In 2014, consultant psychiatrist Dr Nick Carrigan from Clara, Co Kilkenny, moved to Australia with his wife, Dr Allison Newman, also a consultant psychiatrist and from Tyrrellspass, Co Westmeath, with their three young children
The reasons were numerous. The financial crisis and recession of 2008 and the implementation of the Universal Social Charge (USC) in 2010 had a huge impact on Carrigan’s take home pay.
“We had a nice house, which meant we had a kind of stupid mortgage. Interest rates skyrocketed for a while and cleaned out our savings as well because our mortgage repayments doubled for a brief period.”
He took on a second job working for the Mental Health Commission outside of work hours.
“Quite often after work I’d get into my car and drive to Portlaoise, Mullingar or Clonmel to review patients for the commission. So I was doing extra on-call and working a second job as well. I was lucky to have had the option but still it really cut into leisure and rest time.”
The reduction in take-home pay, although a factor, was far from the only reason they felt that as a family, they could no longer stay in Ireland. Carrigan said other doctors had “started voting with their feet” so it became harder to recruit colleagues and the workload for permanent staff increased.
“It started with junior colleagues leaving as in general they are more mobile and have less responsibilities. So the standard of junior doctor was more mixed. Working with a poorly-performing junior doctor actually increases your workload as you have to re-check everything. It’s better workload-wise to have nobody.”
His on-call shifts increased at St Senan’s Hospital in Enniscorthy, despite no extra pay. While locum doctors were brought in to fill roster gaps, Carrigan said consultant locums were not typically on the on-call rosters.
“Someone who’s a locum can say ‘look I don’t want to do on-call’, so they can come in nine to five and go away and probably get twice what you’re getting paid and don’t do any on-call.
“As the substantive consultant you might have to supervise two juniors which involves an hour-long sit-down meeting with the supervisee once per week at the very minimum. Managing education sessions, doing rosters, running committees, participating in interdepartmental or regional work, doing head of department, chairing policy groups, running specialist clinics (ECT or Clozapine in psychiatry) etc, etc, all have to be done by permanent consultant staff, so we were doubling and tripling up in these roles also.”
Consultants were ultimately liable if anything went wrong. “The service didn’t have much money … so if something goes wrong, they cut a service and there’s an adverse outcome, the consultant gets sued because we have the indemnity. It was pretty ruthless.”
While work could be rewarding in Ireland, it was also slightly overwhelming, Carrigan said. One particular hospital he used to work at gives him a knot in his stomach whenever he thinks of his time there.
His working life, he said, was made a lot more difficult by medical administration.
“There seems to be some kind of hatred of medics by medical administration. It’s bizarre. I don’t understand it.”
In one job Carrigan worked at in Ireland, he and a senior house officer (SHO) would see 40 patients in a morning clinic from 9am until 1.30pm, so they worked through lunch break. A hospital manager at St Senan’s said because his lunch break was unpaid, he’d have to stay behind for an hour in the evening.
“I used to work through my lunch break anyway. That was nonsense. And all the other daytime staff were gone home. I couldn’t see any patients without support staff. So I was supposed to sit in my office for an hour?
“It’s a pity. There are lots of very well-trained people but there does seem to be an attitude problem with general HSE [Health Service Executive] management.” Comment was sought from the HSE but it did not respond.
Even with the pay cuts and increased workload, Carrigan said his family could have coped. But during the recession, he said a lot of negativity began to build in the media towards medical consultants. He said attitudes changed and people in well-paid, stable government jobs became “a focus of resentment and especially consultants, it appeared”.
These attitudes affected how people in Carrigan’s personal life interacted with him and eventually contributed to him and his family leaving Ireland.
“As high-paid public servants, we were kind of in the firing line. There was lots of this ‘fat cat’ consultant stuff. It was relentless. Everyone was hurting financially and anyone who was seen to be doing okay financially was resented. It was a terrible time in Ireland.
“I would go to family gatherings and have friends and some extended family members parroting this anti-consultant stuff at me. I’m thinking, I’m working twice as hard, I’m working in the public system, I’m trying to make up for the lack of funding and the failures and then in my social life I’m getting hammered by people.
“It was tough when those closest to you had absorbed the anti-consultant narrative. It was probably the final straw in my decision to emigrate.”
Carrigan doesn’t agree with the depiction of the “fat cat” consultant that was prevalent at the time.
“I don’t think greed is a characteristic unique to the medical profession or as prevalent as is portrayed in that profession. Doctors don’t look after themselves well enough which is why they endure the horrible working conditions that prevail in Ireland and the UK.”
Carrigan said at the time, he certainly saw abuses by consultants doing a mix of public and private work. However, he said the bad behaviour of a “tiny percentage of the profession” was being used as a stick to beat the rest of consultants who at the time were “getting flogged at work trying to keep the creaking health system going with service cuts and departing colleagues”.
He argues that if someone fulfils their contractual commitment to the HSE then “why shouldn’t they be allowed to do extra work outside of that commitment? Should teachers be banned from doing grinds?”.
“Public systems are always going to be less efficient than private, profit-motivated ones. That’s just human nature.”
There’s no comparison between the work-life balance in Ireland before emigrating and in Western Australia now.
“In Australia, at half four, I’m either on a bicycle or on a kayak after work,” he said. He is less stressed, has more time for hobbies, family, exercise and has lost about 10kg since he arrived eight years ago.
An Australian consultant, who was on the Australian Medical Association committee that negotiates consultant contracts with the WA [Western Australia] government every three years, told Carrigan at a conference once that they don’t let Irish consultants “anywhere near the negotiations” as Irish doctors in WA were “too happy” and they “wouldn’t negotiate hard enough”.
The Australian health system and those working in medical administration look after staff better, Carrigan said. He is building up long-service leave and is due three months off, with pay, in 2024 for 10 years continuous service. He keeps up with developments around new medical consultant contracts back in Ireland. “There’s very little trust, I wouldn’t put it past them to pull the rug out once they get enough people home.”
“I’m a bit obsessive about this stuff, I’m always looking and I really resent having to move but it just had to happen.
“There’s lots of angry medics on Twitter, but we’re just talking to ourselves, nobody’s listening. I’m never going back. There’s nothing that would make me go back at this point.”
