Irish hospital consultants are the envy of many of their foreign counterparts because of high levels of pay. Not only are they employed on full-time hospital contracts by the State, but one-third of them are allowed to double or even treble their incomes through private practice in those same hospitals.
Efforts by the Government and the Health Service Executive to reform this system has led the Irish Hospital Consultants Association (IHCA) to withdraw from negotiations on a new contract.
HSE chief executive Brendan Drumm has claimed that a minority of consultants who operate simultaneously in both the public and private sectors are opposing change and preventing their colleagues from becoming involved in the reform process. There was, he argued, no system in the world where you would be paid full-time as a public service doctor and still be allowed "to earn twice or three times your income on your evening job".
A shortage of consultants is one of the reasons why our public health service is in such a mess. Seeking to employ an extra 1,000 medical staff to address this deficit, the Government has - quite rightly - decided that in future consultants should devote all their energies to the needs of public patients. A private employer would require no less. But reform is being resisted.
On the face of it, a dual-style hospital contract is a recipe for inequality, particularly in a system where medical services are already skewed in favour of private patients. Conflicts of interest, in terms of hospital working hours and levels of commitment, are difficult to avoid for the consultants concerned. And the question of securing value for money from full-time State employees who earn a disproportionate amount of their income from the private sector remains moot.
Traditionally, consultants have tended to dictate medical policy. And they have fiercely resisted attempts to circumscribe their influence. Efforts to retain the so-called Category 2 contract, which allows for combined public and private practice in State hospitals, come as no surprise. But this should be resisted in the interests of a more efficient and transparent public health service.
Even as the dispute rumbles on, consultants are trying to have their cake and eat it. The Irish Medical Organisation (IMO) recently lodged a 20 per cent pay claim to the Review Body on Higher Remuneration in the Public Service. This is separate from negotiations on a revised contract, designed to compensate for loss of private earnings and for the acceptance of new managerial and clinical roles. The IHCA may follow suit. But before such a claim is considered, a new contract must be sorted out.