Spin doctors outnumber specialists in our hospitals
Crisis management is the order of the day but the solution to our gap in manpower is a simple one, writes John Crown
Published 03/07/2011 | 05:00
Members of the Seanad were informed during the week that there will be an emergency debate next Friday, which is not normally a sitting day for the Upper House. This newly-minted senator felt a slight frisson of excitement and more than a puff of delusional self-importance when I heard this. Now I would have the opportunity to claim my rightful role in the great affairs of state!
While visions of Lincoln, Churchill and Chamberlain, Lenin and Kerensky, Parnell, Grattan and Gandhi danced through my head, I wondered what the national emergency was. Had we decided to declare war on Germany and France over the bondholders? Was Kerry planning to secede from the union and set up a Confederate Republic under the dynastic rule of the Healy-Raes, and with a novel form of telephone-based participatory democracy? Was Roscommon introducing slavery?
No, the national parliament needs to meet so that Ireland, the country with the largest number of medical schools per head of population in Europe, can pass emergency legislation to allow foreign trained doctors from non-EU countries -- in the great majority of cases from India and Pakistan -- to have a longer period of temporary registration in Ireland. This in turn is needed to plug the manpower gaps caused by the shortfall of junior doctors. If we don't do this on Friday, some hospitals might close the following Monday.
As has been discussed in this column before, it is flat out wrong that the labours of trainee doctors, whose principal occupation should be learning their specialty, are required to keep the health service running. We urgently need to appoint more specialists. It is doubly wrong that the countries whose doctors we are taking are amongst the most medically underserved nations on earth. Ireland has five times as many doctors per head of population as India.
Legislate on Friday, stay open on Monday. Crisis management remains the order of the day, and the politics of the last health care atrocity remains the principal driver of public policy. Such dismal planning might indicate a shortage of planners, or a limited political engagement in the policy process.
Nothing could be further from the truth. Our under-doctored health service is festooned with planners, inspectors, auditors, managers, management consultants and civil servants. It has enough spin doctors to make the whole population dizzy, but not enough neurology doctors to treat them if that happens. It is overseen by a team of ministers, a Dail Select Committee and a Joint Oireachtas Committee. So many Quango-Roos hop across our health service landscape that it resembles an Australian tourism ad.
The specialist doctor shortage has several disastrous effects. The first is that the waiting times to be seen or to have treatment for an operation are unbelievably long. The second is that most hospital care is given by junior doctors. Thirdly, individual doctors make too much money. One reform would solve all three problems and that is to appoint more specialists.
The new administration is in no hurry to do that. Although Minister for Health James Reilly correctly pointed out that it was unacceptable that one doctor (sadly not me) made €1m from the VHI last year, his planned remedy will do nothing for waiting lists or safety. The minister feels that the VHI must be paying doctors too much for their services, and announced that he will appoint a VHI board (he is the sole shareholder) with the express intention of reducing fees. Individual VHI payments for treatment are, however, already much lower than in the UK, but because successive health ministers have kept specialist numbers down, there is a distorted market and we have large practices and incomes. The fix is simple -- hire more doctors, reducing waiting times, and increasing safety. Making a dangerously small number of doctors do the same work for less money will not increase safety.
There is another problem here. Wearing his minister hat, the minister decides on consultant numbers, wearing his VHI hat he will decide reimbursement. This is as pure a cartel as a cartel gets. It is a one-man cartel. The Competition Authority might take a look.
Thankfully we have competition in the insurance market.
Senator John Crown is a consultant oncologist