According to a report from the Health Service Executive (HSE), nearly 100 hospital consultants in Ireland earned more than €300,000 ($353,000) in 2022. The highest-earning consultant, working in emergency medicine, was paid a staggering €974,000 ($1.15 million). The number of consultants earning above €300,000 increased by 41% compared to the previous year, despite efforts to limit spending on high earners.
The cumulative earnings of these consultants amounted to €36 million ($42 million), with an average pay of approximately €372,000 ($437,000). Almost half of them earned over €300,000 in both 2021 and 2022. The report raises concerns about patient safety when consultants are overworked due to excessive extra payments. Additionally, assigning them additional tasks may violate the European Working Time Directive.
Consultants have the potential to earn various allowances and payments on top of their basic salary. These include on-call and overtime payments, as well as a clinical director’s allowance. Some consultants received large sums for compensatory rest day payments and annual leave that they did not take, which were considered non-compliant. Although there is a cap on on-call payments at €30,000 ($35,000), seven payments exceeded this limit and were deemed non-compliant.
The HSE management attributes the high earnings to a shortage of consultant staff in certain specialties and regions. They also mention that local arrangements are sometimes made to support vulnerable services or respond to crises or emergencies. However, they acknowledge the need for intensified efforts to manage the situation and establish more sustainable healthcare services.
Two-thirds of the high-earning consultants work in acute hospitals, while 21% are in community operations and 3% in corporate national services. Among the consultants in community operations who earned over €300,000, 19 out of 20 were psychiatrists, highlighting a staffing issue in mental health services. Regional hospitals accounted for almost 70% of the high earners in the acute sector, and two regions contributed to 60% of all high earners.
The auditors who conducted the report note that there has been limited progress in implementing earlier plans to address high earners among consultants. They emphasize the importance of management attention to control the environment surrounding additional payments. A central register that would list all local agreements has yet to be fully established, and national reporting of high earners or local agreements has not commenced.
In addition to concerns about patient safety, the report suggests that pay inequality could impact staff morale and lead to increased staff turnover due to burnout among consultants.
Sources:
- Health Service Executive report on high-earning consultants
- European Working Time Directive