Consultants and GPs must take medicine

THE gravy leaks out of all sorts of strange places. Everybody is now familiar with the gravy flowing through the ranks of senior politicians and public servants. But what about other sections of the elite?

Did you know that the state pays pensions to doctors who work in private practice? General practitioners, who are contracted to treat medical card patients, also get a little something put into a pension pot for their troubles.

Think about it. The doctors are in private practice; one element of their income is a state contract. As well as paying them generously for undertaking the contract, the state tops up the payment with an extra 10% towards a pension.

What about the taxi driver who has a state contract to transport, for example, hospital patients? Is there any chance he might get a little something for his pension, or is he not qualified enough to enjoy that privilege?

The contract under which GPs receive their pension contribution dates from 1989, a time when vested interests were in a position to better hide how they ran the country according to their own needs. Times change, but some habits persist.

Last year, the state spent an estimated €477 million on the GMS scheme, which covers the treatment of 1.67 million medical card holders. The contract is paid on a capitation basis, which on average is around €240 per person per annum. This is divided up between an estimated 2,600 GPs, although a small minority of those may not be on the scheme. Very few of the doctors concerned treat medical card patients exclusively. For some it’s just a lucrative sideline to the main bulk of their work.

Would it be too much to ask that the Government examine the quality of the gravy on offer here? Surely GPs are in a position to take care of their own pension arrangements? Surely they are better placed than practically all other workers in the private sector? What if the pension gravy was taken away?

There are many sections in the country which could do with an extra €47 million. In a recent submission to an Oireachtas Committee, Social Justice Ireland pointed out that there are now 218,000 children at risk of poverty, up 35,000 in just two years.

In the budget, cuts to services and some allowances for social welfare recipients are going to make up a huge bulk of the cuts. The coming year is going to be extremely harsh for a lot of people. Basics, like healthy eating, are beyond thousands of families already. Yet, in certain sections of society, the gravy is still on offer.

General practitioners do an important job. Looking after the primary healthcare of the nation is a task that is sometimes undervalued. Many, if not most, are hard working and conscientious (including my own GP!). Yet that alone does not entitle them to the kind of perks which persist in the current environment, while others go hungry.

Remunerating sectors such as the doctors is not done on the basis of the service provided, but on their capacity to wield power. This was most evident in the whole policy of universal medical cards for citizens over 70.

Like much else the policy was rushed through by Bertie Ahern led government in 2002. The rush was to ensure that it was in place for the election that was due later that year. Ahern and Charlie McCreevy were so eager to have the policy in place that they didn’t bother negotiating with the GP fraternity about the new arrangement. Presumably, the politicians thought that a similar deal could be struck to that which already existed for medical card patients.

Not so.

The Irish Medical Organisation went into negotiations with long faces, explaining that all these extra medical cards, combined with the age demographic of the recipients, would put unbearable pressure on their practices. They wanted their palms suitably greased. They knew damn well that the Government hadn’t a leg to stand on, having already announced the policy.

The result was that each over-70 medical card was worth €640 a skull per annum, over three times what was being paid for standard medical card holders. And the amount being shovelled into the pension fund was correspondingly increased three-fold. The Over-70 card became known as gold plated among GPs, and why wouldn’t it?

Guess who did the negotiating on behalf of the doctors? One James Reilly, then president of the IMO, now the Minister for Health, tasked with rationing the gravy for vested interests.

While the good doctor is unlikely to turn on his fellow GPs -—he can after all feel their expensive pain — he has at least moved to stop another anomaly which boosted the coffers of hospital consultants.

Heretofore, the consultants were exempted from paying PRSI on their private incomes. This was another little perk negotiated by the body’s representative firm in less enlightened times.

Reacting to the proposal, consultant in emergency medicine Pat Plunkett told Irish Medical Times that this amounts toyet another pay cut.

“You have to question how many cuts the Government are going to make,” Mr Plunkett, speaking on behalf of the IMO, told the newspaper.

“There may come a day when the balance tips and the minister for heath may find himself without an adequate number of consultants to run the health service,” he said.

Is this guy for real? Another cut? Wow, will he be able to put the Christmas dinner on the table at all?

Irish hospital consultants are among the best paid in the world. Their colleagues in the neighbouring jurisdiction work get paid, in some instances, as little as half the going rate in this country.

Why?

A hint might be gleaned from Mr Plunkett’s observation that some consultants may have to flee. What? Leave us with no expertise? Come back please, here’s more money. In a country where vested interests have long ruled, hospital consultants long ago carved out a powerful corner for themselves.

The place is banjaxed, with genuine hardship spreading across the land like a virus, and consultants fear their income might be in danger of slipping towards that of mere mortals.

As with GPs, consultants also provide a vital service. They worked to get where they are, and they work hard at it, some more so than others. But what underpins their view of how they should be paid is not their contribution to society but a sense of entitlement.

Like many others in the rarefied atmosphere of the so called professions, those in medicine believe they are entitled to all the gravy that comes their way. Whether it is nice little pension arrangements, or perks in PRSI, they genuinely believe that they deserve everything they get. If there is to be any attempt to refashion a proper republic from the embers of the current one, it’s high time we got cracking on tackling the vested interests who have managed to position their sense of entitlement above the basic requirement for fairness in society.