienced over the past year or so.
