Saturday, 7 February 2009

The idiot's guide to "slashing overtime"

So, I was listening to Mary Harney on the radio the other day. She's the Irish minster for health, and I liked what I heard. That surprised me greatly.

She said she was going to "slash overtime" for junior doctors. Great. Our Juniors in Ireland work shifts that are up to 72 hours long, with no guaranteed breaks, and no guaranteed sleep.

There's also a shortage of junior doctors in Ireland, which means they can work a lot of overtime.

Now, Mary Harney said she wanted to reduce overtime in order to save money, so her motives weren't pure. But that's fine,a s long as she was committed to cutting their hours.

How shocked was I, then, when I heard that when she says she wants to "slash overtime", she actually means "not paying overtime rates". 

Essentially, what used to happen is that juniors would be paid time and a quarter for their first 9 hours of overtime every week. But the new policy will mean they just get paid normal rates paid to them for their overtime.

That's how she wants to slash the overtime bill. I guess it's likely to achieve it's aims.
The alternative would have been to realise a decade ago that we were short of docs, and train enough of them!

Not content with dropping the morale of doctors by making them work overtime at normal rates, she's also slashed the training budgets.

Basically doctors get a subsidy from the government for courses and education each year. The amount is variable depending on the doctor's seniority, but it can be a few thousand euros per annum

Out of this, the doctor is expected to pay for courses in emergency resucitation, and to attend conferences and surgical skills courses etc. These things cost money, but we should be teaching our doctors how to resuscitate people,and we should be teaching our junior surgeons their basic skills. Not any more. No money for it. 

Of course, Harney knows that young doctors won't be able to progress up the ladder without dong these courses, so they'll pay for them out of their own pocket, and will do them on their own holiday time. Everyone's a winner.

Of course, many young doctors won't have the time, or the finances to do all the courses they need, so they'll skim. They'll do what they can, but training will suffer in a MAJOR way. I'm concerned that the public don't understand the implications of making no provision for the training of medical staff after the graduate from university. Just think of the difference between a newly qualified intern, and a consultant. The difference isn't simply the result of experience. It's a result of training, too. 

Many of my Irish colleagues feel that this will result in the worst post graduate training in Europe. I agree. These will be the doctors looking after you when you're old. That is, if they stay in the country. Many are planning to follow those of us who've been tempted overseas.

There have been other cuts proposed, but the most laughable has to be the announcement of "a mandatory one hour lunchbreak each day". I had to do a double take when I read this. Every doctor in the country knows that most days a junior doc doesn't get a lunch break. They most certainly don't get an hour. A quick rushed sandwich in the canteen is considered a success, as they still have to carry their pagers while on a break. No-one has suggested that someone else will be covering these duties at lunchtime, so they'll still be carrying emergency pagers. They'll still be on-call.

When the one doctor who's working in intensive care gets paged at 1.30pm to tell him Mr. O'Malley in bed 3 is having severe chest pain, is he going to say "sorry, I've a half an hour of lunch still to take"? Of course he's not. He's going to forsake the rest of his break and deal with the patient.

The government know this, and they don't give  a hoot.

It would have been more honest for them just to say "we don't care about you. We know your consultants won't kick up a fuss to defend you, and we know you're desperate to climb the ladder. So, we know you'll pay for courses yourselves, and you will go without breaks, and you won't complain. We know you're an easy touch".

But somehow we all know this will turn into greedy doctor propaganda if anyone dares speak out.

Thank goodness for the welcoming Australian healthcare system, I reckon. I suspect I'll be hearing  a few more Irish accents on the wards over the coming year.


  1. Work to rule:

    Completely comply with the proposed cutbacks!

    They want you to strike so that you will be seen as being greedy.

    Take an hour lunchbreak, at 1 pm every day, if you are an anaesthetist/surgeon do not start any case that is likely to impinge on your lunch break. ( emergency cases excepted)
    Hand in your bleeps to switch at 1pm- thats what happened in SJH a few years ago when management tried the same thing.
    When SVH tried to end the living out allowance- the NCHDs demanded to move into their accomodation- And management had to back down.

    End your clinics at 1pm.

    Take the day off before call and the day after- no more long weekends.

  2. I completely agree with the above. I think the Irish NCHDs need to grow a pair. Importantly, they also need the consultants to do the honourable thing, and back them up.

    Otherwise they'll be seen as easy pickings in the future.

    Honestly guys, don't let yourselves be the first port of call for cutbacks. Don't let the government misrepresent you in the media. In short don't go the way of the UK's junior docs.

    Dr. Thunder

  3. I am a consultant. You will get consultant support.

  4. The mandatory one hour lunch break is such a classic example of the bureaucratic ill-informed claptrap coming from the HSE. If you couldn't laugh, you'd cry!

  5. mandatory, yet unpaid?

    we have one too, but if there is any evidence that you weren't able to take one, you get paid overtime for that lunch hour (at T+1/2).

    my irish friends who have moved here to australia all wonder what we gripe about with hours and pay.