The revelation of a complete lack of applications for hospital consultant posts across a range of specialties in 2013 will come as a surprise to many. It had been thought that Minister for Health James Reilly’s decision in 2012 significantly to reduce pay scales for newly-appointed consultants to levels that supposedly compared favourably with those paid across Europe would not affect the quality of candidates. Despite an expected fall in interest from Irish-trained doctors, it was anticipated there would be no shortage of applicants from Eastern Europe and the Indian sub-continent.
However, the move by the Health Service Executive (HSE) chief executive Tony O'Brien seeking Department of Health permission to increase pay levels for experienced specialists suggests official acknowledgement of a staffing crisis at the highest level of the system. It backs anecdotal evidence of particular problems where consultants working in the Republic wish to apply for more senior positions.
One high-profile professorship at a leading Dublin teaching hospital remains unfilled as interested candidates face a potential €40,000 to €60,000 drop in the salary they currently earn for taking on greater responsibility. Older consultants working in public hospitals are paid from €136,000 to €192,000 per annum. Those who have taken up posts since late 2012 earn €95,000 to €116,000 for the same job. Hopes that the new deal would lead to a consultant-provided service by a greater number of consultants appear to have been dashed.
The desirability of having consultants rostered on a 24-hour-a- day, seven-day-a-week basis remains. For patients it means the standard of care at night and at weekends will improve, with consequent benefits for patient safety. It also removes a significant barrier to the full utilisation of hospital resources, facilitating evening use of operating theatres and weekend use of expensive radiotherapy suites.
However it seems that warnings by medical representative organisations of a "brain drain" have materialised through a combination of departing senior consultants and a reluctance of newly-minted specialists to return from training abroad. President of the Irish Hospital Consultants Association Denis Evoy had warned that the continued "degradation" of working conditions and contracts was resulting in a system that could not cater for patients.
But it would be a mistake to see the current recruitment crisis in purely monetary terms. The absence of candidates from other European countries, for whom the new salaries would not differ significantly from those available at home, suggests wider issues in the health service are also a problem. A “blame and shame” culture allied to a system struggling with staff shortages and underfunding may well be a significant additional disincentive to seeking employment in Ireland.