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Irish Medical Consultants

There’s an almighty row going on at the moment about the contracts being offered to new hospital consultants.

An incredible uproar.

And the reason? Well, the government is going to hire more consultants, but they’ll have to work exclusively in the public health service. They won’t be able to have private patients under the new contract but instead will have to devote their full attention to public work.

This won’t affect the conditions of employment enjoyed by the present consultants, nor will it reduce their income in any way, but they’re not a bit happy. They don’t want their money-making system changed, and they’re not used to being questioned.   You see, Irish consultants have a great set-up, whereby they get a salary from the government and can also treat private patients in public hospitals, using theatre facilities, laboratories and hospital beds provided by the taxpayer. Not to mention all the nurses and junior doctors, also paid for by the taxpayer. On top of all that, many of them behave like arrogant strutting demi-gods, as we saw for instance in the Neary scandal.

They like it that way, and who could blame them?

I had a look around and, as far as I can establish, these are the only group of public-service workers entitled to this kind of working arrangement. As far as I’ve been able to find out, all other professional groups within the civil service and in local councils are barred from doing private work. Lawyers, engineers, veterinarians, architects and a host of others are all explicitly barred from working privately in their own profession.

When you walk into an Irish hospital, you can choose to be a private patient or a public one, and it is a festering scandal in this country that, if you walk into a publicly-funded hospital and choose to go private, you will get faster treatment in the hospital and better attention from the consultant, because you can pay. This is true and it’s a disgrace.

Did you know that in Ireland, by law, there’s a universal entitlement to free healthcare, regardless of whether you have private health insurance or not? And yet, everybody entering an Irish hospital is asked if they have insurance, and if the answer is yes, they’re automatically routed into the private channel.

The Comptroller and Auditor General recently published a report into all of this. He concluded that, even though hospital consultants have, by agreement with the government, a right to use up to 20% of hospital beds for their private patients, they routinely take more. Likewise, they refuse to account for their hours of work though – depending on their category – they receive between €140,000 and €180,000 a year to attend work.   In addition, for their private work, they get all the back-up services available at the hospital, paid for by you and me, including staff to work for them.

Now, I know I made this comparison before, but just let me say it again. It’s the very same as if you walked into your local Council, and you said to the planner: I want to build a house.

The planner looks back at you and says, OK, but you’ll have to wait two years. I’m busy.

So you say, But I can pay!

And the planner takes a step backwards. Why didn’t you say so? Come into my Council office here and I’ll get a Council technician to draw up the plans for you. We’ll print them out on the Council’s printer and you’ll have permission tomorrow morning.

Seriously. Isn’t it exactly the same? And yet, any planner attempting such behaviour would be arrested.

There was an article in the Irish Times last Friday that I thought was very revealing of the sort of elitist condescending mindset at work among some of the medical profession in this country. An outraged sense of entitlement not unlike that of your average welfare scammer.

It was written by a guy called Ronan Cahill, described as a senior specialist registrar at Cork University Hospital.  He’s close to becoming a consultant himself, and no doubt he received all this training from my taxes and yours, but he’s not the slightest bit happy that the gravy train is about to come off the tracks. He thinks that the level of pay on offer won’t attract people to take up consultant posts in this country. Incidentally, the salary is in the order of €200,000 a year, and I heard one English-based consultant on the radio during the week saying it was better than the British rates, and better than many self-employed consultants in the USA could make.

But the real giveaway, I thought, was a nasty little comment embedded in the article where he remarked that the new contracts would prove attractive to clock-punching, detached, disengaged automatons whose ambition is levelled at achieving a reasonable monthly salary.

I had to read it twice to be sure I was right.

clock-punching, detached, disengaged automatons

Hold on. That’s me he’s talking about, isn’t it? And you. And nurses. And junior doctors. And technicians. And radiographers. And physiotherapists. And everyone else inside or outside the health service who holds down a paying job. The very people, in other words, whose taxes paid for Ronan’s training. This is a guy who regards just about the entire world with contempt and I have no doubt he’s a good example of his breed. No wonder he’s peeved: this man is clearly consultant material, in his condescending attitude if nothing else.

Ronan makes the point that exceptionally innovative, educated people – such as himself – won’t train to be consultants any more because the money won’t be good enough. All along, throughout his training, he expected to get the State salary and also have his own private income, and to be fair to him, you can see his point. There is a lot more money in the private work. He’s right.

Aha! I have it!!

Why doesn’t Ronan forget about the public work? Why doesn’t he just go off and work in a private clinic where the rewards are so much greater? That will solve his problem.

Oh! No, sorry, I was wrong. It won’t.

You see, then there would be no €200k from the State. No free beds. No free nurses. No free theatres. No free technicians. No free pathology. But worst of all, there would be nobody at the front desk to tell 20% of publicly-entitled patients that they have to go privately and pay Ronan a big pile of money. That’s what’s pissing him off, the miserable, grasping little prick.
And they accused the nurses of greed?


related article from The Bitter Pill


Tribunal Lawyers’ Fees (and Hospital Consultants)

So the lawyers aren’t going to suffer a crippling reduction in fees after all. What a relief.

It looked for a while as if they were going to be forced to manage on a measly €1,000, but no.  Common sense prevails and their fees remain at a richly-deserved €2,500 per day.

Now, I know that some begrudgers are saying uncharitable things about the fine fellows who struggle by on this pittance.

Bah! say I. Year after year, at the Planning Tribunal, these splendid intellects have toiled away for a paltry  €650,000 a year in the service of the Nation – as fine an act of patriotism as you will ever see. Foresaking the thrill of going out and competing for work, they have instead chosen the dull and unglamorous drudgery of the Tribunal, with the dreary boring sound of its week-by-week cheque for €12,500 flopping onto the carpet. Oh Jesus, you can hear old Tribunal lawyers groan, Not another fucking €12,500 cheque for me to lodge.”

I feel their pain.

Quite properly, they point out that they gave up the chance of earning far higher fees to work at the Tribunals. True. I had the same experience. By taking a day-job, I gave up the chance of becoming a Texan oil-billionaire.

Now, don’t get me wrong. I wish the lawyers the very best, and I certainly wouldn’t want to seem churlish, but there’s one thing I can’t help wondering: as the Tribunals are not courts of law, why do they need to be run by lawyers? If they’re looking for people with a high level of professional training and administrative skill, why not consider other professions? Can accountants not read and speak? Or geologists? Or physicists? What about union negotiators? Architects? Doctors?

Oh. Now don’t get me started on that.

All right, then. Go on.

Hospital consultants. Now there’s another crowd of fine individuals, for sure and certain.

These are a bunch of guys who want to have a contract to work as public employees, including a guaranteed salary, pension and all the rest, which is fair enough. But they also want to be able to run a private practice, and why not? I can see how there would be no conflict of interest at all there. That’s why, here in Ireland, you can just walk into any hospital and say I’m sick – fix me, and they’ll ask you if you’re a private patient or a public patient, but it won’t matter. You’ll receive instant attention either way, isn’t that right? Not like in that parallel Ireland invented by the media where you walk into a hospital and they ask you if you can pay, and you say no, and they tell you to come back when you’re dead. That was all made up by commies in the media, wasn’t it? And consultants won’t put you to the top of the list just because you can pay them. Of course not. And they don’t have the use of facilities already paid for by you in your taxes – do they? Oh Jesus no. They pay for the whole lot. Of course they do.

It’s just like when you walk into your local Council, and you meet the planner and you say

I want planning permission for my bungalow.

And the planner says Fuck off!!

But I can pay, you protest.

And the planner takes you by the elbow. Why didn’t you say so? Come in here to my consulting rooms paid for by the public, and I’ll draw up your plans on the computer bought out of your taxes and it’ll all be sorted out by the morning for you and don’t worry one bit. Would you like a coffee while you’re waiting?

That’s right. Nobody would mind that, would they? Of course not. And that’s why we allow hospital consultants to do the same thing.