A HSE audit has found that 99 hospital consultants earned €350,000 or more in 2023, for public work.
The average remuneration was €416,000.
The internal audit shows that the highest paid consultant earned €963,000 - down by around €10,000 for the highest paid consultant the previous year.
The payments were made for a range of factors including overtime, on-call payments, payments for annual leave and rest days not taken, cross cover, plus payments made under the National Treatment Purchase Fund to cut waiting lists, under local arrangements.
The specialist areas which drove much of the payments were radiology, emergency medicine, surgery and psychiatry.
The number of consultants earning over €350,000 rose from 57 in 2022, to 99 in 2023.
There are over 4,600 consultants working in the HSE.
The HSE audit said that the increase in the number of consultants in the €300-€350K pay bracket was due to new pay agreements and the unwinding of cuts made under the Financial Emergency Measures in the Public Interest Act.
The combined pay for the 99 consultants was €41m.
The HSE added that the pay covers the calendar year of 2023, which was a transition year for the roll-out of the public only consultant contract, which began in March that year.
The audit recommends that a single live register of legacy exceptional payments be put in place and that each Regional Finance Director validate their register each quarter, which would be re-authorised each year by the Regional Executive Officer.
The report also recommends that there should be a systematic wind-down of off-contract payments, through measures including filling vacant consultant posts, commissioning extra capacity, like diagnostics and theatre time and re-rostering planned work into the extended working day.
The audit notes that patient safety may be compromised where consultants are overstretched and staff turnover may increase if additional tasks for consultants lead to burnout.
The Internal HSE Audits are released by the HSE each quarter, under Freedom of Information.
The 2022 Internal Audit highlighted similar issues.
