Fairness as a concept is in many ways like beauty, in that both are highly relative and live within the eye of the beholder. I’m aware that there are many other injustices in society which deserve outcry and attention; however, the 2012 new-entrant consultant salary cut is one which has consequences, not just for those directly affected, but also for anyone accessing the Irish public health service.
Given the extraordinarily difficult economic circumstances that befell the country in the period from 2008 onwards, cuts in public service pay were, unfortunately, unavoidable. I know that the IMO worked very hard through the various national agreements to limit the impact of those cuts. However, an insidious cost levied by the State was the decision that the pay of future public servants would be cut; this stark departure from the concept of fairness saw the pay of new-entrants cut by 10 per cent. What is often forgotten is that this cut applied to all new entrant public servants and was, by that measure at least, fair. The next new entrant cut would be anything but.
So it was in July 2012 I finally, after 13 years of apprenticeship, completed my training and walked into a locum consultant post with my certificate in hand. For reasons that are too long to explain, leaving the country was something I was desperate to avoid. Having not been successful in my first permanent consultant interview I applied for a position that had been advertised in September 2012 that I felt I had a good chance of getting.
Shock
My usual morning routine is to wake to the RTÉ 7am news broadcast. Only twice in my life have I been so shocked by the information that I questioned the option of getting out of bed. One was the eruption of the Icelandic volcano in 2010 and the other was the interview with then Minister for Health James Reilly on a fateful morning on 17 September 2012. On that morning he announced that he was cutting the salary for new-entrant consultants by a further 30 per cent.
To say this was a shock would be an understatement. I think in my half-awakened state I went through all of Kubler-Ross’s stage of grief in 20 minutes. Like all doctors I had spent over a decade as an NCHD, moving every six months; doing overnight on-call shifts; sitting interminable examinations; sacrificing multiple life events all in the expectation that one would one day enter into a consultant post on a par with colleagues and now that carpet had been pulled from underneath me and my contemporaries. Surely this was a joke and surely this could not be legal.
I was called for interview and was successful in getting the permanent post on a type A contract and signed as a fully-fledged permanent consultant. This joy was seriously tempered by the fact that I was moving from the pre-2012 salary that I was on as a locum to take a 30 per cent reduced salary. Just for context it should be noted that because, as a consultant, I was now not getting paid an hourly rate for being on-call, as I had been as a NCHD and taking into account the change in tax rates, I was actually regularly taking home less per month than I had when I was a much more junior doctor.
You can imagine my anger at the unfairness that I was working with colleagues who were doing the exact same job as me, paying the exact same medical indemnity costs (which albeit are relatively low in my specialty, but in others were sizeable), the exact same Medical Council and college fees, but earning significantly more. Initially the four point scale proposed was all 30 per cent less than the salary for established consultants and it looked as though the cut would be permanently locked in.
Dr Matthew Sadlier
Call to arms
To say the call to arms was raised in the IMO would be an understatement. In those early days it seemed, however, that we were ploughing a very lonely furrow. As I was one of the first to be appointed at this rate there were few colleagues to look to for support. I lodged a personal case through the IMO with the Labour Relations Commission (LRC) and waited for that to be processed.
As everyone knows at this stage the 30 per cent cut caused multiple problems to the overall health service. Consultant posts, which used to be fought for like Olympic medals, suddenly were advertised with no applicants. NCHDs, who now saw the light at the end of the training tunnel suddenly extinguished, left the country in droves, realising that if they were going to have to spend the rest of their lives abroad then the best option would be to link into the Canadian, Australian or other country system at an earlier phase.
The political pressure that the IMO put on the powers that be eventually seemed to have effect and through a long process we ended up in negotiations. We managed to achieve a compromise or “intermediate” solution. Full parity was our target; however, it was always my feeling that we would never solve this problem in one jump, as political face needed to be saved. The result of the negotiations was a salary scale which at the highest point basically achieved parity and with the concept of variable incremental credit it certainly allowed for me and other friends to manage our mortgages and be able to hold our heads somewhat high.
My case also proceeded through the LRC (now the Workplace Relations Commission) and eventually we got a Labour Court hearing. However, the ruling did not go in our favour, the letter of the law seemed to win out against the spirit of fairness. It became clear to me leaving the court in Beggars Bush that this fight would not be won through any such legal cases (as we’d already taken one) but rather through old fashioned political combat.
In addition to the financial aspect of the salary reduction, more painful in some ways was the psychological aspect of feeling less valued and less important than your colleagues. Realising that you were doing the same role, taking the same decisions, having the same responsibility, but being on such a considerable pay differential. Along with this, what was disappointing was both the lack of support and action from many quarters, except the IMO, and the criticism at the negotiated new pay scale. When you got told, by those who didn’t suffer an effective 40 per cent pay cut, that you shouldn’t have accepted a pay deal that let you achieve near pay parity, but rather hold out for some Nirvana that didn’t exist, it was very hard to take.
Over the last year, of course, we have seen both victories and complications. I would be lying if I didn’t say that the successful outcome of the court action by pre-2012 consultants didn’t sting. Particularly as attempts by the IMO to have the new-entrant consultant issue addressed in the context of the settlement were rejected by the State side. The pay gap between colleagues grew.
Overall I still cannot understand the logic or rationale behind this crazy policy. Cutting salaries of new entrants actually produces very little initial savings (as it takes a few years for enough new-entrants to be in the system for savings to be made) and in reality I imagine this policy has actually led to an increased consultant and NCHD wage bill. Instead of almost all consultants and NCHDs being on HSE contracts we have seen a huge growth in expensive agency locums filling the gaps in the system which I’m sure is greater than any ‘savings’ made.
One would sometimes wonder if the State takes a perverse pride in having supposedly “clipped the wings” of us new-entrant consultants. As part of the national public service pay negotiations the IMO was successful in having the issue of consultant recruitment and retention put on the agenda for the first phase of the pay commission. The IMO made detailed submissions to the Public Service Pay Commission highlighting the consultant recruitment and retention difficulties that persist to this day. The commission recognised this, noting that public service-wide solutions would not satisfactorily remedy the unique difficulties that are still faced in recruiting and retaining consultants into the public health service. Yet, political lip service notwithstanding, there is an ongoing refusal to engage seriously with the IMO – the only consultant representative body that has the automatic right of engagement under the Public Service Stability Agreement – to finally fix this problem. While warm words from the Taoiseach and his Ministers are nice, we need action and not platitudes.
Fight for fairness
In the end the most serious aspect of this, however, is the impact it has had on patients. With over 500 consultant posts unfilled and waiting lists increasing, I cannot but imagine what impact this has had on individual patient journeys and outcomes. To determine that would probably require some sort of commission, however, I wouldn’t be holding my breath over that one.
But the “fight for fairness” must go on.
As a new-entrant consultant and a member of the IMO Consultant Committee I am asking that all consultants both pre-2012 and, most especially, post-2012, as well as NCHDs, who are after all our future consultants, join me and the IMO in our Fight for Fairness campaign. Ending this unfairness is the only way to end the recruitment crisis, to keep our highly skilled NCHDs in Ireland and to ultimately deliver a better healthcare system for our patients.
Well said. This is a key issue for medical graduate retention and the quality of our health services.