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 Post subject: Re: protected professions
PostPosted: Mon Jan 21, 2013 1:10 am 
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drochfhiach wrote:
Back in the real world...

If anybody wants an insight into the morale and conditions of Irish hospital doctors have a read through this and the comments that follow. As someone who has been through the system it makes for very sad reading.

http://www.medicalindependent.ie/blog-p ... k#comments

I predict an exodus over the coming years. Chatting with a few consultants they will not be far behind their juniors.


That was a very moving article particularly the comments section. I'm quite disturbed after reading this but it echoes a lot of the mood I pick up in the profession right now.

I'd urge everyone to click on the above link and take the time to read through the comments section.

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 Post subject: Re: protected professions
PostPosted: Mon Jan 21, 2013 1:12 am 
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drochfhiach wrote:
Back in the real world...

If anybody wants an insight into the morale and conditions of Irish hospital doctors have a read through this and the comments that follow. As someone who has been through the system it makes for very sad reading.

http://www.medicalindependent.ie/blog-p ... k#comments

I predict an exodus over the coming years. Chatting with a few consultants they will not be far behind their juniors.


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.


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 Post subject: Re: protected professions
PostPosted: Mon Jan 21, 2013 1:19 am 
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Ardillaun wrote:

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 very attractive.


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.

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 Post subject: Re: protected professions
PostPosted: Mon Jan 21, 2013 3:37 am 
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Terra Incognita wrote:
Ardillaun wrote:

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 very attractive.


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.


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 Post subject: Re: protected professions
PostPosted: Mon Jan 21, 2013 8:10 am 
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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.


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 Post subject: Re: protected professions
PostPosted: Mon Jan 21, 2013 10:28 am 
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taipeir wrote:
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.

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).

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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.

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.

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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.

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.
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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.

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.


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 Post subject: Re: protected professions
PostPosted: Mon Jan 21, 2013 12:29 pm 
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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.


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 Post subject: Re: protected professions
PostPosted: Mon Jan 21, 2013 1:17 pm 
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taipeir wrote:
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.

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.

Quote:
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.


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.


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 Post subject: Re: protected professions
PostPosted: Mon Jan 21, 2013 3:54 pm 
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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.


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 Post subject: Re: protected professions
PostPosted: Mon Jan 21, 2013 10:06 pm 
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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.


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