Hospital consultants earn basic salaries of between £69,000 and £86,000 from the State for supervising the treatment of public patients for 33 unmonitored hours.
On-call and emergency allowances can add a maximum of £17,000. On top of this, consultants may engage in unlimited private practice.
Essentially, consultants have three main sources of income: their State salaries, their VHI or other health insurance income for treating private patients, and out-patient fees paid by private patients.
Some consultants, particularly in rural areas, have very little private practice and work long hours for public patients. These receive maximum public earnings of £103,000 including allowances.
In paediatrics, geriatrics and psychiatry, most consultants also have little opportunity for private practice.
But many consultants working in other areas of medicine, particularly in larger hospitals in the cities, take up their right to unlimited private practice.
For such consultants, incomes from the VHI alone average £87,000 a year, effectively doubling their salary to some £180,000 per annum. Some earn less, others more.
The VHI paid £110 million to consultants last year. Its remaining outgoings were to public hospitals (£85 million) and private hospitals (£135 million).
When consultants who earn very little from private practice (psychiatrists, geriatricians, paediatricians and academics) are excluded, some 1,150 consultants remain.
If the 155 in exclusively private practice are assumed to earn an average of £150,000 each from the VHI, the remaining consultants engaged in public and private practice earned an average of £87,000 from the VHI on top of their State salaries.
To this can be added payments from non-members of the VHI, plus payments for out-patient consultations, which are not generally reimbursed by the VHI. Opportunities for sizeable out-patient earnings arise disproportionately for some consultants, such as surgeons, and hardly at all for others, such as anaesthetists.
So a significant number of consultants can be confidently said to earn in excess of £200,000 per annum. Incomes of half a million to a million pounds a year have been mentioned by a number of medical sources, although the Irish Hospital Consultants' Association denies that such incomes exist.
Even verifiable incomes contrast with consultants' incomes in some European countries. In Denmark, hospital consultants earn the same as general practitioners - salaries comparable to higher public servants.
In Ireland the secretary general of a government department earns £90,000, less than many consultants earn from their public practice alone.
In Sweden in 1993, the average hospital specialist earned two and a half times the earnings of a registered nurse or midwife.
In Ireland the average hospital consultant will from their State earnings alone receive some four times the salary of a comparable nurse (£23,000) and eight times as much when VHI earnings are included.
In Britain, 70 per cent of consultants work "wholetime" for the NHS, and for them private practice earnings are limited to 10 per cent of their salaries.
No one questions that most Irish hospital consultants work hard. It is for whom they work and how their incentives are structured which are controversial.
They take on a "crushing burden", says Prof Muiris FitzGerald of St Vincent's Hospital in Dublin, servicing "a rapidly escalating population of very sick patients in public hospitals while at the same time running a busy private practice without the support of junior doctors."
Particularly contentious is the issue of how consultants' public hospital commitment is monitored.
Health administrators say that, effectively, the consultants' contract allows no monitoring of consultants' hours.
The medical organisations say consultants submit schedules of work and that to go further is to threaten the relationship between doctor and patient.
In some countries, protecting the interests of patients is seen as giving the democratic system a greater say in medical practice.
An US academic, Prof Marshall Raffel, concluded in a study of healthcare in 10 industrialised countries that the influence of the medical profession has been declining in response to rising health costs, so that "government, business leaders, interest groups and others insist on having a say in determining the shape of the health system".
In Ireland, consultants are wealthy, powerful people with an expertise which places them on one of the few remaining pedestals in Irish life.
"The doctor has the status of a mini-God. There are no votes in saying I am going to disturb 1,000 consultants," says one health system manager. `If a politician appears in argument with a doctor on the evening news, the doctor always wins."
Within the EU, only the UK has fewer practising doctors per head of population than Ireland. However, Canada, with a very successful health system, has a comparable doctor-patient ratio to Ireland.
International comparisons of specialist numbers can be misleading since their role varies greatly in different countries. A study conducted for the Medical Manpower Forum found that while Scotland had more public consultants, the overall number of hospital doctors per head of population was fairly similar to Ireland when private hospital doctors in both countries were included.