Pricing doctors out

Medical indemnity regime in Ireland not operating in the best interests of doctors or patients

A "brain drain" of young doctors from the State's's public health system has been recently highlighted by the Medical Council. In a new threat, the Joint Oireachtas Committee on Health and Children has heard that an exponential increase in clinical indemnity costs is forcing consultants out of the private sector to look for work abroad.

According to the Irish Hospitals Consultants Association (IHCA) the cost of clinical indemnity has doubled for many specialties in recent years. There are now no full time private practice obstetricians in Ireland as their annual practice insurance would be in excess of €335,000. The concern is that some surgical specialties will also disappear from our private hospitals as clinical indemnity rates continue to climb: as orthopaedic surgeons resign from private hospitals patients with health insurance could have difficulty accessing hip and knee replacements. Ear nose and throat specialists, cardiac surgeons and neurosurgeons are among other specialists who are effectively being priced out of full-time private practice here. The prospect of more people being forced to seek medical care in our beleagured public hospitals is not an enticing one.

Speaking at the Oireachtas committee, Simon Kyall, chief executive of the Medical Protection Society (MPS), which insures doctors, said it has had to increase subscription rates because of a large increase in both the rate at which private consultants are being sued and the average size of those claims. This change does not reflect a decline in professional standards, he said; among possible contributory factors were a growing compensation culture and an inefficient legal process.

The MPS favours an “open disclosure” system when adverse outcomes occur. As well as long overdue legislative changes in the area of medical tort, Government should legislate to strengthen the role of candour and open disclosure in routine clinical practice. For patients who are clearly harmed by medical negligence, it is not acceptable for them to have to to wait years to obtain the compensation they need and deserve.