The Health Service Executive in Ireland recently announced that locum doctors were not going to be paid for their half-hour lunch break in an effort to save money. This is a nice piece of accounting, understandable given the dire state of the Irish economy, but may lead to a seemingly paradoxical increase in cost to the hospital.
As I understand it, Ireland is currently experiencing one of the worst doctor shortages in the developed world and this will undoubtedly be driving locum salaries northward in a way that would send shivers down the spine of the average health service accountant. No doubt this has something to do with the knee jerk response of cutting some fat where possible - I can visualize the spreadsheet now.
Health service finance functions, particularly in public health, are often protected somewhat from the brutal forces of supply and demand so the locum market represents an interesting microcosm where capitalism, red in tooth and claw, rules. Payment awards seldom apply to locums and the market moves quickly to maximize locum rates, playing vacancies, employers and yes, even agencies, off against each other.
In a market where supply is tight any disincentive to take a role can quickly result in an unfilled vacancy where other more attractive options exist.
When I tweeted this article a few weeks ago a number of doctors reacted indignantly to such “lunch-money” clauses to the extent that they indicated that they may refuse to take the job on principle – in short, they found it insulting. Doctors are not clock-punchers by nature and the job, particularly in acute areas such as Emergency Medicine, does not lend itself to strict half-hour lunch breaks.
Ironically, the money saved can quickly be eroded if the job remains unfilled until the last minute. Locum rates can jump 20-50% in the final 24 hours before the job is filled. The hospital is at risk of paying significantly more in the long run. At worst, the role may go completely unfilled putting patients at risk.
In my experience accountants, like most expert advisers, can sometimes think in terms of their own narrow discipline without taking the broader context into consideration. Their advice is perfectly correct on one level but ultimately a balanced business decision has to be made to guard against such perverse outcomes.
Are the locums being unreasonable? In their defense being a locum can be a thankless task and little things like this can be the last straw. Come on HSE – give a doc a (lunch) break.
Dr. John Bethell
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