Health professionals await decision on further fee cuts

Doctors, dentists and other self-employed health professionals are awaiting with trepidation an imminent decision by the Department of Health on possible further cuts to their fees.

The decision by the department on fees cuts under financial emergency measures in the public interest (FEMPI) is long overdue, given that the attendant review was carried out at the start of the year.

Despite the urgent need to drum up income to fund the health services, Minister for Health James Reilly hasn't been in any hurry to make an announcement.

Cynics have suggested that Dr Reilly was anxious to get the spring conferences out of the way before revealing his hand in a way that will surely antagonise his former medical colleagues.

Another cut to fees is seen as almost inevitable given the budgetary pressures on the Government; indeed, Dr Reilly has been accused by the Opposition of prejudging the issue in remarks made some months ago.

Over the edge
The various groups representing the professionals have all predicted that another fee cut on top of the three imposed in recent years will push many of their members over the edge financially.

Members of the public might beg to differ, in the light of the handsome six-figure sums paid by the taxpayer to many practitioners in respect of medical card patients, as revealed in the contract payment lists published by The Irish Times last week.

The very release of these figures was seen by the representative bodies as a softening-up exercise to prepare public opinion in advance of an announcement. The fact of a single GP earning more than €720,000 from the public purse in these straitened times sits poorly with the widespread hardship elsewhere in society.

Of course the Irish Medical Organisation and other professional bodies protested that presenting figures like this in isolation was "farcical" without taking account of overheads such as staff, premises, heating and light.

They are right, but the IMO – whose standing has been weakened by its own financial frailties of late – didn’t bother to mention that the figures refer only to earnings from public patients. In our singular two-tier system, GPs are free to provide services for both public and private patients.

The proportion varies greatly from doctor to doctor but many of those ranked high on the list would also have a substantial private practice. The highest-earning doctor, a well-regarded GP in Dublin, operates from two premises, one in a working class area and another in a more middle class part of the city where private patients would be greater in number. He charges €60 for a consultation. That doctor operates in Tallaght from modern, purpose-built premises, but other colleagues have invested little in their surgeries.

The controversy over primary care centres showed how reluctant some GPs are to modernise their offering. Yet the fee for the patient varies little from one practitioner to another.

Another factor which has softened the blow of fee cuts in recent years is the increasing amount of business doctors and pharmacists (though not dentists) have been doing. Rising unemployment has meant more people qualify for a medical card, so almost two million people can now avail of free GP services.

So, like many others in today's society, doctors and pharmacists are doing more work for less money.

When the axe falls
The Irish Pharmacy Union says the income of community outlets is significantly down and one in four pharmacies is making a loss. Yet the number of pharmacies in the State remains broadly constant, which tells a story of its own.

The real question is not whether health professionals’ fees are going to be cut, but what they are going to do about it when the axe falls. GPs have already started refusing to carry out services which they regard as additional to their contract with the HSE, while pharmacists are still licking their wounds from a bruising and unsuccessful fight with their paymaster a few years back.

Both groups will have to decide whether the time is right to embark on a serious campaign of resistance to successive cuts in their income.