protected professions


#141

Doesn’t that suggest at least that scale fees are good at keeping fees low, whereas the fees for full contests (which have no real standardised metric) are much higher, therefore introducing hourly rates will actually increase the costs of litigation.

It doesn’t make a lot of sense that they are not updated. The taxing masters deal with these on a daily basis and they decide what a particular case is worth. They could easily make this information public and thus provide a public scale. They could also provide anonymous case studies of scenarios where more or less than scale was awarded.


#142

No one want to pay hourly rates to any professional. Fine, work out an agreed fee but everyone wants it fixed.


#143

Except the competition authority and the IMF (who want to implement their ideas). Probably lawyers themselves when they realise that per hour billing increases fees.

I read a post on another site (i think irisheconomy.ie) that in other countries, they are moving away from per hour to a per case basis for charing fees because per case is cheaper and more efficient. Ireland, yet again, is different.


#144

[mod edit: stay on topic]


#145

I was reminded by this story on RTE right now about something I had read recently which tied back to the post above. I happened to find myself looking through some late eighties news stories and one that stood out included the statistic that 80% of newly qualified doctors were leaving the country as soon as they qualified and 60% of doctors in the state hospitals had qualified outside the state. I think this was around 1988.

More: rte.ie/news/2011/0621/health.html


#146

I know several newly qualified Doctors (qualified in the last few years), the issue they have is not so much the pay as it is the hours they have to work. They do work exceptionally long hours and for not great pay, I get paid more as a techie on a per hour basis.

Almost without exception they talk about leaving this country and working somewhere else, and the main reason is so they can have a life outside of work.


#147

Imagine running a race where they keep on moving the finish - that’s what makes it even more demoralising. People can stay as junior doctors for far too long in Ireland.


#148

I see Irish consultants are still keeping the boom mentality going:

anhourago.eu/show.aspx?l=8701867&d=504

Several interesting features of the Irish consultant system compared to Canada:

  1. Pensions are generous. In Canada, the majority are defined contribution rather than defined benefit - you get back what you and your employer invest for you.
  2. Disability insurance etc. is paid by the hospital rather than financed by the doctor.
  3. Academic physicians often earn more than others.
  4. The public system subsidizes the private.
  5. Rates for some procedures paid by VHI seem very high.
  6. Pyramidal structure. Training takes too long and many don’t make it to become Irish consultants. The game is not worth playing. In Canada, nearly everybody makes the equivalent of consultant grade if they want to.
  7. Irish consultants expect to be paid as much as anybody in the world ‘to attract and retain the best’ even though the country is broke.
  8. Job security. It’s too hard to fire a consultant.

Given the straitened circumstances the country finds itself in, I would suggest:

  1. Defined contribution pension plans for all doctors.
  2. A review of procedure rates – some of these should be put out to tender.
  3. Training for specialists should take 5 years from graduation, maybe 6 for surgeons and 2 years for GPs. It’s not that complicated.
  4. Reduce consultant pay and create more positions - make the structure more cylindrical.
  5. Reduce job security. Consultants should be appointed for 5 years and then have to reapply for their jobs.

#149

May I suggest 2 more

  1. Graduate more doctors, which should have the benefit of increasing supply of the service and create price competition within it.

  2. Relieve the IMO of the function of regulating the medical profession. Self regulation has not worked, either in relation to quality or cost.


#150

There are plenty of doctors graduating. Unfortunately we are unable to hold on to them in hospital medicine due to better training, hours/conditions and long term prospects abroad.

The IMO is a medical trade union I think you are mixing this up with the Irish Medical Council (which incidentally has a lay majority)


#151

At least some of those graduates leaving have paid for their own medical education via the Graduate Program ; hopefully they’ll cotton on and apply appropriate fees across the board


#152

I recognise the correction in relation to the IMO and IMC.

I also recognise that the IMC has a lay majority, 12 medical members versus 13 non-medical members, appointed by (list is not exhaustive); the Minister for Health and Children, Health and Social Care Professionals Council, Independent Hospitals Association of Ireland and the HSE. This has been the case since 2007 only. I would submit that the there is still defacto self regulation through regulatory capture of this agency [1].

If you are unable to hold onto a sufficient number of doctors, then there are not sufficient numbers graduating. The solution would be to graduate more doctors. The same retention rate from a suitably enlarged pool would have the effect of; retaining an adequate number within the hospital system, reducing the workload (improving the hours and conditions) on those who remain within the hospital system, increasing the number of doctors within Ireland to closer to European norms [2].

This would hopefully also have the effect of increasing competition within the GP system which, in theory, should provide for better access to service and better outcomes, which is what it is ultimately all about.

[1] irishtimes.com/newspaper/ireland/2011/0601/1224298207189.html

[2] Czech Republic: 3.5 per 1,000 people 2003
Austria: 3.4 per 1,000 people 2003
Germany: 3.4 per 1,000 people 2003
France: 3.37 per 1,000 people 2004
Portugal: 3.3 per 1,000 people 2003
Sweden: 3.3 per 1,000 people 2002
Ireland: 2.79 per 1,000 people 2004


#153

I get the impression that although the number of students in the irish medical schools has increased over the years, the ratio of overseas students to irish students has increased. Many of these overseas students will leave immediately after graduating.

As a number of people have posted above, the ratio of junior doctors to consultants is very high and as a result there just aren’t enough irish doctors to fill all of the posts. In the past many of these junior doctor posts were filled by doctors graduating in India, Pakistan, Egypt Libya and the Sudan. Recent changes in allocation of work permit to extra EU doctors has made it difficult to recruit to many junior doctor positions.


#154

Thirty years ago, there would have been about ten foreign nationals out of a class of 150 in UCD. That must have increased at least 6-10 times.

I believe that reducing the training time and increasing the number of permanent posts might encourage more grads to stay but it’s hardly the easiest time to tinker with the system.


#155

Coming late to this thread but I sincerely hope OPTICIANS and PHARMACISTS are listed as protected professions.

As regards the latter…you hand in your prescription and you pay whatever you’re told. So much for price display, shopping around, consumer choice XX


#156

Prescription drug prices are set by the Government.


#157

:unamused:


#158

Who do you think buys the vast majority of medicines in Ireland - it ain’t private prescription patients.


#159

I hate to quote the Irish Times Letters page but there was a good example of an auld wan who kept getting refills of her prescription though there was plenty left in the tube of ointment ; the 50c charge (or whatever it was) meant that she copped herself on. NOw they’re getting rid of this modest charge though the vast majority of people can afford it…


#160

anything available for free to a person is treated by that person as having no cost/value

this even comes down to SW payments/Rent Allowance where certain lifestyle SW recipients cannot link they can only be paid these payments if people work and pay taxes and it isn’t the Government giving them free money but fellow citizens taxes that allow it