Leo the minister enjoys a triumph while the GPs get rich - and poor
GPs picked the wrong battle with the under-sixes, says Maurice Gueret. Instead, they should have seized the IMO chains of office
It has been a good week for families with very young children or juniors on the way. Doctor visits will no longer cost the same as a family ticket to the zoo. From the first of next month all surgery visits will be free of charge for all kids under the age of six. And that subtle exotic aroma of a freshly filled nappy will return to a waiting room near you.
I am quite sure the bulk of our nation's GPs will have signed up to the Under 6 contract by the end of June, even in south Tipperary. They have to, or they will no longer have family practices in the true sense of the word. If you lose all young couples and their toddlers, you really lose viability in the long run. The scheme pays doctors the equivalent of three private visits a year per child and there are two weigh-ins thrown in for a bit of extra neurosis. Despite cries to the contrary, there will be no wolf in the surgery and it's not the end of the world for doctors.
One eminent professor of general practice was ecstatic. He tweeted that Dr Varadkar's achievement in getting the deal through put Noel Browne's Mother and Child Scheme in the shade. But the academic was rounded upon by some colleagues for this comment. You see, patients don't always die when doctors differ. Other medics suggested that the serious crash of the Under 6s computer system within hours of launch from overuse was a metaphor for what might happen in GP waiting rooms next winter.
The French novelist and critic Emile Zola would tell an anecdote about a doctor who was so busy on the riverbank fishing people out of the water that he had no time to go upstream to see who was pushing them in. Well, I ceased to fish patients from rivers some years ago. I had a nice little practice that, after a decade, was barely breaking even. I liked to talk. Too much, perhaps. Many doctors begin sidelines and nixers in their early years to make ends meet. They do factory medicine, red-eye locums at night, methadone clinics or modern money-spinners such as Botox jabs and fillers. I didn't like any of that stuff. So I began to scribble, edit and publish. With the simple overheads of an Amstrad word processor and a kettle, a new career emerged without the crippling costs of a practice. There was even time for that most leisurely of pursuits, the dabble into politics.
Not having patients to mend around the clock gave me a chance to watch trade battles like the Under 6s crusade and the Over 70s confrontation from the sidelines. It struck me this week that we may have just witnessed a very sad case of doctors throwing themselves and each other into the river. The profession divided perfectly for Leo, and he simply strode through the gap, walking on his favourite holy water.
Now I don't want to bore readers with trade union stuff, but a little background is essential to understand these recent hostilities. For the last 40 years, the Irish Medical Organisation (IMO) has been the big beast of GPs. Just as farm organisations are sometimes accused of over-representing big farmers, the IMO is sometimes viewed as being the voice of the well-established GPs rather than the young doctors starting off in practice.
The large practices hoovered up cash from the medical card scheme while many good young GPs over the years had to close their practice doors, and either emigrate or pay 'hello money' to join the big boys as their partners. We are still none the wiser about how a union that pleaded destitution of its members for so long managed to offer a €10m pension pot to its chief executive.
The IMO has had smaller rivals over the years and the current incarnation is the National Association of General Practitioners (NAGP). It organised the little rally of stethoscope-swinging protesters outside the Dail last year. Now, I wouldn't inflict my membership on the roll-call of any trade union but if I had to, I'd say the NAGP represents a more thoughtful face for general practice. My ideas about paying doctors salaries instead of fee-per-items like hucksters might at least be listened to politely by the NAGP. I think its costliest mistake is that it picked the wrong battle with the Under 6s. A wiser move might have been to rush the temple of the IMO, overturn the tables and seize the gold chains of office.
Now it's a mistake for doctors to assume that all patients are the same, and patients should avoid this labelling trap too. GPs in Ireland are like fingerprints. No two are alike. There are some who have borrowed millions to develop their practices and now cannot meet even the interest on their loans. There are others who kept their practices small, lean and mean with a medical card list that is far too long for one doctor. They may still be trading profitably.
Then we have high-earning doctors who are rarely seen in their own practices, as they hire in cheap medical labour to do the donkey work. This allows them concentrate on more lucrative work like job medicals, insurance claims, solicitor reports or real estate management. There are some doctors who are open 12 hours a day, seven days a week. They have colleagues who do a two-hour surgery in the morning and an hour in the evening. You cannot even be sure that the doctors who appear as top earners in the General Medical Services Scheme (GMS) are the wealthiest GPs in the State. In fact, if they have lots of staff, huge overheads and give plenty of time to each patient in their practices, they may be amongst the poorest.
It is possible to become really wealthy from general practice. Perhaps a small minority do. To play the system in this way you would see the maximum number of medical card patients in the least amount of time and spend the rest of your day doing lucrative nixers or relieving private patients of €50 notes and more.
It's hard to explain to overseas doctors the Irish system of general practice. Half the country seems to pay twice what they should to support a system where the other half, decided on the whim of politicians, pays nothing at all. No other country in the world has the same system of general practice. It figures.
Dr Maurice Gueret is author of 'What The Doctor Saw' and 'The Doctor's Case'