Consultant Workforce Report 2018

Published by: National Doctors Training & Planning Health Service Executive Dublin

Copies of this report can be obtained from: National Doctors Training and Planning Oiliúint agus Pleanáil Náisiúnta na nDochtúirí Health Service Executive Feidhmeannacht na Seirbhíse Sláinte Block 9E, Sancton Wood Building Aonad 9E, Áras Sancton Wood Heuston South Quarter Ceathrú Heuston Theas Saint John's Road West Bóthar Eoin Thiar Dublin 8 Baile Átha Cliath 8

W: www.hse.ie/doctors E: [email protected] T: 07669 59924

Table of Contents

Executive Summary ...... 1 Foreword ...... 2 1 Background ...... 3 2 Consultant Application Approvals in 2017 ...... 4 3 Distribution of Consultant posts by medical disciplines and specialties ...... 5 4 Distribution of Consultant posts across healthcare settings ...... 8 5 Age profile of Consultants in HSE-funded posts ...... 9 6 Gender of Consultants ...... 13 7 Registration held with the Medical Council ...... 17 8 Contract types and classes held by Consultants ...... 19 9 Tenure (permanent or non-permanent)...... 21 10 Working Full Time and Less Than Full Time ...... 24 11 Approval status of posts ...... 25

Executive Summary

National Doctors Training and Planning (NDTP) provides this report on Consultant posts in Ireland to contribute towards improved workforce planning. This data, held in the Doctors Integrated Management E System (DIME), helps frame discussions regarding the recruitment, retention, replacement, location, and practice arrangements of the Consultant workforce.

Analysis of data for the 1st of January 2018 shows that:  DIME contained information on 3,249 HSE-funded Consultant posts (of which 3095 were approved posts) and 3,017 doctors in those posts  Despite approving almost 100 new Consultant posts in 2017, the number of Consultant post approvals fell for the second year in a row  The increase in Consultant numbers varied among specialties e.g. the Radiology establishment of Consultants grew by less than 1%, whereas the Intensive Care Medicine establishment grew by 9%  27% of Consultants need to be replaced before 2028 to maintain the existing status quo  The percentage of Consultants aged 55 years and over varied by type of hospital, medical discipline and between clinical sites  Almost two thirds of the Consultant workforce is male  While there are almost equal numbers of male and female Consultants in the under 40 age categories, males had significantly higher representation in older age groups  Gender patterning was evident across medical disciplines and specialities (e.g. female Consultants were less likely than males to be working in surgical specialties)  4% of Consultants held General registration with the Medical Council and were not on the Specialist Division of the Register. Consultants in Model 3 hospitals were more likely than Consultants in Model 4 hospitals to hold General registration  13% of Consultant posts were held by doctors with non-permanent contracts. The percentage of Consultants with non-permanent contracts varied by type of hospital, medical discipline and between different clinical sites  13% of Consultants worked Less Than Full Time. This rate varied for male (12%) and female (16%) Consultants  112 Consultants worked in unapproved posts. The percentage of Consultants working in unapproved posts varied by hospital type and between clinical sites.

Foreword In my new role as Director, it gives me great pleasure to present NDTP’s first annual assessment of the Consultant workforce.

This Consultant workforce report is possible due to the development of NDTP’s Doctors Integrated Management E-System (DIME), which for the first time provides a central source of data on Medical Workforce in the Public Sector.

NDTP’s Strategic Plan 2016 – 2020 identified the requirement for a dedicated NDTP database of medical staffing, to underpin the core functions of the division (i.e. Medical Training, Consultants Division and Medical Workforce Planning), and to help to achieve our vision that ‘Patient care and patient outcomes are maximised as a result of an aligned and appropriately skilled medical workforce’.

DIME provides invaluable data on the current medical workforce, and equips the HSE with the knowledge required to understand both the current and future medical workforce challenges, and hence respond to these challenges more effectively. This report will be published on an annual basis going forward and thus will show trends in areas such as workforce growth, gender distribution, age and permanent/locum appointments.

The report demonstrates significant challenges for Model 3 Hospitals. For example, almost one third of all consultants working in these hospitals are 55 years old or over, and 17% of consultants employed in Model 3 Hospital are in a non-permanent capacity. Certain specialties also face workforce challenges, such as Obstetrics & Gynaecologist in which 40% of consultants are 55 years or over, compared to the average rate of 26%.

It should be noted that the data provided within this report is based on the information provided by individual clinical sites via the DIME system, and is based on a completion and verified rate of almost 90%. Further developments are being applied to the system to enhance the data in the coming years, including distinguishing between unmatched posts and vacant posts - this will allow NDTP to report on consultant vacancies.

I would like to thank the clinical sites and Medical Workforce units for their hard work in populating and maintaining the data within DIME. I would also like to thank the NDTP for their foresight and perseverance in developing the DIME database upon which this report is based and to highlight the principal role of Simon O’Hare in developing this report.

Prof Frank Murray MD. Director National Doctors Training & Planning, HSE.

1 Background This is the first assessment of the Consultant workforce in Ireland. While there are limitations to this data (e.g. NDTP does not hold information on private practice), this report is useful for framing discussions on a number of Consultant workforce planning issues (e.g. recruitment, retention, replacement, geographic spread of services, equality, and working arrangements). In coming years, NDTP will merge this assessment report with the ‘Annual Assessment of Non-Consultant Hospital Doctor posts’ (latest version available here) to provide a better understanding of the medical workforce and strengthen workforce planning.

The NDTP Consultants Division is responsible for the HSE regulatory role in the context of Consultant appointments1. The Consultants Division processes all applications for additional or replacement Consultant posts for consideration by the Consultant Applications Advisory Committee (CAAC). Membership of the CAAC includes senior HSE officials, medical Consultants, representatives from patient advocacy groups and representatives from the Irish Hospital Consultants Association and the Irish Medical Organisation. For many years, it has been possible for NDTP to provide data on the number of approved Consultant posts in Ireland. However, it has not been possible to provide data on the profile of our Consultant workforce.

NDTP’s Doctors Integrated Management E-System (DIME) captures information on all doctors employed in the public health system. In late 2016 NDTP developed the Consultants Module of DIME to improve the level and quality of information available regarding Consultant posts and Consultants employed in the Irish Health Service. NDTP continues to liaise with clinical sites to ensure that Consultants are being matched to Consultant posts. There is a number of objectives behind the development and rollout of the module including:

 Having every Consultant working in the public health service matched to a Consultant post, knowing where all Consultants are working in the public health system and what the tenure of their employment is  Knowing the status of Consultant posts, whether they are approved or unapproved and whether they are filled or vacant  Having data on the number of permanent, temporary, agency, or locum Consultants employed;  Having the reporting capability to provide information on both Consultant posts and Consultants by clinical site, hospital group, community healthcare organization and medical discipline (including speciality and sub-speciality)  Creating a central repository of Consultant workforce data that is used by both employers and NDTP to facilitate enhanced medical workforce planning. About this data On the 1st of January 2018, DIME held information on 3,249 HSE-funded Consultant posts. 3095 of these posts were officially approved. 2816 posts were matched to a Consultant(s) and had details of the post verified.

In general, information in this report is accurate at the 95% confidence level, ±1%. Some variables have a lower completion rate than others (e.g. hours worked per week) and the quality of information varies between clinical sites. This means for local information, and some specific variables, the margin of error increases. NDTP aims to further develop this information and analysis on Consultant posts, workforce demographics and working arrangements (and how these variables interact with each other), so that recruitment, retention and replacement challenges in healthcare settings, and medical specialties, can be better identified.

1 These functions are referenced in the Consultants Contract (2008).

2 Consultant Application Approvals in 2017 In 2017 the CAAC approved 174 applications for Consultant posts.

Figure 1 shows the proportion of CAAC approvals that were for additional and replacement posts and Figure 2 shows the trend in approvals since 2011.

Figure 1: Additional and replacement post approvals by the CAAC (2017)

Additional posts 76 98 (44%) Replacement posts (56%)

While the CAAC approved almost 100 additional Consultant posts in 2017, the annual growth in Consultant posts fell the second year in a row.

Figure 2: Total number of CAAC approved additional and replacement posts (2011-2017) 350

300

250 106 Replacement 200 posts

83 150 93 95 76 Additional posts

Numer of consultant posts consultant of Numer 111 100 62 182

50 101 98 112 98 77 54 0 2011 2012 2013 2014 2015 2016 2017

3 Distribution of Consultant posts by medical disciplines and specialties After completing their internship, many doctors undertake postgraduate training with a view to becoming a medical specialist. The Medical Council in Ireland recognises over 50 medical specialities in which doctors can train. To help with describing and visualising data, in this report medical specialties are sometimes grouped into smaller categories called medical disciplines (e.g. the medical discipline ‘surgery’ contains 13 different surgical specialties).

At the 1st of Jan 2018, DIME contained information on 3,249 Consultant posts across the range of healthcare settings.

Figure 3 shows the distribution of all Consultant posts on DIME by medical discipline, Figure 4 shows the share of all Consultant posts by medical specialty, and Figure 5 shows the annual growth in the number of posts by medical discipline.

Figure 3: Distribution of Consultant posts, by medical discipline (2018) Medicine 24%

Surgery 17%

Psychiatry 14%

Anaesthesia 12%

Radiology 9% Medical discipline Medical Pathology 9%

Paediatrics 7%

Obstetrics & Gynaecology 5%

Emergency Medicine 3%

Intensive Care Medicine 1%

0% 5% 10% 15% 20% 25% 30%

% of all Consultant posts

Figure 4: Distribution of Consultant posts by medical specialty (2018)

General Medicine 12.1% Anaesthesia 11.8% Radiology 8.2% Psychiatry 8.1% Paediatrics 6.5% General Surgery 6.0% Obstetrics & Gynaecology 5.0% Histopathology 3.8% Geriatric Medicine 3.6% Orthopaedic Surgery 3.5% Emergency Medicine 3.2% Child & Adolescent Psychiatry 3.2% Haematology 2.1% Microbiology 1.8% Otolaryngology 1.8% Cardiology 1.7% Psychiatry of Old Age 1.6% Urology 1.5% Ophthalmic Surgery 1.4% Dermatology 1.4% Psychiatry of Learning Disability 1.3% Neurology 1.3% Medical Oncology 1.3% Palliative Medicine 1.2%

Medical Specialty Specialty Medical Plastic Surgery 0.9% Radiation Oncology 0.8% Intensive Care Medicine 0.7% Cardiothoracic Surgery 0.6% Infectious Diseases 0.5% Neurosurgery 0.5% Rehabilitation Medicine 0.4% Oral & Maxillofacial Surgery 0.4% Neurophysiology 0.3% Immunology 0.3% Paediatric Surgery 0.2% Chemical Pathology 0.2% Biochemistry 0.2% Clinical Pharmacology 0.2% Rheumatology 0.1% Genito-Urinary Medicine 0.1% Clinical Genetics 0.1% Neuropathology 0.1% Metabolic Diseases 0.0% 0% 2% 4% 6% 8% 10% 12% 14% % of all Consultants posts

Figure 5: Growth in Consultant posts by medical discipline (2017-2018)

Radiology <1%

Anaesthesia <1%

Surgery 3%

Average 3%

Emergency Medicine 4%

Pathology 4%

Psychiatry 4% Medicaldiscipline

Medicine 4%

Obstetrics & Gynaecology 4%

Paediatrics 6%

Intensive Care Medicine 9%

0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10%

Annual growth in Consultant workforce

4 Distribution of Consultant posts across healthcare settings Figure 6 shows the distribution of Consultant posts across the range of HSE health settings, and Figure 7 shows the distribution of Consultant posts between Hospital Groups (HG).

Figure 6: Share of Consultant posts by healthcare setting (2018)

Ireland East Hospitals Group 16%

South / South West Hospitals Group 16%

Dublin Midlands Hospitals Group 16%

Saolta Hospitals Group 14%

RCSI Hospitals Group 14% Healthcare Healthcare setting Community Health Organisations 13%

Children's Hospital Group 6%

University of Limerick Hospitals Group 5%

0% 2% 4% 6% 8% 10% 12% 14% 16% 18%

% of all Consultant posts

Figure 7: Share of Consultant posts by Hospital Group (HG) -2018 20%

18% 19% 18% 18% 16% 16% 16% 14%

12%

10% % of Consultants all 8%

6% 6% 6% 4%

0% University of Children's RCSI HG Saolta HG Dublin South/South Ireland East Limerick HG HG Midlands HG West HG HG Hospital Group

5 Age profile of Consultants in HSE-funded posts Figure 8 demonstrates the age range of Consultants in HSE-funded posts across all healthcare settings. Figure 9 shows the gender distribution of Consultants by age.

Figure 8: Age range of Consultants matched to HSE funded posts (2018) 25%

23% 20% 22% 20% 15% 16% 10% 9% 8%

%Consultants of all 5% <1% 0% 2% Under 35 35-39 40-44 45-49 50-54 55-59 60-64 65 or over Age Categories

While there were almost equal numbers of male and female Consultants in the under 40 age categories, males had significantly higher representation in older age groups.

Figure 9: Age of Consultants in HSE funded posts, by gender (2018) 100% 90% 80% 43% 49% 70% 58% 58% 68% 72% Male 60% 80% 50% 96% Female 40% 30% 57%

%Consultants of all 51% 20% 42% 42% 32% 28% 10% 20% 4% 0% Under 35 35-39 40-44 45-49 50-54 55-59 60-64 65 or over Age categories

26% of all Consultants were aged 55 year or over, providing a crude estimate of the numbers of Consultants that need to be replaced before 2028 to maintain the existing status quo.

The percentage of Consultants aged 55 years or over varied for different types of hospitals (Figure 10) and healthcare settings (Figure 11).

Figure 10: Percentage of Consultants aged 55 years or over, by type of hospital (2018) 50% 45% 40% 43% 35% 30% 31% 25% 20% 23% 15% 10%

5% % of Consultantsaged 55 orover 0% Model 2 Model 3 Model 4 Type of hospital

Figure 11: Percentage of Consultants aged 55 years or over, by healthcare setting (2018) CHO 2 30% Ireland East Hospitals Group 30% Saolta Hospitals Group 30% University of Limerick Hospitals Group 28% CHO 4 28% CHO 6 27% CHO 8 27% Average 26% CHO 1 26%

Healthcaresetting CHO 5 26% Children's Hospital Group 25% Dublin Midlands Hospitals Group 25% RCSI Hospitals Group 25% South / South West Hospitals Group 24% CHO 7 23% CHO 3 19% CHO 9 16%

0% 5% 10% 15% 20% 25% 30% 35% 40% % of all Consultants aged 55 and over

There was considerable variation in the percentage of Consultants aged 55 years or over for different medical disciplines and specialties, as per Figure 12 and Figure 13.

Figure 12: Percentage of Consultants aged 55 years or over, by medical discipline (2018) Obstetrics & Gynaecology 40%

Surgery 31%

Anaesthesia 29%

Average for all disciplines 26%

Emergency Medicine 25%

Psychiatry 25%

Medicaldiscipline Radiology 25%

Pathology 25%

Paediatrics 24%

Medicine 22%

Intensive Care Medicine 16%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

% of all Consultants aged 55 or over

Figure 13: Percentage of Consultants aged 55 or over, by medical specialty2 (2018)

Neurosurgery 46% Obstetrics & Gynaecology 40% Otolaryngology 38% Psychiatry of Learning Disability 35% General Surgery 34% Cardiology 33% Radiation Oncology 30% Rehabilitation Medicine 30% Anaesthesia 29% Microbiology 29% Immunology 29% Orthopaedic Surgery 28% Urology 28% Oral & Maxillofacial Surgery 27% Palliative Medicine 26% Average for all specialties 26% Plastic Surgery 26% Psychiatry 25% Emergency Medicine 25% Haematology 25%

Medicalspecialty Child & Adolescent Psychiatry 25% Radiology 25% Paediatrics 24% General Medicine 23% Histopathology 23% Ophthalmic Surgery 23% Cardiothoracic Surgery 22% Psychiatry of Old Age 20% Dermatology 17% Intensive Care Medicine 16% Geriatric Medicine 16% Paediatric Surgery 14% Chemical Pathology 14% Medical Oncology 13% Infectious Diseases 13% Neurology 12% Neurophysiology 10%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

% of Consultants aged 55 or over

2 Specialties with fewer than 10 Consultants in posts are excluded from this table.

Table 1 demonstrates the percentage of Consultants aged 55 years or over for selected clinical sites. Table 1: Consultants aged 55 years or over by Principal clinical site3 (2018) Principal Clinical Site % of Consultants aged 55 or over per site MHS Kildare / West Wicklow 7% MHS Cork North Lee 8% MHS Carlow / Kilkenny 10% Mercy University Hospital 12% Connolly Hospital, Blanchardstown 17% Rotunda Hospital 18% MHS Dublin North 18% BreastCheck - Eccles Unit 18% MHS Louth / Meath 18% Royal Victoria Eye & Ear Hospital 18% Tallaght Hospital 18% Children's University Hospital, Temple Street 18% MHS Limerick 19% CAMHS Galway 20% South Infirmary-Victoria University Hospital 20% Mater Misericordiae University Hospital 20% University Hospital, Limerick 21% Waterford Regional Hospital 21% Cork University Hospital 22% Our Lady of Lourdes Hospital, Drogheda 23% MRH Portlaoise 23% St James's Hospital 23% Galway University Hospitals 24% Naas General Hospital 24% Beaumont Hospital 24% MHS Cavan / Monaghan 25% Coombe Women & Infants University Hospital 26% Average for all principal sites 26% Mayo University Hospital 27% CAMHS Dublin North City 27% Portiuncula Hospital, Ballinasloe 28% St Vincent's University Hospital 28% MHS Galway / Roscommon 29% Our Lady's Children's Hospital, Crumlin 30% MHS Wexford 30% National Rehabilitation Hospital 30% St Luke's Hospital, Rathgar 30% University Hospital Kerry 31% Area 4 & 5 MHS - Lomans & Tallaght 33% MHS Waterford 33% St Luke's General Hospital, Kilkenny 33% National Maternity Hospital 35% Cappagh National Orthopaedic Hospital 36% MRH Mullingar 36% MRH Tullamore 36% BreastCheck - Merrion Unit 36% Central Mental Hospital, Dundrum 36% MHS Laois / Offaly 36% Wexford General Hospital 37% Sligo Regional Hospital 37% South Tipperary General Hospital 38% MHS Mayo 38% St Columcille's Hospital 38% Our Lady's Hospital, Navan 40% Letterkenny General Hospital 41% MHS Cork South Lee 50% Cavan General Hospital 56% CAMHS Cork 60%

3 Sites with fewer than 10 Consultants matched to posts are not included in this table

6 Gender of Consultants Figure 14 demonstrates the gender profile of Consultants; males held just under two thirds of all Consultant posts. Figure 15 shows the gender profile of Consultants in different healthcare settings.

Figure 14: Gender of Consultants matched to HSE funded posts (2018)

36% Female

Male 64%

Figure 15: Gender of Consultants matched to HSE posts, by healthcare setting (2018)

Ireland East Hospitals Group 27% 73%

University of Limerick Hospitals Group 29% 71%

South / South West Hospitals Group 29% 71%

Saolta Hospitals Group 33% 67% Female Male RCSI Hospitals Group 34% 66%

Healthcaresetting National average 36% 64%

Dublin Midlands Hospitals Group 37% 63%

Children's Hospital Group 49% 51%

Community Health Organisations 55% 45%

0% 20% 40% 60% 80% 100%

% of all Consultants

Figure 16 demonstrates the gender profile of Consultants by medical discipline and Figure 17 shows the gender profile for selected medical specialties.

Figure 16: Gender of Consultants matched to HSE posts, by medical discipline (2018) Surgery 13% 87%

Emergency Medicine 21% 79%

Anaesthesia 33% 67%

Medicine 33% 67%

National average 36% 64% Female Male

Medical discipline Medical Radiology 37% 63%

Obstetrics & Gynaecology 45% 55%

Paediatrics 50% 50%

Psychiatry 53% 47%

Intensive Care Medicine 53% 47%

Pathology 55% 45%

0% 20% 40% 60% 80% 100% % of Consultants

Figure 17: Gender of Consultants matched to HSE posts, by specialty4 (2018)

Oral & Maxillofacial Surgery 100% Neurosurgery 8% 92% Cardiology 8% 92% Urology 10% 90% Orthopaedic Surgery 10% 90% General Surgery 10% 90% Cardiothoracic Surgery 17% 83% Otolaryngology 20% 80% Plastic Surgery 21% 79% Emergency Medicine 21% 79% Neurology 26% 74% General Medicine 27% 73% Neurophysiology 30% 70% Ophthalmic Surgery 31% 69% Anaesthesia 33% 67% National average 36% 64% Radiology 37% 63% Female Medical Oncology 38% 62% Male Geriatric Medicine 38% 62%

Radiation Oncology 39% 61% Medicalspecialty Obstetrics & Gynaecology 45% 55% Psychiatry 47% 53% Paediatrics 50% 50% Rehabilitation Medicine 50% 50% Infectious Diseases 50% 50% Intensive Care Medicine 53% 47% Haematology 54% 46% Histopathology 56% 44% Microbiology 57% 43% Psychiatry of Learning Disability 57% 43% Psychiatry of Old Age 58% 42% Child & Adolescent Psychiatry 63% 37% Palliative Medicine 67% 33% Dermatology 69% 31%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% % of Consultants

4 Specialties with fewer than 10 Consultants matched to posts are not included in this table

7 Registration held with the Medical Council Consultants in Ireland usually hold Specialist Registration with the Medical Council.

Doctors with Specialist Registration may practise independently, without supervision and may represent themselves as specialists. Doctors with General Registration may also practise independently without supervision but may not represent themselves as being specialists.

135 Consultants (4.5% of all) held General Registration with the Irish Medical Council (as in Figure 18).

Figure 18: Registration type held by Consultants (2018)

4.5%

General Registration

Specialist Registration

95.5%

Consultants in Model 3 (10%) and Model 2 Hospitals (9%) were more likely than Consultants in Model 4 hospitals (2%) to hold General Registration with the Medical Council (as per Figure 19).

Figure 19: Registration type for Consultants in HSE marched posts, by type of hospital (2018) 100% 2% 9% 10% 90%

80%

70%

60% General Registration Specialist Registration 50% 98% 92% 90%

%of Consultants 40%

30%

20%

10%

0% Model 4 Model 2 Model 3 Types of hospitals

Prior to March 2008 Specialist Registration was a not mandatory requirement to be appointed to a Consultant post.

After excluding Consultants who hold General Registration, but who took up post before the mandatory employment requirement came into effect, there remained 85 Consultants with General Registration in HSE funded posts (2.9% of all).

Figure 20: Registration type held by Consultants - adjusted5 (2018)

2.9%

General Registration

Specialist Registration

97.1%

5 After removing Consultants holding General Registration before the mandatory employment requirement

8 Contract types and classes held by Consultants6 Figure 21 demonstrates the type of contract held by Consultants matched to HSE-funded posts and Figure 22 demonstrates the class of contract held by Consultants.

Figure 21: Types of contracts held by Consultants in matched posts (2018) 1800

1600 1660 1400 (56%)

1200

1000

800

Number of Consultants of Number 600

400 512 (17%) 200 312 186 (6%) (10%) 142 (5%) 163 (5%) 0 Type C Category 2 Category 1 Type B* Type A Type B Contract types

Figure 22: Class of contract held by Consultants in HSE funded posts7 (2018)

12% Consultants' Contract 1997 Consultants' Contract 2008

88%

6 For a detailed description of the different contract types and classes please refer to guidance here and here. 7 Contract classes held by fewer than 10 Consultants are excluded from this analysis

Figure 23 demonstrates the breakdown of contract classes of by gender and Figure 24 shows contract class by medical discipline.

Figure 23: Class of contracts held by Consultants, by age (2018) 100% 2% 2% 11% 16% 13% 90% 20% 22%

80%

70% Consultants' Contract 1997 Consultants' Contract 2008 60%

50% 100% 98% 98% 89% 84% 88% 40% 80% 78%

30%

20%

10%

0% Under 35 35-39 40-44 45-49 50-54 55-59 60-64 65 or over

Figure 24: Class of contracts held by Consultants, by medical discipline (2018) Surgery 23% 77%

Obstetrics & Gynaecology 19% 81%

Anaesthesia 12% 88%

Emergency Medicine 12% 88% Consultants' Contract 1997 Radiology 12% 88% Consultants' Contract 2008

Psychiatry 9% 91%

Medicine 8% 92%

Pathology 5% 95%

Paediatrics 1% 99%

Intensive Care Medicine 100%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

9 Tenure (permanent or non-permanent) Out of 3011 Consultants, 406 (13% of all) did not have a permanent contract (e.g. doctors working through an agency or on a fixed term contract), as per Figure 25.

Figure 25: Tenure held by Consultants (2018)

13% Not permanent

Permanent

87%

The following figures show the tenure held by Consultants: in different healthcare settings (Figure 26), in different types of hospitals (Figure 27), by discipline (Figure 28), and for clinical sites (Figure 29).

Figure 26: Tenure held by Consultants, by healthcare setting (2018)

Children's Hospital Group 98% 2%

Dublin Midlands Hospitals Group 90% 10%

South / South West Hospitals Group 89% 11% Permanent

University of Limerick Hospitals Group 88% 12% Not permanent

RCSI Hospitals Group 88% 12%

Ireland East Hospitals Group 88% 12%

Saolta Hospitals Group 83% 17% Healthcaresetting

Community Health Organisations 77% 23%

0% 20% 40% 60% 80% 100% % of Consultants within healthcare setting

Figure 27: Tenure held by Consultants, by type of hospital (2018) 100% 6% 9% 90% 19% 80% 70% 60% Not permanent 50% 94% 91% Permanent 40% 81%

%of Consultants 30% 20% 10% 0% Model 4 Model 2 Model 3

Figure 28: Tenure held by Consultants, by medical discipline (2018)

Pathology 95% 5%

Obstetrics & Gynaecology 90% 10%

Surgery 89% 11% Permanent Radiology 88% 12% Not permanent Anaesthesia 88% 12%

Medicine 88% 12% Medicaldiscipline Paediatrics 87% 13%

Intensive Care Medicine 84% 16%

Psychiatry 79% 21%

Emergency Medicine 73% 27%

0% 20% 40% 60% 80% 100%

Figure 29: Tenure held by Consultants for selected Principal clinical sites8 (2018)

MHS Wexford 50% 50% MHS Cavan / Monaghan 58% 42% South Tipperary General Hospital 59% 41% MHS Carlow / Kilkenny 60% 40% MHS Cork North Lee 62% 38% MHS Kildare / West Wicklow 64% 36% CAMHS Linn Dara 67% 33% Permanent MHS Mayo 69% 31% Not permanent MRH Mullingar 69% 31% Letterkenny General Hospital 70% 30% CAMHS Galway 70% 30% MHS Galway / Roscommon 71% 29% MHS Laois / Offaly 73% 27%

CAMHS Dublin North City 73% 27% Clinical Clinical site Wexford General Hospital 73% 27% Our Lady of Lourdes Hospital, Drogheda 74% 26% Portiuncula Hospital, Ballinasloe 75% 25% Cavan General Hospital 76% 24% MHS Dublin North 76% 24% University Hospital Kerry 77% 23% Connolly Hospital, Blanchardstown 77% 23% Waterford Regional Hospital 78% 22% Sligo Regional Hospital 80% 20% Our Lady's Hospital, Navan 80% 20% MHS Limerick 81% 19% St Columcille's Hospital 85% 15% Mater Misericordiae University Hospital 86% 14% Mercy University Hospital 86% 14% Coombe Women & Infants University Hospital 86% 14% MHS Louth / Meath 86% 14%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%100%

8 Sites with fewer than 10 Consultants in post, and sites with fewer than average numbers of Consultants with non-permanent contracts, are excluded from this figure

10 Working Full Time and Less Than Full Time Of the 2802 Consultants about whom DIME contained working arrangement information on, 372 (13%) worked Less Than Full Time (LTFT).

Figure 30: Working arrangements – Full Time or Less Than Full Time (2018)

13% Full time Less than full time

87%

Female Consultants were more likely than males to work Less Than Full Time (Figure 31) and Consultants in unapproved posts were more likely than those working in approved posts to work Less Than Full Time (Figure 32).

Figure 31: % of Consultants working Less Than Full Time, by gender (2018) 30%

25%

20%

15%

10% 16% 5% 12%

%working than less Time Full 0% Female Male Figure 32: % of Consultants working Less Than Full Time, by approval status of post (2018) 25%

23% 20%

15%

13% 10%

5% %working than less fulltiime

0% Approved Not approved Approval status of post

11 Approval status of posts As of 1st January 2018, 112 Consultants (4% of all) worked in posts that had not been approved by the CAAC (as per Figure 33).

Figure 33: Approval status of Consultant posts (2018)

Approved

Not approved

96%

The percentage of Consultants working in unapproved posts varied by hospital type (Figure 34) and between clinical sites (Figure 35).

Figure 34: % of Consultants in unapproved posts, by type of hospital (2018) 10%

7% 7% 6%

4% 5%

3% %of Consultants unapproved in posts 2% 3%

0% Model 4 Model 2 Model 3 Type of hospital

Figure 35: % of all Consultants in unapproved posts, for selected clinical sites9 (2018) St Luke's General Hospital, Kilkenny 27% MHS Wexford 25% Mayo University Hospital 22% Wexford General Hospital 20% Naas General Hospital 20% South Tipperary General Hospital 17% Our Lady's Hospital, Navan 15% Children's University Hospital, Temple Street 15% MHS Carlow / Kilkenny 11% Central Mental Hospital, Dundrum 10% Cavan General Hospital 10% MRH Mullingar 9% Waterford Regional Hospital 8%

Clinical Clinical site Sligo Regional Hospital 7% MRH Tullamore 7% University Hospital, Limerick 6% University Hospital Kerry 5% Royal Victoria Eye & Ear Hospital 5% St Vincent's University Hospital 4% St James's Hospital 4% Grand Total 4% Letterkenny General Hospital 4%

0% 5% 10% 15% 20% 25% 30%

% working in unapproved posts

9 Only sites with 10 or more Consultants, and with a greater than average share of Consultants in unapproved posts, are included in this figure.

Notes ______