Young doctors see no future as country GPs
The HSE incessantly advertises GP jobs in rural Ireland but young medics prefer emigration, says Jerome Reilly
Published 03/05/2015 | 02:30
Rural Ireland is facing a healthcare crisis as young doctors turn their backs on country life and refuse to even apply for jobs as GPs in remote areas.
Hundreds of older GPs are due to retire in the next year, which will leave many communities without a permanent local doctor.
At least 18 permanent GP positions around the country are vacant - some for as long as three years - though all the communities currently have locums
"After the closure of post offices, banks and garda stations, now many rural areas won't have a GP. That is our fear," said Dr Margaret O' Riordan, medical director of Irish Council of General Practitioners (ICGP) .
"Unless corrective measures are introduced, the current trends in emigration and retirement will result in fewer general practitioners to treat patients in rural areas in the next 10 years," she said.
Dr O'Riordan said that rural GPs have been hit hardest by cuts, which means many young doctors feel a career as a country doctor is simply unsustainable.
Cuts in government supports have made setting up a country practice financially unviable, she claims
"The services patients enjoy in rural locations are not sustainable without restoration of some of the cuts made to GPs' pay and conditions under FEMPI (Financial Emergency Measures in the Public Interest) or the Rural Practice Allowance, or both," she said.
The Rural Practice Allowance is a specific payment awarded under the General Medical Card Scheme to GPs who practice in a village with a population of less than 500, and who are more than three miles away from a town with a population of 1,500 or more.
It was worth around €16,000 a year to doctors before it was removed.
Research carried out by the ICGP shows that 12.5pc of trainee GPs are planning on emigrating post-qualification and a further 25pc are undecided.
In Feakle, Co Clare, which has been without a GP for nearly a year, the mainly elderly population now have to travel substantial distances to see a doctor, in an area which has almost no public transport links.
The Health Service Executive failed to attract any applications for the job in Feakle, despite advertising the position three times.
In Gortnahoe, South Tipperary, the local GP recently retired on age grounds. But after advertising the position twice, the HSE was unable to attract a young doctor to the post. Now, the retired doctor is back in his old surgery as a locum at the request of the health service, even though he is past the retirement age.
The crisis will become more acute in the next 12 months as more and more doctors reach retirement age.
Three out of every 10 Irish GPs are aged over 55 years and two out of 10 are aged over 60.
Many rural practices, especially those in isolated areas, have had a locum doctor, rather than a permanent GP, for years. The people of two of the Aran islands, Inis Oirr and Inis Meain, where 255 people are registered with medical cards, have had a locum doctor for seven years and three months.
"Our analysis indicates a high number of GPs coming close to retirement age and many established GPs are very disillusioned with the current situation regarding general practice in Ireland," said Dr O'Riordan.
"The difficulty facing the HSE in attracting GPs is only likely to worsen unless these issues are addressed. In this scenario, patients throughout the country, and particularly patients in rural areas, will face increasing difficulty accessing a general practitioner in their local area in the years to come," she added.
Dr Lineen-Curtis has been GP in Achill for the past 14 years, but now the mother of four is considering her position as cuts make her job near impossible, she says.
"Austerity measures hit all GPs hard, but rural practitioners even more so, and the knock-on effect here is the reduction in manpower from a four-GP partnership to just three," she says.
The Achill practice includes a busy day-care centre for the elderly, a community nursing unit, and its doctors also have to visit two offshore islands on a regular basis to treat sick patients.
And there is an increasingly complex workload in an increasingly aged population.
"Services are becoming more and more stretched. Our local population of about 3,000 grows exponentially during the summer because of visitors and there is a large geographical spread."
"With no out-of-hours cover, it is becoming ever more difficult to maintain standards of care and our own health and quality of life at the same time," she says.
"As a full-time GP with four children aged seven to 12, I am finding it more and more difficult to keep on top of it all. The mobile phone is never more than a few feet from my hand and family time is constantly interrupted, all hours of the day and night, to attend to my patients' needs."
"I genuinely love being a GP, and love living in rural Ireland, but everyone needs time off from the intensity of dealing with all the complex issues that we deal with on a daily basis. I feel strongly that this need is being utterly overlooked by the HSE, and that rural GPs are not valued. I am, for the first time, considering the alternatives," she said.
Another GP, Dr John McCormack, has made his home and career in Rosmuc in the heart of Connemara for the last 12 years. Now, he is questioning if there is a future for a general practice in the isolated village.
"What was once a rewarding career has suffered more than any other area of general practice from increased workload and lack of investment," he claims.
Dr McCormack suggests there are many similarities between rural practices and urban inner-city practices.
"There are high levels of deprivation with difficulties in attracting GPs to set up or stay in practice. With the high levels of deprivation, there is an increased illness burden, and this has workload implications.
"For us, the on-call area is massive. It extends from Inverin to Carraroe to Lettermore, Lettermullen, Casla, Camus, Rosmuc, Maam Cross and further. Last week, a medical student from Singapore attached to the practice was astonished that the time it took to drive from one end of the area to another, was greater than the time it took her to drive from one end of her own country to the other. We have too much geography and not enough GPs," he says.