Medicine 'not a closed shop'


There are no "closed shops" or restrictive practices operated by the medical profession in Ireland, a hospital consultant and senator said today.

John Crown was speaking on RTÉ radio as the Government plans to tackle the issues of costs in the legal and medical profession required under the terms of the EU-IMF agreement.

“The simple reality is that the income of doctors in this country is principally driven by market forces and the overwhelming market force is medical shortage. This shortage is not determined by any closed shop or restrictive practice put in place by doctors. The only people who appoint doctors are the Government,” he said.

“Over the years the policy has been to restrict appointments - particularly at specialist level. We have unbelievably low numbers of specialists per head of population than other European countries.”

“The principal cost curtailment is not the salary of the doctors. The principal cost curtailment is curtailing the activity because if you have fewer surgeons there are fewer operations, if you have fewer consultant physicians you have fewer medications being prescribed and fewer tests being prescribed. That is the restrictive practice that must be ended. We need to appoint more people,” Mr Crown said.

The Senator said he supported plans by the Minister for Health James Reilly reform the health service and to introduce a universal health insurance system.

“The system would be single tier and under that system people who see more patients will make more money, and those that see less will make less. That is the way these type of market forces work. It will be very fair and very equal.

“However, an arbitrary decision to state in advance of appointing new doctors who are doing the work of five to six people by European standards that they will pay them less does not seem to be the most rational way of dealing with the problem. The most rational way is to fix the distorted market force by appointing more people,” Mr Crown said.

Mr Crown said appointing new doctors would drive down the incomes of those currently practicing and would provide better, fairer care to patients. He called for those on new hospital contracts to be offered the old hospital contracts saying it would save the State €100,000 per doctor.

“Pending the reform that the Minister has promised, he should offer all doctors a chance to revert to the old contract,” he said.

The EU-IMF programme singled out the legal, medical and pharmacy professions as sheltered sectors which required legislative changes to remove restrictions to trade and competition by the end of September.

Restrictions on the number of GPs qualifying and on GPs wishing to treat public patients must be eliminated. Restrictions on advertising must also to be lifted.

The Legal Services Bill, which will establish an independent regulator and contain reforms to address high legal fees, is expected to be published in September