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?


  1. As a medical student, I find stories like this somewhat scary. For a start, they all end up coming down to Mail-style "annual salary" figures, and never per-unit-labour figures.

    I was talking to a GP this week. The previous day he'd had two clinic sessions. He put 90 patients through. The following day, a partner GP put 50 through just in the late afternoon clinic.

    Those people were seen, examined, diagnosed and treated in the community - and were kept out of our beleagured hospitals. Because of the particular patient population, many of those would have been medical card and GP visit card patients. It doesn't matter how much that cost the taxpayer - how much did it *save* the exchequer by keeping them out of A&E? A bloody fortune is how much.

    Thanks to the expansion of med school places through graduate programmes, in the very near future half of Irish doctors will be graduating with over €100,000 in debt. The assumption from on high is that a big portion of these docs will end up in GP land because of the 'lifestyle' aspects of the job [more predictable hours and so forth]. If they maintain this disgusting attack, that's not going to happen - all they'll be left with is a whole lot of juniour doctors sitting licensing exams for the US and Oz.

  2. I have a way of making the healthcare system so efficient that it can provide healthcare.
    Don't manage to bankrupt the country in a time of plenty!

    How the Government managed that one is a bit beyond me. The country was thigh deep in cash not so very long ago. Did any of those in charge budget for a rainy day? Did they do, well, ANYTHING? NO!

    And now the old, poor and sick are being forced to bail out these greedy morons?

    Rest assured they'll burn in hell. Unfortunately they will probably not be held accountable for their actions in this lifetime.

  3. "Reducing expenditure on the NTPF would have been one of several health care ‘cuts’ considered by the government, but cutting the medical card for over-70’s is what it chose. Above all else, bail out the boys. Maintain the illusion that the private hospital sector is efficient and cost effective, rather than invest in the public hospitals so that they can deal, in a timely manner, with the patients that were referred to them. And spin it so that it looks like the medical card money was only going to doctors for doing nothing anyway. In this analysis, spending money on GP’s is the same as wasting money. (On the contrary, the evidence in the medical literature is that expenditure on primary care offers the best value for money in health care - much more so than expenditure in the acute services). But do not, under any circumstances, dare to mention or to threaten the extravagant profligacy of NTPF money (€100 million) being doled out to the beloved private hospitals and investors."

    The above link is worth a read. Taking care of Irish citizens is basically going to be phased out, as PD Harney would have it, and only the market and profit shall determine who gets healthcare.

    America here we come!

  4. So, at a time when Harney should be investing in primary care having ensured that our A&E departments have become too prohibitively expensive to visit, she now has her sights firmly set on clawing back money from the GP service so that it'll fail to accommodate the extra burden! I don't suppose this has anything to do with privatisation, has it? ;-)

  5. So, you're saying that when I go to the GP, am seen for 15 minutes tops, asked a few questions and poked or prodded, then pay 60 euro, that's money well earned? Before I go shouting that GPs are overpaid, as the sore spot in my wallet would lead me to do, I'll just ask... is there something I'm missing? What's the background work that I'm not aware of, that justifies this cost?

  6. Well, pfm, 60 euro for 15 minutes is expensive. But less than half of that is profit. Your GP pays thousands in insurance and pays staff and rent, aswell as other costs. This is ignoring that fact that they are private business people, who will have invested a lot of cash into their business.

    Then there's the training they undertook to get to the stage where they are able to, in most cases, sort out your health problems within 15 minutes off meeting you. There's also the years of working 100 hour weeks serving the public as essentially slave labour in our public hospitals.

    And finally, part of what you're paying for is someone to take a hell of a lot of responsibility. If you've ever missed a serious diagnosis, then you'll know just how heavy a burden that is.

    I payed my lawyer about 80 euro for him to notarise my medical degree, which took seconds. Your GP doesn't earn an enormous amount more than some plumbers or electricians that I know. That seems odd, when you consider the gap in training an responsibilty between them.

    Dr. Thunder