The World Cup may or may not end up in Qatar, but if it is, there will be a lot of Irish doctors on-hand to treat casualties
Doubling the number of trainee GPs will not solve the growing problem of a shortage of GPs in the country, according to the chair of the Irish Medical Organisation’s GP committee, but instead would be like ‘increasing the water pressure in a leaky pipe’.
Dr Ray Walley – who has a GP practice on Dublin’s northside said that having met the newly-appointed Minister for Health, Leo Varadkar, he had confidence that the Minister understood the problems facing general practice, but that increasing the number of GP trainees would not solve the looming shortage.
Dr Walley said that a recent Freedom of Information request by the General Medical Council in the UK had shown that Ireland was supply more GP Principles to the NHS than any other country in the world per capita. The number of Irish-trained GPs in the NHS was 1,049, which, he said represented eight years’ worth of GP training in Ireland.
He pointed out that one in every eight GPs in Ireland was aged 64 or older and that this was an age when many people retire. But he insisted that increasing the number of GP trainees would not solve the problem.
“We have three to four hundred applications for those GP trainee posts each year but we had to do a second round of interviews to get up to the figure of 157 qualified trainees,” he said.
He pointed out that increasing this figure was not really possible as a basic requirement of getting into the programme was an ability to speak English, and this wasn’t the case for many applicants.
But he said that it was an indictment of the system that Ireland was failing to retain its own doctors.
“We have had a meeting with Minister Varadkar, which is more than we had with his predecessor Dr Reilly, who despite making a lot of noise about consultation with doctors in opposition never met us once during his tenure. At least we are now at the table,” he said.
But he said that GPs were ‘fed up’ with the Irish system and having to personally resource general practice out of their own pockets. They were voting with their feet to go abroad where they can make a decent living and are not subject to the vagaries of the Irish health system.
“Doctors are a dedicated group. They get into this job with its long hours because they feel a vocation to it. But in Ireland, since there is no chronic care programme, when they refer a patient to a consultant there is a two or three-year waiting list. There is a lack of joined-up thinking in the system. Many GPs when they go abroad find that it’s not just about the money, there is a professional satisfaction to be had when dealing with a health system that actually works, and that is a big part of the attraction of working abroad.”
One such doctor who has left Ireland for Qatar agrees. Dr Paddy Davern (51) left a practice in Tipperary Town having given up the prospect of making a living from medicine in Ireland.
“Ireland wasn’t viable for a GP,” he says. “I was working extra hours after work with Caredoc and doing night shifts in the local emergency department. I couldn’t work any more hours and I couldn’t make a living. I had cut back on expenses and holidays for four years but couldn’t cut back anymore.”
Since moving to Qatar, however, he says he see a ‘light at the end of the tunnel’.
“I’m getting paid the same here as I was at home, but there’s no tax. It’s 48 hours a week with 58 holiday days, 10 bank holidays and five casual days. I can see a future now,” he said.
Along with another 20 Irish doctors he is developing a mobile general practice system in Qatar which is integrated in the general health system.
“They’re not young GP’s out here. You would have to have done a minimum of three years as a trained GP so the profile is of people in their 30’s, 40’s and 50’s,” he says.
This has an even greater effect on GP training in Ireland as many of the doctors in question, including Dr Davern, were GP trainers in Ireland – the very group of people needed to train the next generation of doctors.
Dr Davern’s daughter – who recently qualified as a doctor – has also emigrated to Australia. Two of his other children are in University and they brought their 15-year-old out to Qatar.
He says he hasn’t had time to think of being homesick and is deriving a lot of professional satisfaction from setting up the mobile GP service and watching it develop from scratch.
But Dr Walley says that it is not just the lack of resources that is driving GPs from the country.
“I spoke to a senior doctor who has left to join the NHS. The procedure for complaints in the UK is much different and doctor-friendly. Here, if a complaint is made about you your name is out there. But 86% of complaints never go past the complaint stage. It doesn’t matter – your name is out there anyway.”
But he said that without proper resources, none of the government’s plans could work.
“We talk about the Dutch system but in Holland, 10% of the budget goes to general practice and another 10% goes to primary care. Physiotherapists and occupational therapists may ease pain but it is the doctors who reduce morbidity and mortality. And we expect to get Dutch results with a funding level of 2-3% which isn’t going to work.”
“We need to think about upping our spending to Dutch levels in order to get a system like that. It’s not a matter of care for the under-6’s or the elderly, which the Minister has said is his priority. There just won’t be the doctors there to run the system if things continue as they are.”
Dr Walley said that he was confident that the new Minister would make a difference.
“He seems to have read the brief. He’s not just taking the word of his advisors. He knows the detail that you wouldn’t expect from someone unless they knew their way around the system and had read through all the documentation. But fundamentally, the big issue is resourcing the system. And while the Minister might understand that, the level of knowledge about the problem is political circles is very low and while the under-funding continues, GPs will continue to seek better opportunities abroad. At the moment, it’s hard not to see it getting worse every year.”