Thank troika for watershed moment in Irish medicine


OPINION:A closed shop meant many young doctors could not treat medical card patients, writes DR RUAIRÍ HANLEY

NEW LEGISLATION that grants every qualified GP in Ireland the automatic right to treat medical card patients represents a watershed moment in the history of Irish medicine. It should be welcomed by patients across the State.

The background to this reform is a shameful reflection on our health service. For almost 40 years, Irish GPs have worked in an unequal and blatantly discriminatory system.

Under this regime, all colleagues were entitled to treat any private patient who wished to attend them. However, the right to see medical card holders was severely restricted, largely at the behest of those who already had access to these patients.

Through a byzantine mechanism of “numbers”, “interviews” and “lists”, entry to the system was almost entirely dependent on either the indifference, patronage or physical demise of already established GPs.

Patient preference was dismissed as irrelevant by those who wielded control.

This disgraceful state of affairs meant that many young, fully qualified doctors were prevented from opening new practices, denied the right to treat medical card holders who wished to attend them, and, in some cases, forced to emigrate from a nation with a severe shortage of GPs.

Those who remained in Ireland were required to take on lengthy subservient roles as “assistants”. Their only alternative was to try to establish practices in remote areas that had been rejected by established GPs as financially unviable.

Naturally, these arrangements handed enormous power to those who had already climbed the greasy pole.

While the majority of older colleagues behaved honourably, they could make or break the careers of their equally qualified younger peers.

This led to a climate of deference and obsequiousness among “establishing” GPs, which ensured few challenges to the deeply unfair system.

It would be easy to blame politicians for the creation of this inherently corrupt culture.

However, the truth is that it enjoyed the tacit approval of the Irish Medical Organisation, which has long held a statutory position of influence over GMS entry for doctors.

This approach was presumably motivated by a desire to protect the incomes of senior colleagues by insulating them from fair competition.

In 2010, the Competition Authority produced a report recommending that all qualified GPs should have access to the medical card system and be allowed to establish practices where they wished.

These findings were welcomed by a majority of doctors in Ireland, with an Irish Medical Times survey finding more than 70 per cent in favour of the proposed changes.

Regrettably, the IMO refused to support the Competition Authority recommendations and a number of high-profile GPs spoke out strongly against the proposals.

In my opinion, the arguments they produced against fairness, equality and patient preference were often cynical and, on occasion, completely farcical.

For example, some reform opponents began using the term “deregulation” to describe the most regulated profession in the State, which is enduring a long-standing manpower crisis.

Other prominent doctors suggested that allowing greater patient choice would somehow discriminate against sick people living in parts of the State with a chronic shortage of GPs.

This new-found, deeply touching concern for medically deprived regions conveniently ignored the fact that already established doctors were not prepared to work in these areas, thus creating the problem in the first place.

Furthermore, socially disadvantaged locations usually have large numbers of medical card patients, and thus are most likely to offer the prospect of a thriving practice for new entrants to the system.

Despite the ludicrous weakness of their position, reform opponents probably hoped that, in keeping with tradition, the report would be quietly shelved. However, the arrival of the “troika” was to change everything.

Incredibly, as part of our bailout agreement, the EU-IMF insisted upon full implementation of the Competition Authority report into medical general practice.

In an ironic twist, it was a former IMO president Dr James Reilly who, after a lengthy delay, placed this legislation before the Oireachtas.

It is to the enormous credit of both the Minister and all our political parties that the Bill passed through both Houses unopposed.

As a result of this reform, medical card patients throughout the land will have a greater choice of doctor.

Inevitably, this will lead to the opening of more GP practices and ultimately will make Ireland a better place in which to be sick.

It is deeply regrettable that it took the economic collapse of our nation to bring about the introduction of fairness and equality to Irish general practice.

I believe it is true to say that on this issue, the IMF has done the State some service.

Dr Ruairí Hanley is a GP and a columnist with the Irish Medical Times