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.
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
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
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 , 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 .
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
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.
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.
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.
Elected member, Association of Anaesthetists Trainee Committee
SAT5 Anaesthesiology Specialist Registrar, Cork University
- 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
- 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
- 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.
- 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
- 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,
- Claim, claim, claim. Keep receipts and claim for
all relevant courses, exams and expenses. Ideally,
claim within six months to avoid a battle.