# Why is the cost of most things so high in Ireland?



## Brendan Burgess (26 Aug 2017)

Interesting article by Cliff Taylor in today's Irish Times 

*Cliff Taylor: High-cost Ireland set to continue punishing the young*


The hard figures back up the perception of high-cost Ireland. Ireland is one of the dearest places in Europe to live. According to new figures from [broken link removed], the European Union statistical office, Ireland was the fifth most expensive country in the EU last year for a basket of goods and services, “beaten” only by Switzerland, Iceland, Norway and Denmark.
...

Sky-high rents make it either difficult or impossible to build up a deposit for many, unless parents can step in. Housing costs are then high and banks charge an average of 3.55 per cent for a mortgage, compared with the 1.87 per cent average across the EU.
...

Ironically, our high costs also make it more difficult for Government to address some of the key issues. Take house-building. It appears that the cost of building a house here is high by international standards. Wages for skilled labour are high, as is the cost of cement and other materials. Insurance costs and development levies add further to the bill. Add on VAT at 13.5 per cent and costs here are, on some estimates, 25 per cent plus higher for a normal apartment compared with other major cities.
...
Why is Ireland high cost? Some of it represents the historical success of the “insiders” in various lobbies and professions in maintaining practices and prices that gouge the public or other businesses – take parts of the legal profession, for example. Some of it is because, as a small island economy, competition can be limited. Some of it is a legacy of the trauma faced during the bust. Insurance costs have soared because insurers priced everything way too low for a period - and are now overcompensating. Banks were bust and have got away with charging over-the-top interest rates for so long because others fled the collapsing market.


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## Gordon Gekko (26 Aug 2017)

Interesting that of the four other "EU countries" that are more expensive than Ireland, only one is actually in the EU...

Switzerland, Iceland, and Norway aren't in the EU!


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## mathepac (26 Aug 2017)

Statistically speaking then, if you eliminate the four that "beat" us, we end up top of the pile for all the wrong reasons, again.


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## odyssey06 (26 Aug 2017)

On top of the factors already noted... I wonder if there is an element of celtic tiger / euro switchover legacy.
What I mean is a country which goes through a boom quickly more likely to see a surge in costs, than one that undergoes a gradual increase in living standards. Did we take our eye off the ball when the money was flowing in?

Against that, a lot of the costs should have been wrung out of the system during the crash... except of course in anything state or semistate related who seem incapable of being held to account in terms of conduct and value for money.


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## MrEarl (26 Aug 2017)

Hello,

I think that all would agree that we as a small country, with less resources (natural, human, financial etc.) will not be as competitive as many of our larger European neighbors.

However, that said, phrases such as "Rip off Ireland" and the "Paddy Tax" have not come from no where.  There is inappropriate levels of profiteering coming from certain quarters both here in Ireland and abroad, too many barriers to entry in certain quarters preventing real competition,  even a bit of pure stupidity playing it's part - by the Irish consumers who tolerate some of this nonsense. Things will only get better when we make them better and that means taking action, something the Irish population has traditionally proven extremely slow to do (water charges being the only exemption of any real note, in the last 100 years).


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## newtothis (26 Aug 2017)

I would say the original article has it bang on, with: "Why is Ireland high cost? Some of it represents the historical success of the “insiders” in various lobbies and professions in maintaining practices and prices that gouge the public or other businesses – take parts of the legal profession, for example. Some of it is because, as a small island economy, competition can be limited."

Take banks for example: what motivation have local banks here to start competing seriously? Much easier to behave in a cosy- quasy- cartel- like way. What possible monivation has any outside bank to come in and disrupt?

Also, I wouldn't hold my breath waiting for things like the arcane way property is transacted here changing any time soon.

One potential bright spot is the way the onward march of technology could disrupt many more sectors. However, equally it could decimate employment: not much point in having cheaper mortgages or whatever if nobody has a job to sustain one.


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## qwerty5 (26 Aug 2017)

In my (uneducated) opinion we have several factors that seem to cause higher prices.

In no particular order (and off the top of my head).

Insurance payouts - I frequently see payouts in the newspapers that are like small lottery wins. Somebody has to pay for that. Our courts don't seem to follow any rules and just pluck numbers from the air.

Governments that tinker, rather than govern - Our governments seem to be paralysed by stuff if it's not popular. Our rent crisis has been building for years and our government have been tinkering, trying to keep everybody happy while not doing anything of much significance. They've marked the landlords as the bad guys (which is popular) so the solutions they've put in are all stick and no carrot for landlords. Who could have guessed that this would mean that people don't want to be landlords anymore?

Minimum wage - This is a chicken and egg item. Stuff is expensive so the minumum wage has to go up, which can make stuff more expensive. Google the minimum wages across Europe. According to this (https://en.wikipedia.org/wiki/List_of_European_countries_by_minimum_wage) ours is the third highest. This affects everything. An example is childcare. I've a baby in childcare. By regulation there has to be one carer for 3 babies under the age of 1. So if the crech makes no money and has no other costs (which they obviously do), and the carer gets minimum wage then this means that I have to pay €500 pm minimum just to cover the persons wages. Then people complain that childcare is expensive. Before having our baby we were planning on getting an Au-Pair. But we can't afford it.
As a side note, when the government announced the small subsidy for people sending kids to creches last year I heard people on the radio saying this discriminated against people who didn't send kids to creches. It was a real WTF moment. They'd prefer there was no subsidy rather than give working parents a tiny dig out.

We (as a country) talk about doing stuff for years rather than getting it done. This is not good for business. Examples are the Metro North, the Athenry Apple Data Centre debacle, the childrens hospital etc. etc. We should be capitalising on Brexit. But no, Dublin is suffering gridlock and people can't find places to live. What would you do if you were a company considering Dublin to relocate to?

Our transport costs - These seem to be higher than many other similar sized countries but many of our transport companies are teetering on the brink of going under. I have a relation working for one of the companies that is not making much money and the practices he describes to me (e.g. getting 4 hours sleep during a night shift) don't seem like practices that many companies should be supporting. But if you try and fix it, it's Striiiiiiike.

Mentality of some of our citizens - Some, not all, of our citizens seem to think the government owes them a living. An example is the recent storm about a bank giving an example of some adults living with their parents to save for a mortgage. It's what my parents did, what I did and what I'd expect my kids might have to do. But it is heresy to some people. Another is highlighted by an article I read a little while ago. A young mother who's been homeless for 3 years with 3 kids. Two were above 3 but one was 1 year old. For some reason it's acceptable to have no control over getting pregnant (with no apparent father to support them) when you're homeless. We have to pay for that so that comes from our taxes. Myself and my wife had to wait until we could afford to give a baby a decent life. For others, it's pop them out then go to the state with the hand out.

Our left wing politicians - Apparently if I work 50 hours a week, spend hours commuting and then study when I get home so that I advance my career, then I'm a great target to aim at to tax more.

For our mortgages - if a bank sniffs at taking a house back that somebody hasn't been paying the mortgage for years on certain parts of society start to howl. There were 14,000 BTL mortgages in arrears over 90 days in Q4 2016. We have low repossession rates. So if the banks can't repossess what else are they going to do? They'll increase the price of their other products e.g. the variable rate that I'm stuck on for the next 20 years. In Ireland it seems if you take out a mortgage and don't pay it or rent out a house and don't pay the rent then the problem is all the banks / landlords and not the person signing the contract.

And we're a small country. Some cost is obviously to do with economies of scale and the fact that we're an island.

Other than that, it's all good 
Actually it is, Ireland is a great place to live and work. There is great opportunity if you are able to see it and get it and navigate around the issues above. I have some friends though that suck the life out of you with negativity and for some reason their lives never seem to get better.


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## TheBigShort (26 Aug 2017)

qwerty5 said:


> In my (uneducated) opinion we have several factors that seem to cause higher prices.
> 
> In no particular order (and off the top of my head).
> 
> ...



Where do I start?


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## TheBigShort (26 Aug 2017)

qwerty5 said:


> Insurance payouts - I frequently see payouts in the newspapers that are like small lottery wins. Somebody has to pay for that. Our courts don't seem to follow any rules and just pluck numbers from the air.



By and large insurance payouts are in line with strict guidelines within the industry. The problems arise, as I see it, is when the insurance company resist the claim and it goes to court. If the insurance company lose they appear to be effectively at the mercy of the court. The reality, in most instances, is the court



qwerty5 said:


> Governments that tinker, rather than govern - Our governments seem to be paralysed by stuff if it's not popular.







qwerty5 said:


> They've marked the landlords as the bad guys (which is popular) so the solutions they've put in are all stick and no carrot for landlords. Who could have guessed that this would mean that people don't want to be landlords anymore?







qwerty5 said:


> An example is childcare. I've a baby in childcare. By regulation there has to be one carer for 3 babies under the age of 1. So if the crech makes no money and has no other costs (which they obviously do), and the carer gets minimum wage then this means that I have to pay €500 pm minimum just to cover the persons wages. Then people complain that childcare is expensive. Before having our baby we were planning on getting an Au-Pair. But we can't afford it.







qwerty5 said:


> As a side note, when the government announced the small subsidy for people sending kids to creches last year I heard people on the radio saying this discriminated against people who didn't send kids to creches. It was a real WTF moment. They'd prefer there was no subsidy rather than give working parents a tiny dig out.







qwerty5 said:


> We (as a country) talk about doing stuff for years rather than getting it done.







qwerty5 said:


> Dublin is suffering gridlock and people can't find places to live.







qwerty5 said:


> What would you do if you were a company considering Dublin to relocate to?









qwerty5 said:


> Our transport costs - These seem to be higher than many other similar sized countries







qwerty5 said:


> I have a relation working for one of the companies that is not making much money and the practices he describes to me (e.g. getting 4 hours sleep during a night shift) don't seem like practices that many companies should be supporting. But if you try and fix it, it's Striiiiiiike.







qwerty5 said:


> Mentality of some of our citizens - Some, not all, of our citizens seem to think the government owes them a living.







qwerty5 said:


> An example is the recent storm about a bank giving an example of some adults living with their parents to save for a mortgage.







qwerty5 said:


> It's what my parents did, what I did and what I'd expect my kids might have to do.







qwerty5 said:


> A young mother who's been homeless for 3 years with 3 kids. Two were above 3 but one was 1 year old. For some reason it's acceptable to have no control over getting pregnant (with no apparent father to support them) when you're homeless.







qwerty5 said:


> Myself and my wife had to wait until we could afford to give a baby a decent life. For others, it's pop them out then go to the state with the hand out.







qwerty5 said:


> Our left wing politicians - Apparently if I work 50 hours a week, spend hours commuting and then study when I get home so that I advance my career, then I'm a great target to aim at to tax more.







qwerty5 said:


> For our mortgages - if a bank sniffs at taking a house back that somebody hasn't been paying the mortgage for years on certain parts of society start to howl.







qwerty5 said:


> There were 14,000 BTL mortgages in arrears over 90 days in Q4 2016. We have low repossession rates. So if the banks can't repossess what else are they going to do?


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## TheBigShort (26 Aug 2017)




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## MrEarl (28 Aug 2017)

LMAO


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## Purple (28 Aug 2017)

TheBigShort said:


>



You're great crack after a few drinks!


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## Gordon Gekko (28 Aug 2017)

The fact that professionals are so protected and so overpaid feeds into everything and increases costs across the board.


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## Purple (28 Aug 2017)

Gordon Gekko said:


> The fact that professionals are so protected and so overpaid feeds into everything and increases costs across the board.


Some of them, not all of them.


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## Sophrosyne (28 Aug 2017)

Just looking at energy costs …

My electric usage is low but when standing charges, levies and taxes are added it makes a considerable difference.

For instance, on one bill the charge for usage was €49.66, when the above are added it became €99.71 or an additional 50%.

In another bill the charge for usage was €15.11, which became €63.11 or an additional 76% after add-ons.


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## Delboy (28 Aug 2017)

Sophrosyne said:


> Just looking at energy costs …
> 
> My electric usage is low but when standing charges, levies and taxes are added it makes a considerable difference.
> 
> ...


A lot of the add-ons are to keep the Green industry going


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## Sophrosyne (28 Aug 2017)

Well it seems contradictory to environmental principles that the less energy one uses, the greater the percentage of additional charges.


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## galway_blow_in (28 Aug 2017)

Gordon Gekko said:


> The fact that professionals are so protected and so overpaid feeds into everything and increases costs across the board.



yes and they are so smug in their long established sheltered positions , they see it as the natural order of things that they be allowed gouge


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## Purple (28 Aug 2017)

Sophrosyne said:


> Well it seems contradictory to environmental principles that the less energy one uses, the greater the percentage of additional charges.


Has anyone got data showing those levies and charges being transferred to the State? If not they are just extra charges which go towards paying the very high wages in the ESB.


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## Sophrosyne (28 Aug 2017)

I don't have statistics, but the PSO Levy and VAT go to the State.

VAT is charged on the PSO Levy.

In the case of the bill where the electric usage was €15.11, the VAT & PSO Levy amounted to €19.31.


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## Purple (28 Aug 2017)

Sophrosyne said:


> I don't have statistics, but the PSO Levy and VAT go to the State.
> 
> VAT is charged on the PSO Levy.
> 
> In the case of the bill where the electric usage was €15.11, the VAT & PSO Levy amounted to €19.31.


Does it actually go to the State?


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## Sophrosyne (28 Aug 2017)

Well, obviously, VAT goes to the State.

The PSO Levy is a State subsidy paid for by users of electricity. Information from the CER:

“The proceeds of the levy are used to contribute to the additional relevant costs incurred by PSO-supported electricity generation which are not recovered in the electricity market, in many cases via contracts that suppliers have in place with electricity generators. The policy and terms associated with PSO levy supported plant are mandated by Government in the relevant legislation and approved by the European Commission.

The CER has no discretion over the terms of PSO schemes. The CER’s only role here is to calculate the PSO levy in accordance with Government policy and to help ensure that the scheme is administered appropriately and efficiently. As part of this role, the CER calculates the costs properly incurred under the relevant PSO contracts/schemes to be recovered.

ESB Networks collects the PSO levy from electricity suppliers (paid for by customers) and passes it to EirGrid. EirGrid sends these PSO monies to relevant generators/suppliers.”

The PSO levy was €335.4 million for the levy period that ran from 1st October 2014 to 30th September 2015.

I cannot see any later figures.

I understand that the PSO Levy is to increase from October next.


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## Purple (28 Aug 2017)

Sophrosyne said:


> Well, obviously, VAT goes to the State.
> 
> The PSO Levy is a State subsidy paid for by users of electricity. Information from the CER:
> 
> ...


Ok, so short of an examination by someone like the Comptroller and Auditor General we really don't know how much of that €335.4 is really being used properly. It looks like yet another subsidy paid by urban dwellers to rural dwellers.
One more to add to the list of reasons why ribbon development is a bad idea.


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## arbitron (28 Aug 2017)

Gordon Gekko said:


> The fact that professionals are so protected and so overpaid feeds into everything and increases costs across the board.





galway_blow_in said:


> yes and they are so smug in their long established sheltered positions , they see it as the natural order of things that they be allowed gouge



I often hear people complain in general about the cost of professionals but it seems vague.  I would consider professionals to include:
- solicitors
- barristers
- doctors
- dentists
- accountants

Who else would you add to the list?  Could we gather some clear examples of the practices/fees that people consider excessive?


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## galway_blow_in (28 Aug 2017)

accountants are not that overly pricey IMO 

GP,s in ireland earn more than anywhere else in europe and far in excess of their counterparts in the uk


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## Delboy (28 Aug 2017)

There are no barriers to entry for Accountants as far as I can tell. Plenty of bodies you can sign up to, do the exams and your qualified.

Doctors numbers are regulated through the shortage of places in medical schools. 
From a GP perspective, I'm not sure how practices work...do you have to buy out an existing one to get set up? If yes, then thats another roadblock to entry.
From speaking to a young Vet who had to go to Budapest after not getting the points for Ireland, he returned to work for a large practice. He explained to me that you just culdn't go into an area and start working as a Vet, you had to buy out an existing practice.

Barristers/Solicitors...limited number of places each year through Kings Inns/Law Library?

Dentists. Very high points suggest limitied number of students accepted every year?


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## Purple (29 Aug 2017)

arbitron said:


> I often hear people complain in general about the cost of professionals but it seems vague.  I would consider professionals to include:
> - solicitors
> - barristers
> - doctors
> ...


A professional is someone who is a member of a self regulating body and needs to be a member of that body in order to work in that job. You can't work as a doctor without being a member of the ICGP (or whatever) etc. The idea predates the idea of State regulation and is somewhat redundant in the modern world where the State regulates the professional bodies and in many cases the majority of the membership of those bodies comes from outside the profession. To me the notion is elitist and redundant and in effect that's the case anyway now that everyone from Teachers to Nurses to god knows what are now professionals. Rightly so as they are all just doing a job, just as Trade Unions are not for Tradespeople.  
Now if we can just stop doctors telling everyone what job they do that would also be great or should everyone insist on being referred to by the title of their job? It seems utterly bizarre, can you imagine being introduced to someone and them saying "Hi, I'm Teacher Mary Murphy."?


As for fees; they market sets the rate (supply and demand). There are plenty of poor barristers. There are no poor doctors. There are few poor accountants. It is strange that people are far more likely to critically assess their accountant or solicitor than their doctor.


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## Duke of Marmalade (29 Aug 2017)

According to the Indo fees for the oldest profession are €400 an hour compared to €50 an hour in Hamburg or Amsterdam


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## Purple (29 Aug 2017)

Duke of Marmalade said:


> According to the Indo fees for the oldest profession are €400 an hour compared to €50 an hour in Hamburg or Amsterdam


Supply and demand. It says a lot about Dutch women! 
When you make things illegal you make them expensive. 
Pot is much cheaper over there as well.


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## odyssey06 (29 Aug 2017)

Purple said:


> As for fees; they market sets the rate (supply and demand). There are plenty of poor barristers. There are no poor doctors. There are few poor accountants. It is strange that people are far more likely to critically assess their accountant or solicitor than their doctor.



As noted earlier though, the market doesn't supply the doctors. There are lots of students who would very much like to become doctors and work in ireland but they are being artificially constrained from doing so by the arbitrary number of medical places available in the CAO system.
We should double the number of places for doctors, but get them to sign up to 10 years public service - or pay back the fees. I believe a similar setup is the case in Canada.
It's ludicrous that we don't have anough doctors and a lot of the small number we do train up immediately emigrate.


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## Purple (29 Aug 2017)

odyssey06 said:


> As noted earlier though, the market doesn't supply the doctors. There are lots of students who would very much like to become doctors and work in ireland but they are being artificially constrained from doing so by the arbitrary number of medical places available in the CAO system.
> We should double the number of places for doctors, but get them to sign up to 10 years public service - or pay back the fees. I believe a similar setup is the case in Canada.
> It's ludicrous that we don't have anough doctors and a lot of the small number we do train up immediately emigrate.


One third of doctors out of Trinity are foreign students who pay massive fees to train here and most of them would never have planned in staying here. I'm sure the figures for the RCSI is the same or higher. 
When Doctors Unions talk about the high numbers of doctors who emigrate and say that the reason for that is contracts or pay etc they are telling lies.


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## Firefly (29 Aug 2017)

Purple said:


> Supply and demand. It says a lot about Dutch women!



I wouldn't need the hour either


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## arbitron (29 Aug 2017)

Purple said:


> You can't work as a doctor without being a member of the ICGP (or whatever) etc.



You can indeed work as a doctor without being a member of a training body or medical college, the major requirements are just that you have a medical degree and are registered with the Medical Council.  Even without specialist training, i.e. after 1 year out of college, it is possible to go on the General Register and then you can work as a non-consultant doctor.  There are even some consultants (<100 nationally) who are not on the specialist register.



Purple said:


> Now if we can just stop doctors telling everyone what job they do that would also be great or should everyone insist on being referred to by the title of their job? It seems utterly bizarre, can you imagine being introduced to someone and them saying "Hi, I'm Teacher Mary Murphy."?



I agree, but that is a cultural issue.  Older people in particular will insist on using titles.  I absolutely never use titles for anyone - whether prince or pauper I use their first name or nothing at all - but I do understand why people like to call others by titles.  For many it's seen as a way of giving respect and being polite.

There are psychosocial reasons too: it can be a way of reinforcing the clinical relationship, as doctors still have to perform many intimate and sensitive examinations and procedures, and some people find it easier to deal with this if they are more distant from the doctor.

Fewer and fewer doctors use their title now, most prefer 1st names.  Many docs will now say "Hello, my name is John Smith, I'm the specialist kidney doctor".



Purple said:


> As for fees; they market sets the rate (supply and demand). There are plenty of poor barristers. There are no poor doctors. There are few poor accountants. It is strange that people are far more likely to critically assess their accountant or solicitor than their doctor.



The market sets the rate, but what if the market is dysfunctional?  We have a volatile and distorted public system which is heavily subsidised by private insurance.  We also have a private sector which makes hay off the back of the public system's failures.  Having consultants straddle both systems can lead to significant conflicts of interests.

I would like to see the data comparing pay of doctors, barristers, accountants at various levels.  I suspect it is not as clear cut as many think.


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## arbitron (29 Aug 2017)

odyssey06 said:


> As noted earlier though, the market doesn't supply the doctors. There are lots of students who would very much like to become doctors and work in ireland but they are being artificially constrained from doing so by the arbitrary number of medical places available in the CAO system.
> We should double the number of places for doctors, but get them to sign up to 10 years public service - or pay back the fees. I believe a similar setup is the case in Canada.
> It's ludicrous that we don't have anough doctors and a lot of the small number we do train up immediately emigrate.



That is incorrect.  Intern (1st year doctor) places have increased by 50% from 488 in 2004 to 733 in 2017.  The Fottrell report said we need over 700, so we are at the target.  We have more medical students than ever, the majority of whom are Irish.  It is now almost impossible for a non-Irish graduate to get on a training scheme because we have so many Irish doctors coming out of medical schools.  In fact, in 2016 there were Irish medical graduates who could not get intern places.  So the bottleneck is not with medical schools.

To be able to train a doctor clinically you need to have a minimum number of clinical sites and patients.  You can't learn orthopaedic surgery from a book, you have to do the procedures.  If the hospitals are cancelling lists and closing theatres for financial reasons then there are far fewer patients available to operate on.  This also leads to longer waiting lists, so when those patients finally arrive for surgery they are older, sicker, and more likely to need a senior doctor treating them.  And then a significant percentage will have private insurance, so the consultant will have to do the procedure.  This all means less experience for the trainees and Ireland has one of the longest training schemes in the world - so that is an actual bottleneck.



Purple said:


> One third of doctors out of Trinity are foreign students who pay massive fees to train here and most of them would never have planned in staying here. I'm sure the figures for the RCSI is the same or higher.
> When Doctors Unions talk about the high numbers of doctors who emigrate and say that the reason for that is contracts or pay etc they are telling lies.



If you don't believe the unions, have a read of a recent paper from Irish medical schools: https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-015-0003-9

Doctors emigrate because they are paid better abroad, have better working conditions, and are treated better.  The same for nurses.  If you ask them to pay back fees, you will just be encouraging them go to Aus or NZ or USA or Canada where they will finish their training more quickly and be better paid at the end of it.

Speaking to friends who have done Blackhalls and Kings Inns, there seem to be huge barriers.  The Blackhall exams for solicitors are outrageously and unnecessarily difficult.  After Kings Inns, barristers who have connections (family or business) have a good chance at succeeding, but the rest make very meagre living in the first few years.

I have friends/family working as doctors, dentists, barristers, retail, architect, farmers, solicitors, builders, journalist, accountants, teachers, nurses, gardai, HR, civil service... they all have very different levels of education, very different lifestyles, even within job areas.  A friend of mine is a GP and can only afford to rent a small studio apartment in Dublin, she has very little savings.  Another friend is an IT engineer, just bought a Tesla.  Friend who is an accountant, also renting small apartment, drives an 06 Fiesta, has modest savings.

I would love to see some worked examples where some professional fees are clearly unwarranted and where that professional is getting rich as a result.  We can't address issues based on hearsay or imagined situations.


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## odyssey06 (29 Aug 2017)

arbitron said:


> That is incorrect.  Intern (1st year doctor) places have increased by 50% from 488 in 2004 to 733 in 2017.  The Fottrell report said we need over 700, so we are at the target.  We have more medical students than ever, the majority of whom are Irish.  It is now almost impossible for a non-Irish graduate to get on a training scheme because we have so many Irish doctors coming out of medical schools.  In fact, in 2016 there were Irish medical graduates who could not get intern places.  So the bottleneck is not with medical schools.
> Doctors emigrate because they are paid better abroad, have better working conditions, and are treated better.  The same for nurses.  If you ask them to pay back fees, you will just be encouraging them go to Aus or NZ or USA or Canada where they will finish their training more quickly and be better paid at the end of it.



Good to see things have ramped up... I think though we are suffering a legacy somewhat of the under-training as it will take time for these additionals numbers to have an impact.

And the point of asking them to pay back fees is that you would only do so if they didn't work in Ireland for X years. So it would be a disincentive to emigration.


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## Firefly (29 Aug 2017)

arbitron said:


> *Friend who is an accountant*, also renting small apartment, *drives an 06 Fiesta*, has modest savings.



Well you know what accountants are like


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## galway_blow_in (29 Aug 2017)

Delboy said:


> There are no barriers to entry for Accountants as far as I can tell. Plenty of bodies you can sign up to, do the exams and your qualified.
> 
> Doctors numbers are regulated through the shortage of places in medical schools.
> From a GP perspective, I'm not sure how practices work...do you have to buy out an existing one to get set up? If yes, then thats another roadblock to entry.
> ...



i grew up in rural ireland , if you had a routine of doing your shopping in super valu every week , were you to make a change and instead go to tesco , you were not met at the door by someone telling you to go back to super value , different story with the GP clinics operating in the general area , if you were registered in a particular practice but decided you didnt care for the doctor there , were you to ring up the GP clinic six miles over the road , more often than not you were refused an appointment and directly told to go back to where you were registered , whatever about cities , in rural parts GP,s had an unwritten contract with each other that they would not " steal " each others patients , they all more or less had the same fees too


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## arbitron (29 Aug 2017)

odyssey06 said:


> Good to see things have ramped up... I think though we are suffering a legacy somewhat of the under-training as it will take time for these additionals numbers to have an impact.
> 
> And the point of asking them to pay back fees is that you would only do so if they didn't work in Ireland for X years. So it would be a disincentive to emigration.



If I had to choose between your suggestion of (1) fee-free education in exchange for 10 years mandatory service in a public hospital or (2) a €150,000 loan which I could pay back by going to USA, finishing my training in 4 years, work in a better environment, and be paid twice what I would get in Ireland, then I would be hugely incentivised to emigrate.


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## galway_blow_in (29 Aug 2017)

galway_blow_in said:


> i grew up in rural ireland , if you had a routine of doing your shopping in super valu every week , were you to make a change and instead go to tesco , you were not met at the door by someone telling you to go back to super value , different story with the GP clinics operating in the general area , if you were registered in a particular practice but decided you didnt care for the doctor there , were you to ring up the GP clinic six miles over the road , more often than not you were refused an appointment and directly told to go back to where you were registered , whatever about cities , in rural parts GP,s had an unwritten contract with each other that they would not " steal " each others patients , they all more or less had the same fees too



far from a deregulation of the GP sector happening  , those GP,s in the sheltered field went in heavy a few years ago with their spin machine , they smelled a threat to their protected gig and we were subject to endless sob stories in the news about how half of them could barely put bread on the table , this despite the fact that GP fees never dropped a red cent after the crash , the worst was the blather about having to pay staff , rent and electricity bills , yes because mechanics , hairdressers , bakers , corner shop owners , they get electricity and rent for free


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## odyssey06 (29 Aug 2017)

arbitron said:


> If I had to choose between your suggestion of (1) fee-free education in exchange for 10 years mandatory service in a public hospital or (2) a €150,000 loan which I could pay back by going to USA, finishing my training in 4 years, work in a better environment, and be paid twice what I would get in Ireland, then I would be hugely incentivised to emigrate.



So why wouldn't you just go to the USA today if it's such a better deal, sounds like you are going to go? Seems like it would not be possible to incentivise it more...

It could be 5 years in public hospital or 10 years working in the state (public or private), each year worked in Ireland takes 10% or 20% off the balance.

I wouldn't single out medical students per se, but anyone whose training has cost the state > €100,000 and there is a shortage of qualified people in that area should have some sort of clawback.


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## arbitron (29 Aug 2017)

Have a look at this 2012 article from National Consumer Agency on solicitor fees: https://www.rte.ie/news/money/consumer/2012/0224/291714-solicitors-fees-vary-500-survey-shows/

There is a huge variation in costs, e.g. wills ranged from free to €300, probate from €950 to €6,150...

So maybe the main problem is transparency.  If we could all see what professionals (solicitors, GPs, consultants, etc.) charged and make direct comparisons then that would theoretically drive prices down.


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## arbitron (29 Aug 2017)

odyssey06 said:


> So why wouldn't you just go to the USA today if it's such a better deal, sounds like you are going to go? Seems like it would not be possible to incentivise it more...
> 
> It could be 5 years in public hospital or 10 years working in the state (public or private), each year worked in Ireland takes 10% or 20% off the balance.
> 
> I wouldn't single out medical students per se, but anyone whose training has cost the state > €100,000 and there is a shortage of qualified people in that area should have some sort of clawback.



That doesn't make sense. If you force me to stay here for 5-10 years, I would rather go to USA/Oz for 4-8 years, pay off my debts, have a fun experience abroad/travelling, then come back as a free agent. It isn't just about the money, the work/life balance is often much better abroad. If you look at the data, this is happening anyway, more young doctors than ever are going abroad, and unfortunately they are not coming home like they used to.  So if we add the mandatory service into the mix they are hardly going to want to stay.

A lot of people are staying for family reasons. Is that what we want?  Should we not want people to stay because the system is fantastic and they want to work in world-class institutions? I prefer incentives to penalties.

You would just have to make everyone take out student loans. Commodifying education is a dangerous road to go down.


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## cremeegg (29 Aug 2017)

Sophrosyne said:


> Just looking at energy costs …
> 
> My electric usage is low but when standing charges, levies and taxes are added it makes a considerable difference.
> 
> ...



Not too hot on the maths there.


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## cremeegg (29 Aug 2017)

Sophrosyne said:


> Well it seems contradictory to environmental principles that the less energy one uses, the greater the percentage of additional charges.



the green lobby don't care as long as it means more for them. Sorry to be so cynical but the greens are a new movement, that fact that they are so encrusted with special interests is depressing.


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## cremeegg (29 Aug 2017)

The simple reason why everything costs so much is because we can afford and are willing to pay.


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## Firefly (29 Aug 2017)

cremeegg said:


> the green lobby don't care as long as it means more for them. Sorry to be so cynical but the greens are a new movement, that fact that they are so encrusted with special interests is depressing.



That's why they are referred to as Water Melons - green on the outside but red on the inside...


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## Sophrosyne (29 Aug 2017)

cremeegg said:


> Not too hot on the maths there.



Perhaps I did not phrase this properly.

In the first bill (€99.71) my electric usage (€49.66) represented 50.05% of the bill, the remaining 50.20% (€50.05) referred to add-ons

In the second bill (€63.11) my electric usage (€15.11) represented 23.94% of the bill, the remaining 76.06% (€48) referred to add-ons.


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## Sophrosyne (29 Aug 2017)

To me the cost of living relates manly to the cost of:

·  Utilities – Gas, electricity, waste, TV & phone package

·  Groceries – food & household cleaning

·  Insurance – Life, Health, House

·  Transportation

·  Clothing

·  Hair

·  Health – GP visits, prescription medicines

·  House & garden maintenance – new goods, repairs replacements, labour & materials

·  Entertainment – Radio, TV, dining out, cinemas, theatres, books, etc


If my children were still young I would add:


·  Education & childcare


If I still had a mortgage I would add mortgage costs or for some it would be rental costs.


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## Purple (30 Aug 2017)

arbitron said:


> If you don't believe the unions, have a read of a recent paper from Irish medical schools: https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-015-0003-9
> 
> Doctors emigrate because they are paid better abroad, have better working conditions, and are treated better. The same for nurses. If you ask them to pay back fees, you will just be encouraging them go to Aus or NZ or USA or Canada where they will finish their training more quickly and be better paid at the end of it.


According to your link the reasons they were contemplating emigrating were _"career opportunities (85%), working conditions (83%), and lifestyle (80%)."_
GP's in the UK earn between £55,000 and £80,000. That's according to the NHS website.
According to the Competition Authority _"fourth training years in GP practices, trainees' salaries are pegged to hospital registrar pay rates and continue to be paid by the HSE. With allowances, these pay rates can vary from €71,900 to €82,400."_
According to the same report _"The Competition Authority report  also shows that GPs in Ireland earn an average of €220,000 a year from treating medical card patients." [broken link removed]_

The reality is that Doctors and Nurses and other health service employees, be they "professionals" or just mere mortals, are as much part of the problem as anyone else. Instead of trying to fix the dysfunctional system they just look for more money to work in it.
Now if they can just stop telling lies about what they get paid and also get the Consultants who spent a decade and a half obstructing reforms which would improve patient care and earn hundreds of thousands a year crying crocodile tears about waiting lists and a lack of resources.


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## arbitron (30 Aug 2017)

Purple said:


> According to your link the reasons they were contemplating emigrating were _"career opportunities (85%), working conditions (83%), and lifestyle (80%)."_



That just highlights the fact that the Irish system is considered to have poorer working conditions, poorer career opportunities, and poorer lifestyle.  Would you not emigrate for those things?



Purple said:


> GP's in the UK earn between £55,000 and £80,000. That's according to the NHS website.
> According to the Competition Authority _"fourth training years in GP practices, trainees' salaries are pegged to hospital registrar pay rates and continue to be paid by the HSE. With allowances, these pay rates can vary from €71,900 to €82,400."_
> According to the same report _"The Competition Authority report  also shows that GPs in Ireland earn an average of €220,000 a year from treating medical card patients." [broken link removed]_



You have said twice now that doctors or the unions are lying about pay, but you haven't provided any proof.

HSE payscales are publicly available here: http://www.hse.ie/eng/staff/benefitsservices/pay/Consolidated-Payscales-1st-April-2017.pdf

The numbers you quoted are from 2009.  There have been several changes in the payscale since.  The current pay for GP registrars is: €61,404 - €65,920, including allowances.  It was even lower until this year.  So in fact trainees have taken a €10,000 - €20,000 pay cut, which undermines your argument completely.

HSE salaries dipped down after the crash (not forgetting loss of training grants and other allowances that were not on the payscale and are now gone) but are now going up again.  HSE trainee doctors range from €32,938 to €77,283.  But the actual workforce is a pyramid, with the majority of doctors on the lower end (€32,938 - €45,224), a minority on the middle scale (€51,578 - €67,993) and virtually none on the upper scale, as those are legacy posts which were closed to new entrants years ago.  Is paying a surgeon with 10 years experience a salary of €68,000 exorbitant?  What job do you think would deserve that money?


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## arbitron (30 Aug 2017)

Purple said:


> The reality is that Doctors and Nurses and other health service employees, be they "professionals" or just mere mortals, are as much part of the problem as anyone else. Instead of trying to fix the dysfunctional system they just look for more money to work in it.
> Now if they can just stop telling lies about what they get paid and also get the Consultants who spent a decade and a half obstructing reforms which would improve patient care and earn hundreds of thousands a year crying crocodile tears about waiting lists and a lack of resources.



According to your quote from my source above, you can see that doctors are actually looking for better career opportunities, better working conditions, and better lifestyles... which betrays your argument about money?

You quoted UK GP earnings previously, but those are salaried GPs who are bottom of the scale, they are not GP partners who are on around £100,000.  In Ireland, GPs are not HSE employees, they are effectively private contractors with small guaranteed income, relying on private patients for the rest.  In the UK, they are salaried and receive extra funding to build and maintain their practice building and equipment.  The UK are also struggling to recruit GPs, with some areas giving golden handshakes of £20,000+.

If you are comparing like with like, you should look at what GPs make doing either a mix of NHS and private work, or private alone in UK.  A friend of mine runs a private GP clinic in London and the mid-level docs earn figures that would make you weep.  Have a look at this 2011 article: http://www.telegraph.co.uk/news/hea...s-now-thats-what-I-call-a-healthy-salary.html  She tells me it's worse now.

But that's just the UK, other countries are more attractive.

Some anecdotal evidence for illustration:
Oz (friends earning 150-200k), NZ (150k+), Canada (150-300k, one guy got free house and free Land Rover!), USA (150k+) can also be very lucrative, with the added bonus of better weather and better working conditions.  Middle East is also draining hospitals of nurses, managers, docs.  In the last few years I know 5 fantastic senior nurses who have moved to Qatar and UAE, 3 docs who have moved to UAE, 2 hospital managers who have moved to Saudi/Qatar.  They get higher (tax-free) salaries, more time off, better working conditions.

People feel very strongly about this, to the point of talking about duty to fellow countrymen, etc., but people have to be happy in their work.  Those of us who stay in or return to Ireland do so for non-work reasons, e.g. ageing parents.  People will take a salary cut to work in a great system, but the HSE is not an attractive system.

I agree with you about (a vocal minority of) consultants being obstructive, but that is changing.

So long as senior civil servants, TDs, Senators, and consultants have private health insurance, they will not be affected and this will be slow to change.  If they had to give up their access to private healthcare for 10 years, I reckon the system would improve overnight.


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## Purple (30 Aug 2017)

arbitron said:


> The numbers you quoted are from 2009. There have been several changes in the payscale since. The current pay for GP registrars is: €61,404 - €65,920, including allowances. It was even lower until this year. So in fact trainees have taken a €10,000 - €20,000 pay cut, which undermines your argument completely.


 Okay, so 4th year trainee GP's are getting over €60,000 a year. 



arbitron said:


> Is paying a surgeon with 10 years experience a salary of €68,000 exorbitant? What job do you think would deserve that money?


Are you seriously suggesting that someone who has been a qualified surgeon for 10 years is earning €68,000 or €8000 a year more than a trainee GP? Will ya go on out'a that!

I know a GP working in Ireland with no GMS list who gets paid more from the HSE than here sister who is a NHS GP in Wales.
Irish doctors are very well paid relative to their UK counterparts. The system they work within is dysfunctional. I would suggest that resources should be put into fixing the system rather than paying people more to work in the current one.


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## Purple (30 Aug 2017)

arbitron said:


> According to your quote from my source above, you can see that doctors are actually looking for better career opportunities, better working conditions, and better lifestyles... which betrays your argument about money?


This thread is about fees. My point is that doctors are very highly paid. You said that they are emigrating due to low pay. I pointed out that those who are thinking about emigrating are not doing so due to pay.



arbitron said:


> You quoted UK GP earnings previously, but those are salaried GPs who are bottom of the scale, they are not GP partners who are on around £100,000. In Ireland, GPs are not HSE employees, they are effectively private contractors with small guaranteed income, relying on private patients for the rest.


 No, the average payment per consultation for GMS patients is higher than the average payment for private patients when all of the hidden payments that GMS dostors get are taken into account. The figure of €220,000 I quoted is for GMS payments only. Income from private patients is in addition to that.

If you have a large GMS list you get your practice nurse paid for by the State, you get your practice manager paid for by the State, you get a pension which is in effect the same as a Public Servant, you get grants for improvements to your business such as new equipment, IT infrastructure etc.
You can use all of those resources, for which the State has paid, for your private patients as well. 
GP's don't even do out of hours house calls any more; if you call a GP to come to your house at 8pm because your elderly mother has a throat infection you could wait for 2 or three hours only to get a proctologist to your door.


----------



## arbitron (30 Aug 2017)

Purple said:


> Okay, so 4th year trainee GP's are getting over €60,000 a year.



In fact both 3rd and 4th years are paid more than 60k, which is 10-20k lower than the figures you quoted. If you think that's too high, that's your opinion.  GP is a difficult job and they are struggling to get good candidates to take up training.  This year they could not fill all places.  That suggests that what they are offering is not attractive.  How would you calculate their worth?



Purple said:


> Are you seriously suggesting that someone who has been a qualified surgeon for 10 years is earning €68,000 or €8000 a year more than a trainee GP? Will ya go on out'a that!



You are getting confused between consultants and registrars.  If you look at the HSE payscale, you will see that a registrar who is 10 years into training earns less than 70k.  They do entire surgical lists independently, with consultant supervision as required.



Purple said:


> I know a GP working in Ireland with no GMS list who gets paid more from the HSE than here sister who is a NHS GP in Wales.
> Irish doctors are very well paid relative to their UK counterparts. The system they work within is dysfunctional. I would suggest that resources should be put into fixing the system rather than paying people more to work in the current one.



Exactly, if they have no GMS list then they are fully private and not salaried, so why are you comparing 1 private GP in Ireland with 1 public GP in Wales?

You keep saying Irish doctors are very well paid, but what is that based on?  There are 7,000 trainess in Ireland alone across 57 different specialties - do you think each one is well paid?  I would like to see real data.


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## arbitron (30 Aug 2017)

Purple said:


> This thread is about fees. My point is that doctors are very highly paid. You said that they are emigrating due to low pay. I pointed out that those who are thinking about emigrating are not doing so due to pay.



No, your quote only shows that pay is not the only issue.  It is part of the problem. Regardless of the reasons for doctors leaving, the fact is they are leaving and posts can't be filled, which then pushes up costs.



Purple said:


> No, the average payment per consultation for GMS patients is higher than the average payment for private patients when all of the hidden payments that GMS dostors get are taken into account.



What is the source for that?



Purple said:


> GP's don't even do out of hours house calls any more; if you call a GP to come to your house at 8pm because your elderly mother has a throat infection you could wait for 2 or three hours only to get a proctologist to your door.



Is there any evidence for any of this?  It sounds like opinion.  You are claiming no GPs do out of hours - can you link to this?  And how does it relate to fees in Ireland?


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## Purple (30 Aug 2017)

arbitron said:


> What is the source for that?


There. The average payment to GMS doctors per patient visit was €65. The report also cites the feminisation of GP services and the resulting increase in part time work; female GP's are far more likely to work short hours. Cuts in recent times may have reduced that gap slightly as GP's "just happen" to increase their fees for private patients in order to maintain their income.



arbitron said:


> Is there any evidence for any of this? It sounds like opinion. You are claiming no GPs do out of hours - can you link to this?


 You don't even have to be a qualified GP to work as a GP! You do need to be qualified to get a GMS list. Any qualified doctor can work for an out of hours GP service.


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## Purple (30 Aug 2017)

arbitron said:


> No, your quote only shows that pay is not the only issue. It is part of the problem. Regardless of the reasons for doctors leaving, the fact is they are leaving and posts can't be filled, which then pushes up costs.


 I was quoting your source. It shows that over 80% of doctors who were thinking about leaving (lost think about it, very few do it) money wasn't an issue.
The fact that they are leaving is not the reason posts can't be filled. Posts can't be filled because so many doctors can make a great living working part time so two GP's are doing one job and because of the dysfunctional system they helped to create and help to maintain. 
Why not fix the problem instead of permanently treating the symptoms?


----------



## Purple (30 Aug 2017)

arbitron said:


> Exactly, if they have no GMS list then they are fully private and not salaried, so why are you comparing 1 private GP in Ireland with 1 public GP in Wales?


 No, the GP's who do not have a GMS list still get a very large amount of their income from the HSE. In the case I know personally the income from the HSE for the Irish GP with no GMS list was higher than the total income of the UK based GP. I can't say that's universally true.



arbitron said:


> You keep saying Irish doctors are very well paid, but what is that based on? There are 7,000 trainess in Ireland alone across 57 different specialties - do you think each one is well paid? I would like to see real data.


----------



## arbitron (30 Aug 2017)

Purple said:


> There. The average payment to GMS doctors per patient visit was €65. The report also cites the feminisation of GP services and the resulting increase in part time work; female GP's are far more likely to work short hours. Cuts in recent times may have reduced that gap slightly as GP's "just happen" to increase their fees for private patients in order to maintain their income.
> 
> You don't even have to be a qualified GP to work as a GP! You do need to be qualified to get a GMS list. Any qualified doctor can work for an out of hours GP service.



That report is from 2010, and the data is 2008.  Almost 10 years ago.  Since then there have been FEMPI cuts (2009 onwards), including a significant decrease in GP and pharmacy fees, as well as decreased weighting for seeing patients over 70 (who tend to need more time and resources).  So the figures you are quoting are out of date and out of context.  There is also no detail there, just 1 mention of an average, no breakdown.  Do you have anything up to date and relevant?

I don't know what point you are trying to make re: out of hours care.  Again, have you any source that says qualified GPs are no longer doing out of hours cover?  And how does that affect fees?  Surely if any doctor can do it, it would decrease cost through competition?



Purple said:


> I was quoting your source. It shows that over 80% of doctors who were thinking about leaving (lost think about it, very few do it) money wasn't an issue.
> The fact that they are leaving is not the reason posts can't be filled. Posts can't be filled because so many doctors can make a great living working part time so two GP's are doing one job and because of the dysfunctional system they helped to create and help to maintain.



Indeed you were quoting my source, that wasn't the problem, the issue is your misreading of it.  If you read the full paper, 65% state that pay is a factor.

You say very few emigrate but the recent RCSI report highlights it as an issue and states that emigration is rising among doctors aged 25-34.

You say that posts can't be filled because people are going part time.  If it's a great and well paid job that everyone should want, why were they unable to recruit enough trainees to start the scheme this year?



Purple said:


> No, the GP's who do not have a GMS list still get a very large amount of their income from the HSE. In the case I know personally the income from the HSE for the Irish GP with no GMS list was higher than the total income of the UK based GP. I can't say that's universally true.



How are they getting that income from the HSE?  Can you give specifics?



Purple said:


> Why not fix the problem instead of permanently treating the symptoms?



What is the solution?


----------



## Purple (30 Aug 2017)

arbitron said:


> That report is from 2010, and the data is 2008. Almost 10 years ago. Since then there have been FEMPI cuts (2009 onwards), including a significant decrease in GP and pharmacy fees, as well as decreased weighting for seeing patients over 70 (who tend to need more time and resources). So the figures you are quoting are out of date and out of context. There is also no detail there, just 1 mention of an average, no breakdown. Do you have anything up to date and relevant?


 Are you suggesting that their income has dropped to a level at which they are now below the incomes of their UK counterparts? The FEMPI cuts to GP's were an average of 7.5% and yet the NAGP come out with "cuts up to 38%". At best that's a misrepresentation of the facts, or a lie as us plebs call it. 



arbitron said:


> I don't know what point you are trying to make re: out of hours care. Again, have you any source that says qualified GPs are no longer doing out of hours cover? And how does that affect fees? Surely if any doctor can do it, it would decrease cost through competition?


 My point is that GP's, along with Hospital Consultants, want it both ways; lavish pay but outsource the heavy lifting to someone else. 



arbitron said:


> Indeed you were quoting my source, that wasn't the problem, the issue is your misreading of it. If you read the full paper, 65% state that pay is a factor.


 Yes, but not a main factor. You do know the difference between thinking about something and actually doing it? I often think about losing weight, training to run 10k or taking up karate again. I don't do it though. 



arbitron said:


> You say very few emigrate but the recent RCSI report highlights it as an issue and states that emigration is rising among doctors aged 25-34.


 Yes, but they include the non-Irish doctors who trained here but never intended to stay here. I can't find figures on what percentage of students in TCD, RCSI, UCD etc are foreign but my experience 20 years ago was that in TCD the class was over one third foreign students who were never going to stay here. When the RCSI present the emigration figures without that caveat they are at best misrepresenting of the facts, or lying as us plebs call it.



arbitron said:


> You say that posts can't be filled because people are going part time. If it's a great and well paid job that everyone should want, why were they unable to recruit enough trainees to start the scheme this year?


 Because of the dysfunctional nature of the medical industry.



arbitron said:


> How are they getting that income from the HSE? Can you give specifics?


 Smear tests, Prenatal examinations, vaccines, postnatal examinations and all the other schemes that the HSE pays for which are delivered through GP's.



arbitron said:


> What is the solution?


 There is no big answer; there are thousands of small answers. It would be great to see Doctors unions and Nurses unions (sorry, Professional bodies) offering solutions that don't center around their own pay or taking more money from the public to try to fill the bottomless pit..


----------



## arbitron (30 Aug 2017)

Purple said:


> Are you suggesting that their income has dropped to a level at which they are now below the incomes of their UK counterparts? The FEMPI cuts to GP's were an average of 7.5% and yet the NAGP come out with "cuts up to 38%". At best that's a misrepresentation of the facts, or a lie as us plebs call it.



It is hard to know who is earning what when you are jumping between types and grades of doctor.  We can only do comparisons of like with like, and you have been avoiding that.  You are looking at a FEMPI cut from 2013 and ignoring the cumulative changes from 2009.  If you pick and choose DoH statements but don't look at the whole picture then that is adding to the problem.

Talking about people being plebs is a distraction and an easy way to create a caricature of a convenient enemy, but it's not helpful. Sure you could be the Queen of England for all we know.  You can't on the one hand rail against elitist doctors and on the other hand reinforce the divide by talking about "plebs".  The 2 greatest patient advocates that I know are both consultants who grew up in wealthy households and would never use a word like that. Equally the greediest miser I ever met grew up in poverty in inner city Dublin and wouldn't see a patient if they didn't hand over the green first.



Purple said:


> My point is that GP's, along with Hospital Consultants, want it both ways; lavish pay but outsource the heavy lifting to someone else.



The most productive approach in life is to assume good faith and work from there.  If you see doctors (or other professionals) as out to gouge you then you will only create discord.  It is very easy for people to dismiss an entire group - it's lazy thinking.  If you sit back and look at how people talk about greedy civil servants, the lazy unemployed, "snowflake" students, greedy professionals, travellers, etc. then who is actually left in good standing?  Everyone is part of some group, so a little perspective and generosity of spirit is required.  Of course they want to be paid well, everyone does.  It's a matter of personal opinion whether a consultant is worth e100 or e1,000 an hour.



Purple said:


> Yes, but not a main factor.



You went from saying that it's not a factor to saying it's not a _main _factor. The report say it is a specific factor for 65%.



Purple said:


> Yes, but they include the non-Irish doctors who trained here but never intended to stay here. I can't find figures on what percentage of students in TCD, RCSI, UCD etc are foreign but my experience 20 years ago was that in TCD the class was over one third foreign students who were never going to stay here. When the RCSI present the emigration figures without that caveat they are at best misrepresenting of the facts, or lying as us plebs call it.



Again, you are talking about lying and plebs.  Just because you don't like the report or disagree with it doesn't make them liars.  Yes, a percentage of graduates are from abroad, but that percentage is lower than ever.  So in real terms, more Irish are graduating and more Irish are leaving.



Purple said:


> Because of the dysfunctional nature of the medical industry.



This is vague assertion. What specific dysfunction?



Purple said:


> Smear tests, Prenatal examinations, vaccines, postnatal examinations and all the other schemes that the HSE pays for which are delivered through GP's.



Can you furnish us with the reports that shows non-GMS GPs are making 6-figure sums from these?



Purple said:


> There is no big answer; there are thousands of small answers. It would be great to see Doctors unions and Nurses unions (sorry, Professional bodies) offering solutions that don't center around their own pay or taking more money from the public to try to fill the bottomless pit..



There can't be an answer when you won't pose a problem statement.  What is it that healthcare workers should be addressing?

Are you aware that trainee doctors until recently were working 36+ hour shifts on site, often with little or no sleep?  That has been illegal since 2004 but it took a junior doctor strike for the HSE to capitulate in 2013 and agree to a maximum of 24 hours - which is still illegal but was accepted as a compromise.  And the HSE is still breaking these rules.  The major reason for the change was doctor welfare, but there was also huge concern for patient safety.  Doctor salaries went down as a result, because the number of hours worked decreased.  So there is a good example of doctors losing money to improve their working conditions and to improve patient safety.

Nurses also work very hard to look after patients and do many things outside of their pay grade and remit.  The HSE is held together by the good will of its staff.  I know a hospital manager who was lumped with a project that no-one said could be done and they were about to cancel a month's worth of surgical lists - but she worked 12 hours a day, 7 days a week for 3 months straight to get the project done on time so that no patient would be delayed.  She got no overtime and even her boss didn't know she was doing it.  I only know because I grilled her on how she was able to do 12 months of work in 1/4 of the time.  Soon afterwards she was headhunted by a multinational to become a project manager on double her current salary but she didn't even consider it as she is totally committed to her job in the HSE.  So not everyone is in it for the cash and not every manager in the HSE needs to be fired.  Those are lazy arguments.


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## Purple (30 Aug 2017)

arbitron said:


> The most productive approach in life is to assume good faith and work from there. If you see doctors (or other professionals) as out to gouge you then you will only create discord. It is very easy for people to dismiss an entire group - it's lazy thinking. If you sit back and look at how people talk about greedy civil servants, the lazy unemployed, "snowflake" students, greedy professionals, travellers, etc. then who is actually left in good standing? Everyone is part of some group, so a little perspective and generosity of spirit is required.


People who describe themselves as Professionals and use their job title as a prefix to their name are putting themselves on that pedestal, nobody else is putting them there.


arbitron said:


> Of course they want to be paid well, everyone does. It's a matter of personal opinion whether a consultant is worth e100 or e1,000 an hour.


 Or €50 an hour. It's supply and demand economics but if you can limit supply you can earn super normal profits, or get higher wages. That's economics 101.


arbitron said:


> Nurses also work very hard to look after patients and do many things outside of their pay grade and remit.


 There are the same Nurses who used to take blood but won't now because their Union told them not to? The same Nurses who would let me wipe up some coke that my son has spilled o the floor but rather went and called a cleaner, taking 15 minutes to do so? Sure they work hard but that's not efficient and it certainly isn't flexible.



arbitron said:


> This is vague assertion. What specific dysfunction?


 We have a young population, an average density of doctors and a high density of nurses per head of population but we have a terrible healthcare system. Despite that young population we have the second highest spend in per head in the OECD but the poorest outcomes. Does that sound functional to you?



arbitron said:


> What is it that healthcare workers should be addressing?


 The day to day wastes and inefficiencies they see.



arbitron said:


> Are you aware that trainee doctors until recently were working 36+ hour shifts on site, often with little or no sleep? That has been illegal since 2004 but it took a junior doctor strike for the HSE to capitulate in 2013 and agree to a maximum of 24 hours - which is still illegal but was accepted as a compromise. And the HSE is still breaking these rules. The major reason for the change was doctor welfare, but there was also huge concern for patient safety. Doctor salaries went down as a result, because the number of hours worked decreased. So there is a good example of doctors losing money to improve their working conditions and to improve patient safety.


The treatment of junior doctors (as opposed to all NCHD's) was disgraceful and dangerous. If they really wanted to screw up their career making a mistake wasn't the worst thing they could do, no, getting the "wrong" Consultant out of bed in the middle of the night; they is the worst thing they could do.



arbitron said:


> So not everyone is in it for the cash and not every manager in the HSE needs to be fired. Those are lazy arguments.


 I agree. The whole thing about "Front line Staff" is BS. Good management is essential for any organisation. That said if the structure is inefficient then the person working within that structure is inefficient. Being inefficient and not working hard is not the same thing. Looking at individuals misses the point; everyone who works in an organisation knows some of its weaknesses. Good management looks for a way of hearing those voices and creating the most efficient organisation possible. The outcome will mean a reallocation of resources. In effect that means lots of job losses and different people being hired in different areas. Will doctors and nurses vote for job losses, even if it's only a few? I think we all know the answer to that. Will the administrators and others like them vote for job losses? I think we all know the answer to that as well.
As for who is in it for the money; there are as many greedy doctors  and nurses as administrators. Doctors and other "Front Line Staff" are no better or worse, honest or dishonest, hard working or lazy, than anyone else, be that other person a manager, administrator, solicitor, plumber or painter. 

One in every 19 people who works in Ireland works for the HSE. When it is the worst value for money health service in the OECD and sucks up so much of our national resource (€16.4 billion out of total government expenditure of €68.7 billion, or 24 cents in every Euro spent) it is a major part of the answer to the question "why are things so expensive in Ireland".


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## arbitron (30 Aug 2017)

Purple said:


> People who describe themselves as Professionals and use their job title as a prefix to their name are putting themselves on that pedestal, nobody else is putting them there.



Elites are enabled by the general population. As I said before, many people will refer to someone as Dr., Fr., or other honorifics even if you are blue in the face saying "Call me Jack".  If you are talking about older doctors, yes they will use their title more, but younger docs in general don't care.  The #hellomynameis campaign showed this.



Purple said:


> Or €50 an hour. It's supply and demand economics but if you can limit supply you can earn super normal profits, or get higher wages. That's economics 101.



I wrote e100 to see if you would argue the actual point or focus on the number - talking about the e50 is a distraction. Who is limiting the supply?  If the job is so lucrative a surgeon from the UK can easily set up a private practice in Ireland and rake in the money.  But that isn't what happens, so the economics are off.



Purple said:


> There are the same Nurses who used to take blood but won't now because their Union told them not to? The same Nurses who would let me wipe up some coke that my son has spilled o the floor but rather went and called a cleaner, taking 15 minutes to do so? Sure they work hard but that's not efficient and it certainly isn't flexible.



That is a straw man - there is no nationwide campaign for nurses to stop taking bloods. In fact the INMO agreed to nurses taking on more tasks, including bloods, to regain their time+1/6 pay.  The process is very slow, and there is some obstruction, but it's improving. And there are no units where it has gone backwards.  I can't comment on the spilled coke.



Purple said:


> We have a young population, an average density of doctors and a high density of nurses per head of population but we have a terrible healthcare system. Despite that young population we have the second highest spend in per head in the OECD but the poorest outcomes. Does that sound functional to you?



We have a below average number of docs per head of population in most specialties, with waiting lists way beyond the OECD average.  We don't have a terrible healthcare system, that is a dramatic statement.  At worst it is below average value for money, but our outcomes vary from excellent to poor depending on the specialty.  I agree that there is dysfunction, but you haven't given any specifics.



Purple said:


> The day to day wastes and inefficiencies they see.



Instead of presuming that HSE employees are not bothered, it would be better to do some research before making blanket statements.  For example, the Mater runs a lean academy to train healthcare staff how to improve processes and save money.  The RCPI runs quality management and leadership courses.  And so on.  So staff are doing what you claim they are not.



Purple said:


> The treatment of junior doctors (as opposed to all NCHD's) was disgraceful and dangerous. If they really wanted to screw up their career making a mistake wasn't the worst thing they could do, no, getting the "wrong" Consultant out of bed in the middle of the night; they is the worst thing they could do.



Well all NCHDs are by definition all junior doctors, so I'm not sure what you mean by that.  I also don't know what you mean about calling consultants, etc.  It doesn't sound like an objective or evidence-based argument.



Purple said:


> I agree. The whole thing about "Front line Staff" is BS. Good management is essential for any organisation. That said if the structure is inefficient then the person working within that structure is inefficient. Being inefficient and not working hard is not the same thing. Looking at individuals misses the point; everyone who works in an organisation knows some of its weaknesses. Good management looks for a way of hearing those voices and creating the most efficient organisation possible. The outcome will mean a reallocation of resources. In effect that means lots of job losses and different people being hired in different areas. Will doctors and nurses vote for job losses, even if it's only a few? I think we all know the answer to that. Will the administrators and others like them vote for job losses? I think we all know the answer to that as well.
> As for who is in it for the money; there are as many greedy doctors  and nurses as administrators. Doctors and other "Front Line Staff" are no better or worse, honest or dishonest, hard working or lazy, than anyone else, be that other person a manager, administrator, solicitor, plumber or painter.
> 
> One in every 19 people who works in Ireland works for the HSE. When it is the worst value for money health service in the OECD and sucks up so much of our national resource (€16.4 billion out of total government expenditure of €68.7 billion, or 24 cents in every Euro spent) it is a major part of the answer to the question "why are things so expensive in Ireland".



It would have been helpful if you had given concrete examples of what to change and how.  It is extremely difficult to motivate people to improve the HSE when they are under fire from people with no evidence to back up their claims.  This is my last comment on it as it has totally taken over a thread that could be quite productive.


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## Dan Murray (30 Aug 2017)

arbitron said:


> ....For example, the Mater runs a lean academy to train healthcare staff how to improve processes and save money.



Just a quick comment. Visited an old pal in the Mater last week - a mild-mannered and gentle soul. He was extremely disappointed with the standard of care. He felt that the staff were well-intentioned but rudderless (his precise words). His family members said that there seemed to be no one of seniority taking charge and that the quality of communication was awful.

Obviously, this is only the impression of one patient and his family. However, as I know them well and that they are measured folk, I would mark their words.


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## Purple (31 Aug 2017)

arbitron said:


> Elites are enabled by the general population. As I said before, many people will refer to someone as Dr., Fr., or other honorifics even if you are blue in the face saying "Call me Jack". If you are talking about older doctors, yes they will use their title more, but younger docs in general don't care. The #hellomynameis campaign showed this.


Fair enough. 



arbitron said:


> I wrote e100 to see if you would argue the actual point or focus on the number - talking about the e50 is a distraction. Who is limiting the supply? If the job is so lucrative a surgeon from the UK can easily set up a private practice in Ireland and rake in the money. But that isn't what happens, so the economics are off.


 People don't come for the same reason people are leaving; we have a dysfunctional healthcare system. In order to retain staff we pay them more than we do in other countries but that still doesn't  compensate for the shortcomings of the system. In other words we over pay for a sub standard service.



arbitron said:


> That is a straw man - there is no nationwide campaign for nurses to stop taking bloods. In fact the INMO agreed to nurses taking on more tasks, including bloods, to regain their time+1/6 pay. The process is very slow, and there is some obstruction, but it's improving. And there are no units where it has gone backwards. I can't comment on the spilled coke.


 They did take bloods for decades but then refused to do so in order to blackmail the HSE into paying them more. 



arbitron said:


> We have a below average number of docs per head of population in most specialties, with waiting lists way beyond the OECD average. We don't have a terrible healthcare system, that is a dramatic statement. At worst it is below average value for money, but our outcomes vary from excellent to poor depending on the specialty. I agree that there is dysfunction, but you haven't given any specifics.


Out outcomes are well below average and our costs are well above average. That results in wasted money and wasted lives. 
Why the constant push for specifics, but nothing to specific as to be anecdotal? When my car breaks down I know it is broken down. I don't have to know the causes in order to know it doesn't work.



arbitron said:


> Instead of presuming that HSE employees are not bothered, it would be better to do some research before making blanket statements. For example, the Mater runs a lean academy to train healthcare staff how to improve processes and save money. The RCPI runs quality management and leadership courses. And so on. So staff are doing what you claim they are not.


 I run LEAN programs. One of the core  measures is a reduction in staff numbers and/or an increase in output. Has the Mater increased the number of patients they treat while at the same time reducing the number of staff they employ? If total staff numbers have remained the same has there been a major redeployment of staff? You see you can't have LEAN without a high level of labour flexibility. There is a very low level of labour flexibility within the State sector as everyone is unionised. 



arbitron said:


> Well all NCHDs are by definition all junior doctors, so I'm not sure what you mean by that. I also don't know what you mean about calling consultants, etc. It doesn't sound like an objective or evidence-based argument.


It's a stupid definition an misrepresents the truth of the situation. If you work in the hospital sector and don't know what I mean about calling consultants then I worry that you are totally out of touch.



arbitron said:


> It would have been helpful if you had given concrete examples of what to change and how. It is extremely difficult to motivate people to improve the HSE when they are under fire from people with no evidence to back up their claims. This is my last comment on it as it has totally taken over a thread that could be quite productive.


That's a cop out; the people doing the job are always the best people to talk to first about what should change. 
The evidence is our high spend for low outcomes.


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## PMU (31 Aug 2017)

Mr Taylor in the Irish Times article does not refer to which Eurostat publication inspired his article but I think it was http://ec.europa.eu/eurostat/documents/2995521/8072361/2-15062017-BP-EN.pdf/fff33756-4460-4831-9915-4a8c101f2b56, which is based on http://ec.europa.eu/eurostat/statistics-explained/index.php/Comparative_price_levels_of_consumer_goods_and_services. In his article Mr Taylor cited rents, buying a house and childcare as expensive items that particularly hit younger age groups, but the Eurostat publication and the related survey refer to three specific price categories and I can't find renting, house buying and childcare therein. Anyway, you can check it yourself. I'm not saying they are not relatively more expensive in Ireland just that I don't see support for this in the Eurostat data.

In any event, inflation is Ireland is currently negative and has averaged about 1.2% since the crash in 2008. http://www.inflation.eu/inflation-rates/ireland/historic-inflation/cpi-inflation-ireland.aspx. So with inflation currently negative, if certain goods/services are increasing in price, and are presumably regarded as 'expensive', others must be falling in price (otherwise you have inflation). So consumer choice, i.e. whether you decide to buy or not buy a good/service that is increasing in price, to a large extent determines if something is 'expensive' or not.

Mr Taylor suggests insider lobbying; limited competition; state imposed costs and productivity as reasons for high native prices, but I'm certain we are not unique in Europe in these areas, and it would have been more enlightening if instead of jumping on the 'millennials are being screwed' bandwagon, Mr Taylor had suggested policy failure that contribute to high prices, i.e. what are we doing that others are not that leads to elevated price levels in Ireland.


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