protected professions


It will be interesting to see how many consultants follow through and leave. I’d be surprised if many on the old contract actually go. Most people would work for less to stay at home. And those defined benefit pensions remain attractive. Of course, they be reduced at some point.


I signed the department goodbye card of one of my colleagues on “the old contract” last week, he and his family are moving to Canada. Another colleague “on the old contract” from a different speciality also resigned 2 months ago and has already taken up a post in the sates.

Lots of my colleagues are reassessing their position and many are reestablishing contacts overseas with the idea of leaving.


Obviously, for those with teenagers, moving abroad is a big step. The college fees are the least of one’s worries. At our recent med school reunion, the Irish consultants were in generally buoyant mood although that might have been just for the night.

I don’t know of any former Irish consultants working in my province but we have had a recent expression of interest from one - a foreign grad. Maybe he’s the first of many.


Doctors don’t seem to be able to organise a piss-up in a brewery in Ireland. They are too afraid to challenge the seniority based system and therefore get terrible working conditions thrown at them. Look at the verbiage ‘my consultant’…laughing my ass off at this craic. The established doctors and consultants look after themselves at the expense of the new entrants. The new entrants flop around with no direction, possibly because of the selection process for doctors in the first place. Emigrating is not going to solve anything. Go on strike or setup a proper union. Make a bit of effort. Organise yourselves, get power and the higher ups will not be able to threaten you as before. It’s your choices if you want to be treated like a serf on the slim chance you get to climb up the golden tower.

It’s also bad for patients because by not reducing working hours they are not treating patients correctly. They are failing patients. Well we can say this and that and it’s not my fault etc. but it is a failure to give proper treatment and it must be taken into account in performance. So the lack of organisational skill also leads to a system failure and consultants should be hauled up in front of review panels if working junior doctors in this manner.

Also I believe any consultant posts that open up will be eagerly pounced upon, it’s down at the junior doctor level that they are going to have big issues.


My impression is that the chance is not that slim. I’d be interested to know from others who are in the profession, but I had the impression from the couple of doctor friends I have that the route to a specialisation was pretty clear (and GP is one rather popular specialisation within that). This may have been more the case when health spending by the Govt was running well ahead of inflation with no complaints, while the number of graduating medics was being limited. It seems now that the number of grads is climbing, while the health budget overall gets tightened up (and not only in Ireland, though our situation is rather acute). If this is indeed the case, then it leads to a squeeze that may mean people get stuck at lower grades.

In a profession where you have a lot of future-focussed people (prepared to take pain today for pleasure tomorrow) and a career structure offering great future reward, very few will be interested in starting a Union (which may well be a thorn in their side in years to come).

It does of course, but I certainly think with more junior doctors I would see the medic as the victim. A chap I know (now a consultant) described how he would keep a notebook beside him when sleeping so if he woke up and remembered something he needed to do for a patient he could note it down and could go back to sleep without fear of forgetting it. All well and good. What was disturbing, he said, was the number of times he had notes in the book for patients who didn’t exist, or for cases from weeks before. He also had a string of car accidents, some clear cases of falling asleep at the wheel. He never had a similar lapse in hospital, but I remember telling him that if he ever found himself in front of an investigation and they discovered he’d had so many crashes and then (e.g.) operated after that, it would look very bad and the hospital would probably scapegoat him. He agreed that would be the endgame, but said there was “no alternative” as they were short 1 person on the team. This was back in the day when budgets were not so tight, and my view was there was of course an alternative, it would just take money and effort to find the additional doctor (not a consultant level either). With enough of both, the person would be found. My friend did his best, which is to his credit, but at another level he was enabling an unhealthy system.

However, I am absolutely sure that patient care suffers in all of this, and your best defence is to have friends/family supporting you during your care and challenging the decisions being made and the care level being provided. It makes you a nuisance, and it is a zero-sum game (maybe negative sum), but polite persistant pestering, questioning, and note-taking will help to keep you safe.

It’s really only partly the consultants’ fault. True, you won’t fix it if you don’t address the consultants, but the key thing is to change the system and the way hospitals are run. Once you do that, then the consultants as hospital employees need to work within that framework or they may (as you say) face disciplinary procedures like any other workplace.

Looking at hospitals, and talking to medics, the key organisational changes need to happen at hospital and HSE level. The consultant and medical team have a very narrow, very deep, set of skills centred around treating patients. How best to run the hospital is then an operations challenge, much like running any other service organisation. Right now, there’s a vacuum in this area.

I’m not sure if you’re right on that (from a tiny bit of anecdotal evidence). That said, I’m pretty sure the jobs will be filled. If the hospitals were better run (so you got a healthy workplace) it would help with filling those positions even if you kept the salary constant.


Is it possible that stressed and extremely tired doctor do not have serious errors of judgement and suffer memory loss. Of course not! Your doctor friend will not be a good judge of his own capabilities. I shudder to think of the results of a performance exam of a doctor at the start of a busy week and end of a week.

I see the root cause being stratification and individualization, to use a phrase ‘working in silos’, instead of working towards a clear unified goal. This is the mess that results and who benefits, nobody as far as I can see.

Of course health boards and managers have responsibility too, but doctors are supposed to have a duty of care to the patient, and the way they have set up this feudal and frankly inefficient and damaging system is at odds with that.


Absolutely. And though he may not have been in a good position to judge his capabilities at that point, he had enough common sense to know he was seriously impaired. However, the internal logic went “an impaired doctor is better than no doctor, so best to soldier on”. The logic never stretched to examining the overall system. In fact, there was a degree of resistance to changing the system and a fear that enforcing the European Working Time Directive would mean doctors could not any longer be effectively trained as they wouldn’t be able to get enough hours under their belts.

Definitely a lack of systems thinking. However, the doctor is not trained to do that kind of organisational reengineering. You could make a case that medical management could be come a specialty, but it’s probably easier to just get operations/management expertise from outside the medical profession but within the broad technical/industrial community.

Since my last post I read all the comments following that article. It would confirm for me that for many medics, if the hospital system they worked within was humane (both to them and patients) and allowed them to deliver great care to patients with good resources, then salary would not necessarily be enough to make them up sticks to the US or anywhere else. I mean, if every doctor was only motivated by money why would anyone go into a specialism like geriatrics? Clearly the salary has to be good, but spending money on improving the system may in fact have a better effect on staff retention than another few percent on the monthly salary.


I could not agree more.


It’s the way things work for doctors in New Zealand - much lower pay but far, far better working conditions [40hr weeks] / work life balance. They even get better training because they spend the time “doctoring” rather than admin-ing.


That piece was an unwelcome trip down Memory Lane. Little progress seems to have been made on working conditions for Irish junior doctors since my time in the trenches twenty five plus years ago. Call is a bit like combat; the stress alone can destroy people. I know the financial situation is grim but a reasonable limit to hours should surely be enforced for all workers. Interns and SHOs are more conscripts than volunteers - they are obliged to take the jobs they do if they want to put their degrees to any medical use. The emphasis at that stage should be more on education rather than service work. More consultant posts will cost a lot of money but they are needed.


The suggestion (on here) that Doctors should go on strike is all well and good but the fact is patients would die if they did that, it’s not that they might die, it’s that patients would definitely die. The Doctors I know won’t go on strike for that reason, and ultimately it’s why they are worked so hard, because they know themselves patients will die if they don’t. In a similar vein, when a Doctor is in the hospital working and gets a call and told they have to work an extra shift tonight because there is no other Doctor available, what do do expect them to say? If they say no, patients die – you can rationalise it all you want that it’s the fault of the hospital, admin, etc…, but if you were on the other end of that phone and your decision costs lives, how do you say no and live with that decision?

Pay isn’t the issue, as has been pointed out here already also, pay in Ireland is not too bad (though many Doctors don’t get paid their overtime), but quality of life is atrocious. A lot of Doctors who qualified here in recent years have left, and I for one do not blame them.


It’s hard to see from the trenches, but patients die and suffer loss of quality of life because of the way the system is right now. Sure if the doctors didn’t turn up for work tomorrow patients would die, but if the right fixes were achieved then the nett effect could be lives saved.

Ultimately, of course, it shouldn’t be down to the medics to strike to get the system made healthy… and there’s no guarantee that the resulting system would be better. Even when you get good management, it’s not always recognised

Anecdote: a friend of mine works in HSE (not a doctor, but in a clinical role). She says her clinic manager is excellent, and highlights 2 aspects: (1) clinic manager personally triages all cases on the phone to determine whether case should actually come in for appointment, or can wait for normal 6 monthly check-up; (2) she treats the team members with respect, so turnover is much lower than in most clinics. (1) also helps reduce turnover because the service is not so oversubscribed (if a patient presents and is judged in the clinic as not needing intervention, then the overhead and paperwork are much greater) and more time can be focussed on patients who need interventions.

However, my friend says that colleagues in other clinics who know that this clinic has low turnover and a managed waiting list ascribe that to luck or to the neighbourhood. My friend has worked in many clinics, and she says it’s management. She says she’s never seen (1) done anywhere else and (2) is pretty rare too in the profession.


Do doctors’ strikes save lives?

Have you heard that, when doctors strike, the death rate goes down?

More or Less investigated a doctors’ strike in Israel, where it was reported that the death rate dropped by 39% over a three-month period.

We spoke to Judy Siegel-Itzkovich of the Jerusalem Post, who covered the strike, and tried to explain why the number of deaths dropped.

Baroness Julia Neuberger suggested that non-essential surgery is postponed during any strike causing a short-term drop in death rates. … 408337.stm

Apparently there are other incidences of similar results in California and in the UK…


Very interesting. Albeit they seem to look only at the period of the strike as opposed to looking at a longer time-period and total effect.

e.g. Say I have 100 coronary-bypass candidates in January, and my team of surgeons processes the cases during January, 20% die on table, 10% die afterwards, and at end of year 70% are alive with good prognosis. Let’s say there was a doctors’ strike in January and no operations that month. A few of the patients die anyway, but probably not 20%, so it looks like lives were saved. Say 5% die in that month. But when I start operating in February because the patients are not as fit as they were originally now 30% die on the table and 15% die of complications afterwards and I have maybe 50% alive with good prognosis at end of year (much worse than 70%). Plus the deteriorated treatment scenario will carry on for longer than a month in the real world as the backlog gets worked out of the system (so patients who would have been operated on in February ideally get moved to mid March, etc.,).

That said, I think there is a tendency in medicine to be rather selective in data interpretation (much more than one would hope for given the scientific trappings) and I could well imagine that for certain procedures specialties a doctors’ strike might actually turn out to be beneficial if you really got access to all the data.

At least for drugs trials, people are campaigning for better data publication: … ng-trials/

In surgery/medical-devices domains however it is even worse, and a lot of it is rather voodoo/anecdotal.