7th April 2003
If there is one thing I am perfectly sure of it is that when the Taoiseach launched an offensive against "profiteering within the professions" at the I.M.I. Management Conference in Killarney recently, he was not talking about the medical profession.
Relying on Una McCaffrey’s report of his speech published in the Irish Times, 5/4/03, he said that "learned professionals or local monopolists or middle men" had helped to push up inflation and, he said, "it was time to call a halt to profiteering". "The last Central Statistics Office report shows quite clearly that the professional services continue to take profits" the Taoiseach said. "They do not add to growth and they do not add to exports".
Now the medical profession may not add to growth or exports in a way the Taoiseach would like but the increased productivity of the medical profession and our health work colleagues must be known to him. Poor productivity was another target of his and that is not the case in the health service. Does anyone ever look at the increase in the number of cases seen and treated in hospitals, especially as day cases?
The Taoiseach said he wanted to highlight professions who have been shielded from the pressures of internal competition. Well, that cannot mean us because there is competition on every corner from aromatherapists, acupuncturists, physical therapists, counsellors, reflexologists, seventh sons of seventh sons and on and on. The Government is advising consultations with pharmacists, opticians and so forth, and one shop stops where the doctor is the last person one will get to see. He cannot be talking about us.
His source of information may be the same as mine, the Indecon investigation for the Competition Authority. We had a debate on it recently in the Seanad and I decided to address the section devoted to the medical profession.
Apart from calling patients "consumers", a practice which always alarms me especially when I am a patient, and talking about "the market", most of it was reasonable. But some of the conclusions were amazing. How can one say there appears to be little competition between G.Ps when 39% of them said it was "extremely difficult" to get medical help and another 33% said it was "very difficult"? This does not sound like people who are promoting a closed shop. Their fees may have been much the same, about 35 euro a visit, but maybe that is about what it costs and allow for a profit. In "the market" we do not want hopeless types who make a loss, do we? Mind you, they may be working a bit more slowly when they near the end of their average week of 79 hours!
Questioning of a representative group of patients did not find price a major factor in chosing a doctor - proximity, reputation, quality of service and "customer" trust were much more important factors I am not surprised to tell you. Patients would like more information on fees but that should be easily remedied by every doctor having a list in his or her waiting room. Easier entry to the G.M.S is also recommended but the investigators did not seem to know that it is very difficult to get any doctors at all in some areas to take on G.M.S. lists.
The Indecon report points out that there is still a shortage of consultants. This is not the fault of consultants and we must point this out over and over again. The time taken to get an appointment for a patient with a consultant generally still means too long a wait for the patient. No one benefits from this.
The delay in making consultant appointments in both voluntary and health board hospitals would be less if the wheels were put in motion one year before the consultant in position is due to retire. No mention is made of the number of consultants taking early retirement or why this may be happening. While the greatest delay in this area may be due to getting permission for funding from the Department of Health and Children some delays are for personal reasons. A doctor appointed to a post in January may want his or her children to finish out the school year in Philadelphia and so delay taking up the position until the summer.
I am very doubtful about the Indecon enthusiasm for by- passing G.P.s and allowing a situation where patients self refer to specialists. Once I was sitting on a park bench in Florida beside two women who were discussing the skin condition of one of them. "I think I’ll go to see Doctor X", said the afflicted one, "he has the biggest add in the Yellow Pages and if he can afford that he must be good".
Another area with which I have problems is the complaints in the Report about the difficulties in recognising the qualifications of doctors from outside the EU. If the Medical Practitioners (Amendment) Act 2002, which we brought through the Oireachtas last summer with great haste, was implemented the experience of these doctors could be taken into account as well as exams and more of these doctors could get full registration. It is to the benefit of the Irish public to have this happen even more than to the non EU doctors who can easily go to the U.K. for employment.
Finally, the recommendation that there should be a big increase in the number of entrants to Irish medical schools, to help "competition" again, is all very well but, after qualification, these people must be given jobs for one year to be allowed registration by the Medical Council. And at the same time we are told there are too many Non-Consultant Hospital Doctors.
Senator Mary Henry, MD
