Saturday, 18 October 2008

Lazy golf-playing, arse scratching Irish docs costing the elderly their health.

Posted by: Dr. Thunder

I read this yesterday. It's a short article in the Irish independent:


The Tanaiste is putting pressure on doctors to reduce the amount of money they receive to provide healthcare for elderly medical card holders. Mary Coughlan has indicated that if GPs were prepared to take less money, the Government could readdress the abolition of universal medical cards for the over 70s. There has been uproar since the Government announced in the Budget on Tuesday that they would be scrapping the scheme, which automatically entitles every person over 70 to a medical card.The Minister for Health issued modifications to scheme last night.People on the State contributory pension will still qualify, and those over the threshold will receive either a GP-only card or a €400 annual payment, depending on their financial situation.

I think the Irish government are taking lessons in spin from the British government. When I was a paediatric SHO in the UK, all ills were blamed by the government on doctors. We were told we didn't work hard enough. We were told we weren't efficient enough. Patients were told not to let us hold them to ransom.
Then they went to town on the GPs. The Labour government said they were going to sort out those lazy bastards. They told GPs that they'd be paid ONLY for the work they were doing. They had made the assumption that GPs didn't work hard. Everyone working in the NHS knew that was a crock of balls. But I guess people in ivory towers in london don't really get the coal-face view.
Anyway, they paid the GPs for EXACTLY what they did. And it almost bakrupted them. The government soon found out just how productive British GPs are. So, they got paid a lot of money. Not the 250,000 pound salaries that the media talked about. But nonethless the GPs mostly got a payrise, as they were now being paid for work they previously did for free.

So, now the irish government are following suit. Our deputy prime minister (known as the Tanaiste in Ireland) is engaging in a bit of damage limitation. She has had to tell pensioners in Ireland that there's not enough money to provide primary healthcare for them.
But that's bad news. It doesn't look good for the health service when politicians have to make tough decisions that involve curtainling healthcare. That doesn't bode well for the next election.

So, they tell the public that the reason for their piss-poor healthcare provision is that GPs are over paid. They want them to take less money, to help the government out.
Now, I'm not a GP. But if I was, I'd be telling Mary Coughlan to take a jump.
The governement negotiated a contract with GPs, and now suddenly they want to change the terms of that agreement. They know no lawyer is going to be able to pull that off by force, through legitimate channels, so they use this disgusting spin.

"Old people can't get free healthcare because doctors are too greedy". Why are doctors the only group within the health service being asked to take a pay cut? Sure, they have to be paid, but so do lots of other people who are involved in the running of the medical card system. Admin staff, accounts staff, politicians and advisors are all taking a cut.

I would argue they're all less efficient parts of the equation than the GPs.

The Irish government tried this recently with the pharmacists. They decided they didn't like how much they were paying them, so they tried to bully the chemists into taking a big cut in their remuneration. That was equally as cynical, and it didn't work.

My advice to the health service executive is the look at the big picture. If you want doctors to work with you, and cut you some slack when they're senior enough to GPs....then stop treating them like crap when they're juniors.

Who is ever going to feel any loyalty to a health service that breaks them down to the point of emigration??

So, should GPs take a pay cut? Or are there other ways of making the health care system efficient enough to, well, provide healthcare?

Saturday, 11 October 2008

Please welcome our newest blogger, Dr. P

Hi guys,
Dr. Thunder here. Just posting Dr. P's blog entry while we sort him out with a password etc. Dr. P is a medical registrar working in Ireland. Here's his 1st post:

Few things to me seem as naturally paradoxical as locum work.

Condensation builds up on the windscreen of my pride and joy as the clock ambles particularly showly from 8.30 to 8.55. Here goes.
The sympathetic orchestra slowly climaxes in my small intestine as I click my car door shut in the shadow of my place of employment for the next few days.. (or at least the next few hours).
The fear and desire to take flight are in stark contrast with the determination and certainty that won me this short adventure in mercenary medicine in the first place.

I had to regularly update my CV. I had to provide proof that I was Hep B immune(again at least for the next few hours). And most importantly, I had to alert the agency that I would be available to stand in for one of my absent peers.
With lightening fast fingers, I dialed the agency. ‘Hi... Yes I’m available for the job in Portlaoise/Sligo General/St Lukes Hospital… Great… Thanks, talk to you then.’..

Some say locums get a raw deal. Not necessarily so. Suspicion is much more often bestowed on Medical Mercenaries than any significant level of responsibility. Locums usually carry out the work of juniors.

Studies somewhere would surely show that locums are at least twice as likely to be asked to perform the PR exam that the Reg forgot, roughly 30% more likely to be asked to take the peripheral blood culture that eluded the intern and four times more likely to be holding the SHO bleep for the less sought after portion of the night.
Thankfully, this contrasts with the inflated hourly wage of the Locum.
And the less advance notice the Locum recieves, the more hansomely rewarded he or she is.

But what I find most paradoxical however about my species is the fact that most locums are already overworked in their regular jobs.
Why am I doing this on my week off I think to myself as I walk into a ward I’ve never seen, a list of patients I’ve never met and a barrage of questions I’ll hear over and over again?
‘So where do you work normally?’
‘Do you not need your holiday?’
‘Are you saving for something?’
In a climate where we complain of the hours that we are forced to work, I’m choosing to work just a few more.. Why?
Why not? It’s 80 euros an hour. I’ll take a break on my next week off.

Dr. P