The real cost of the crisis in General Practice

We are in the midst of a crisis in General Practice in Ireland but few seem to be fully aware of this, apart from GPs.

The Government have been told, but they are in denial and still following their own misguided agenda when they could be listening to GPs on the ground.......

The real cost of the crisis in General Practice

We are in the midst of a crisis in General Practice in Ireland but few seem to be fully aware of this, apart from GPs.

The Government have been told, but they are in denial and still following their own misguided agenda when they could be listening to GPs on the ground.

The sad reality is that there is an ongoing exodus of highly qualified GPs from this country, traveling to countries where there are good healthcare systems and opportunities for GPs.

As GPs, we know this is happening because these emigrating GPs are our friends and colleagues. Again the Government are in denial about this and again, they are misguided.
There are dozens of vacant GP posts around the country, where a GP has retired or emigrated and where no-one has even applied to take over the medical card contract. In years gone by, there would have been fierce competition amongst 50-100 applicants for any of these jobs.
Irish GPs are among the highest calibre internationally, and we are in high demand in other countries.
Young GPs are leaving in their droves and an increasing number of older GPs have left their practices in recent years. This has never been seen before in Irish General Practice. While young GPs have always gone abroad to gain experience, they would always have come back to set up in business and the Irish Health System benefited hugely from the experience they gained while working abroad.
Now, driven by recent FEMPI (Financial Emergency Measures in the Public Interest) cuts along with the long-term chronic under-resourcing of General Practice, we are seeing established GPs finding it impossible to do business here as private patients continue to financially subsidise a non-viable medical card system, in a way neither fair nor sustainable.

Previously, GPs used their medical card contract income to pay the expenses of the practice but also in some cases to employ assistant GPs to assist with the workload of the practice.

One effect of the FEMPI cuts has been to remove the income that would have paid these assistant GPs wages, the other to remove the best of these potential assistants themselves as they emigrate in search of a wage and leave behind an overworked and stressed out GP doing the workload of 2 doctors.
So while you cannot get an appointment with your GP, our bewildered government are wondering if we should train more GPs.

Here is a true story of one Irish GP's difficult decision to emigrate. He prefers to remain anonymous as he is still working in an Irish town (we'll call it BallyOrdinary – as it is an ordinary town, population about 2000). Dozens of others have similar stories, we were just lucky to capture this one and are very grateful to him for letting us highlight it.


"I came back over 3 years ago after qualifying as a GP to take over my parents' GP practice here in BallyOrdinary. It was not only the logical thing to do - a thriving practice, a good income - but in addition it felt like it was always written in my stars to do so ever since I was a garsun. In fact I did medicine later in life - it took me a while to get there (don't ask) - but I was excited to come back - there was no coercion. My parents were delighted. The patients, in the main, seemed happy enough. My new colleagues locally were really welcoming. I had 2 fantastic staff members. My significant other was also happy to give it a go.

That was the high point of the exercise.
As you all know the FEMPI cuts have been significant over the last few years. The uncertainty of the under 6s contract is coming down the line - this means another cut to your bottom line, whilst at the same time increasing your workload still further (this is not even considering the inequity of the scheme itself from a patient point of view). At the moment as a practice we're treading water. My parents continue to do essential work for free without whom we'd be operating at a loss. They will not be around forever.
With the above in mind when I think about the level of investment required in staying (buying a house, new practice premises, impending HIQA regulatory standards etc.).....well quite simply the numbers don't add up. Not only that, there will be more than enough work for two doctors but not the income for one. It's not just about money - it's also about quality of life. My priority in my work are my patients but if I can't look after myself and my family, in a global sense, then what's the point?

Now I know lots of people are struggling in this country. I listen to them every day and they have my greatest sympathies. I'm not pleading beal bocht for myself but....... like others I've worked really hard to become a GP. I sometimes think people think we saunter through life and end up as GPs! We've dedicated time, energy, sweat, blood and tears in doing so. We have sat (and passed) some of the hardest exams on the planet. To use a business analogy - we've made a significant investment in ourselves. Is it wrong to want a certain return on that investment? It's not available here in Ireland.
Well they don't think this way in Canada, in Australia or in the UK. Sadly it seems to me that that return is now simply not available here. I'm not alone in that conclusion. Colleagues in hospital have long felt it and now it's happening in General Practice. I've been offered work in the UK that's better for me in every way - the NHS has it's difficulties for sure, I know that, but I'll work, get paid an appropriate amount and enjoy my life and my family.
But it makes me angry. And sad. And terribly guilty.

Because now no-one has applied to take on this post. Patients are sad to see you leaving but now they're worried about there being no GP in BallyOrdinary at all. My 2 staff are facing occupational oblivion. Not only that but this Practice brings in 40-60 people every weekday from all over the county and they don't just come to see us. They use the pharmacy that employs up to 8 people. They use the shops, the butchers, the post office, the pubs.
It's a stormy day here in BallyOrdinary - in every way - and it's not over yet.
But I know my reasons for leaving are valid. This is in no small part due to the erosion of General Practice, but my fears lie more in the future. I have an income at the moment. I'm not going unfed. But it's not just about the now, it's really about the future. It's about the next 30 years of my working and personal life.

People quite rightly look at the list size of medical card patients - it is absolutely larger than most - and think "how the hell can this guy really be struggling?". Compared to them right now perhaps I'm not. But that's because my elderly parents are helping out as practice manager, second doc for free.

But the Practice needs investment - we only have one consultation room in the small premises we've been renting for the last 40 years. It absolutely needs a second doc going forward, especially if/when the U6's (and over 70's etc) and HIQA juggernauts arrive. A Practice manager will have to be accounted for. I would have to buy a house.
Could I stay? Absolutely I could. I could work like a dog. I could not see my family. I could develop a drink problem. I could live in a never-ending state of stress, anxiety, poor sleep, teeth grinding, worrying where the next euro is coming from - until I have a terminal MI in my 50's and they lower me into the ground.
The inevitable big funeral will be of no consolation to me or my family. Nor will "Dr Lovely - shame he died young - he was a good doctor all right. Not as good as his father of course! Did ya hear who's replacing him at all....?". (The bit about my Dad is a bit of ironic humour!).
Don't I care about my patients? Of course I do - in my professional life they come first. It is an absolute disgrace what is happening to them in Ireland today. But if I can't get the life I feel I deserve then I'm no good to them.
I really hope things improve for General Practice and Irish GPs in the future - I know many do not have the luxury of the choice I have."


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