Pay issues in Ireland: a trainee perspective

Pay issues in Ireland: a trainee perspective

At the Association of Anaesthetists Irish Standing Committee AGM last November, the local contingent were very interested to learn of the issues with pay, tax and pensions affecting our colleagues in the UK. It will come as no surprise that we are facing similar difficulties in Ireland, and these issues have recently gained importance given the unprecedented recruitment and retention crisis of both trainees and consultants.

Irish trainees are struggling with the system. The report from the Public Service Pay Commission on Recruitment and Retention was published over a year ago, and while progress has been made on some fronts, many issues remain. We have an uncompetitive, inconsistently implemented contract, a tax system which is difficult to navigate, high training costs, and what many would view as a punitive, two-tier consultant contract to look forward to.

The contract

Our base salary is subject to a 39-hour week. Sundays are paid at double time, and we are paid a premium of time-and-a-quarter for overtime and ‘unsociable hours’ between 17:00 and 8:00 - sometimes. I will come back to that later.

Whilst the concept of being paid for every hour we work sounds enticing, the reality is often frustrating. Payslips vary enormously from month to month and require forensic auditing to ensure we are paid on the correct scale, for the correct number of hours, with the correct premiums, and are taxed accurately.

Un-rostered overtime is par for the course in most departments, but Non-Consultant Hospital Doctors (NCHDs) frequently struggle to be paid for these hours, having to jump through ever-smaller hoops to get them approved by middle management.

There are also some unfortunate loopholes which have little logic to them. For example, the aforementioned ‘unsociable hours’ premium between 17:00 to 8:00 are paid for shorter shifts, but not if they comprise part of a 24-h shift. Hardly an incentive!

The politics

Historically, doctors in Ireland have been poor at engaging with unions to improve our contract. On the rare occasion we have gathered some momentum, such as the 2013 NCHD strikes, we fought for incremental improvements to our working conditions, but not our salaries. But is pay really an issue? It is an uncomfortable subject and many doctors in Ireland have questioned the public perception of a campaign to improve our salaries. Political discourse here is currently dominated by the substantial issues of the hospital waiting list crisis, homelessness, the housing crisis, and the rights of asylum seekers, so a relatively small group of relatively well-paid professionals seeking improvements to their salaries doesn’t gain the support that we might hope for.

However, our issues must be viewed in the context of a complex, competitive environment where Irish doctors are highly sought after by other industries and jurisdictions. In recent years Ireland has trained the highest number of doctors per capita in the European Union [1], but an increasing number of graduates are leaving our workforce. Most of these travel to the UK and Australia, and as a result, Ireland is becoming increasingly reliant on recruiting overseas graduates, who now make up 42% of our NCHD workforce [2].

A lost generation

Data from 2018 showed a 38% increase in voluntary withdrawals from the Medical Register. Three quarters were aged ≤ 44. Grievances raised by those withdrawing included remuneration and the costs of medical indemnity and registration, among others. We are losing a generation of doctors, and pay is a central issue.

The 2008 financial crisis has had a lasting impact on doctor recruitment and retention. Overnight cuts to salaries, overtime rates, pension conditions and expenses, combined with large increases in income tax, the introduction of a Universal Social Charge, and the Pension Levy, had an immediate and lasting impact on doctors’ take-home pay.

During the crisis, an additional 30% salary cut was imposed on newly appointed hospital consultants, creating a two-tier salary scale where consultants with identical responsibilities may be earning up to €50,000 less than consultants appointed before 2012. This has been cited by the Irish Medical Organisation as the key factor in an extraordinary consultant recruitment crisis. Twenty per cent of permanent consultant posts in Ireland are currently vacant. Pay is certainly an issue.

System inefficiencies

Salary issues are never more evident than the months following changeover, where switching employers is rarely a straightforward event. Irish trainees rarely spent longer than 12 months in one institution. I personally have changed hospital 11 times in the last six years. Each move required repetitive paperwork, police vetting, P45s and new salary departments. After changeover, the dreaded Emergency Tax regularly rears its head, and NCHDs can often take home less than half the correct salary. It frequently takes up to six months to be corrected. The Emergency Tax issue was supposedly solved this year. A new national system was introduced which replaced P45s with an online employer registration system. Hallelujah. So presumably the last changeover was faultless? Hardly. Many of us remained on Emergency Tax even longer than usual and were eventually advised by our salary departments to physically phone the national Revenue Office en masse. Not a step forward.

These issues come at a time of significant expense. The major NCHD changeover in Ireland takes place in July. This frequently involves an intercity relocation, with the associated moving expenses, rental deposits and annual Irish Medical Council registration all coinciding. The Irish Medical Council does not facilitate paying the registration fee in instalments, and instead demands a lump sum > €600. This can put unnecessary strain on NCHDs, particularly those with mortgages and families who are trying to fund two households.

Are there any positives?

There are. The Irish Medical Organisation has recently achieved significant improvements in the training grants available to NCHDs. Certain mandatory courses and examinations are now fully refunded, and additional funding up to €2000 per year is available to fund other educational activities. The development of a national Lead NCHD network has vastly improved engagement with management, the emergency cuts to public service employees have been partially reversed, and the Irish Medical Organisation is in discussions with the Health Service Executive over the two-tier consultant pay scale.

Conclusions

The problems which we are facing are many and varied. They will not be solved easily, but the recent improvements in training grants should serve as a reminder of what can be achieved when we engage with our unions and management. Our salaries and tax burdens are unlikely to improve in the short-term, but there are other areas with potential solutions. The elimination of Emergency Tax, payment of overtime, facilitation of paying Irish Medical Council fees by instalment and consistency in the application of contracts are the next issues in line.

Murray Connolly
Elected member, Association of Anaesthetists Trainee Committee
SAT5 Anaesthesiology Specialist Registrar, Cork University Hospital

References 

1. Department of Public Expenditure and Reform. Staff Paper 2015. Medical Workforce Analysis: Ireland and the European Union compared, 2015. https://igees.gov.ie/wp-content/uploads/2014/11/Medical-Workforce-Analysis.pdf (accessed 03.03.2020). 
2. Humphries N, Connell J, Negin J, Buchan J. Tracking the leavers: towards a better understanding of doctor migration from Ireland to Australia 2008–2018. Human Resources for Health 2019; 17: 36.

Top tips for getting paid correctly:

1. Know your contract! All NCHDs in the Irish Public Health System are employed under the same contract. Get to know it in detail, as various hospitals implement it differently. 
2. Know your tax! Do a deep dive into the Revenue. ie website. It is surprisingly informative and user-friendly. Here you will find summaries of all your previous income and tax payments. You can also check whether your new hospital has successfully registered you (or not!). You can request balancing statements, claim refunds, and find information on tax exemptions. 
3. Count your overtime. Especially for the first month or two in a new hospital. Are the hours you are claiming matching what you are paid? If not, question them. 
4. Claim, claim, claim. Keep receipts and claim for all relevant courses, exams and expenses. Ideally, claim within six months to avoid a battle.