Tanaiste calls on doctors to reduce their charges

tallaght01 · 18-10-2008 1:11am #1

http://www.independent.ie/breaking-news/national-news/tanaiste-calls-on-doctors-to-reduce-their-charges-1502090.html

the irish times wrote:

The Tanaiste is putting pressure on doctors to reduce the amount of money they receive to provide healthcare for elderly medical card holders.

Mary Coughlan has indicated that if GPs were prepared to take less money, the Government could readdress the abolition of universal medical cards for the over 70s.

There has been uproar since the Government announced in the Budget on Tuesday that they would be scrapping the scheme, which automatically entitles every person over 70 to a medical card.

The Minister for Health issued modifications to scheme last night.

People on the State contributory pension will still qualify, and those over the threshold will receive either a GP-only card or a €400 annual payment, depending on their financial situation.

So, what do people reckon?

Should lawyers take less cash to prop up the crappy legal aid system?

Should junior doctors and nurses take less money so the government can improve the crappy hospital system?

Or is coughlan justified in what she's asking for?

My opnion: It's a crock of balls. She's paying private contracters. If you want to dictate how much private business people charge, then emply them.
Emply docs to work for the state, and provide free-at-the-point-of-entry care to the old, the less well-off and the very young via salaried public doctors.
Just my 2c though.

2Scoops · 18-10-2008 1:22am

A completely transparent exercise in blame repositioning. If nothing else, it will be interesting to see how hard they push this and whether it will affect the equilibrium between public dislike of 'greedy politicians' versus 'rich doctors.'

Bison · 18-10-2008 9:41am

It is very cynical for the government to try and renegotiate this GP agreement through the stress and emotion of old age pensioners worried about their health. They wouldn't have been "over a barrell" if they had actually put some thought into this first and hadn't used it as an election stunt just a few years ago.

I can't comment on whether the over 70's payment is an over/underpayment as I don't know the figures for average visits per year or GP workload for these patients, but the IMO should use this as opportunity to get the HSE to sit down to the overall GP contract negotiations they have been avoiding. They specifically need to address the lack of GP training places in my opinion.

Also, the IMO needs to show a bit of testicular fortitude in the face of these snide comments by politicians implying that if it wasn't for greedy doctors we would all be fine. Every time one is released they should have their own statement ready for the media, perhaps pointing out that if we didn't have such incompetents in senior positions we would all be fine.

asdasd · 18-10-2008 11:24am

It's a crock of balls. She's paying private contracters. If you want to dictate how much private business people charge, then emply them.

consultancy is a cartel.

tallaght01 · 18-10-2008 11:38am

asdasd wrote: »

consultancy is a cartel.

She's talking about GPs.

SomeDose · 18-10-2008 12:30pm

I don't think the HSE could possibly sink any lower in my estimations these days. Pulling at public heart-strings is a favourite spin tactic of theirs. This smacks of the same machinations that Jabba and her HSE cronies tried to pull with the pharmacists earlier this year. They suddenly decided that they didn't like the price they were paying for GMS medicines (which the HSE themselves negotiated with manufacturers) and figured they could unilaterally change their contractual payments to private contractors without consultation. Recent court decisions have rightly deemed this action illegal, so I'd imagine the HSE will be very hesitant to attempt anything similar with GPs.

tallaght01 · 18-10-2008 12:55pm

I just wrote a piece about it in the boards medics blog

RobFowl · 18-10-2008 1:03pm

just to give a bit of background. The IMO (GP's union) have been trying to renegotiate the whole GMS contract since early 2005 at least. The government has refused to meet to negotiate as it claims it cannot negotiate fees and charges with the IMO as a result of their comeptition act.
Interesting to she how quickly they change their stance whey political reality bites ! (ps am a GP and an IMO member so not totally unbiased, In my situation I would actually make more money if the present proposal goes through but I'm strongly against it, totally unfair to people who were promised free medical care and prescriptions by the same goverment who now claim thats its an unfair and inequitable system)

sam34 · 19-10-2008 12:46pm

this is another cynical cheap shot by the government. very easy to blame those big bad greedy doctors. tbh, i wish the imo were a bit more vocal and came out and defended their members. as a union, i feel theyre very low profile.

Heinrich · 19-10-2008 12:55pm

sam34 wrote: »

this is another cynical cheap shot by the government. very easy to blame those big bad greedy doctors. tbh, i wish the imo were a bit more vocal and came out and defended their members. as a union, i feel theyre very low profile.

If I may use a typical Dail buzzword "I won't take lessons" from overpaid, inept and cynical politicians...

asdasd · 19-10-2008 1:55pm

They suddenly decided that they didn't like the price they were paying for GMS medicines (which the HSE themselves negotiated with manufacturers) and figured they could unilaterally change their contractual payments to private contractors without consultation.

good for them. That has been a mainstay of the democratic party's agenda in the US for years - force the manufacturers to renegotiate on price.

The major cost of running the health service is Wages. The second major cost is drugs. Where did the 300% increase in costs go to?

tallaght01 · 19-10-2008 7:05pm

asdasd wrote: »

The major cost of running the health service is Wages. The second major cost is drugs.

But that is ENTIRELY different to saying either are poor value for money, or should be reduced.

If the main cost to airlines was safety, we wouldn't be asking them to skimp on it when times are tough.

metrovelvet · 19-10-2008 7:07pm

The doctors should call on the tanaiste and tds to reduce their charges and take a pay cut.

DrIndy · 20-10-2008 5:58pm

What the OP is proposing is a universal primary care system like in the UK - this would in fact cost much more of government funding that our semi-private GP service we are all used to here as the government would need to stump it all up rather than sting middle income taxpayers with PAYE and then medical costs.

To also radically change the system would mean a few years of chaos and a massive capital program to build primary care centres properly as in the UK.

Its cheaper to take cheap shots. (comment is directed at the government not the OP

)

asdasd · 20-10-2008 6:02pm

But that is ENTIRELY different to saying either are poor value for money, or should be reduced.

YOu are not proving that they are not either. the prices of drugs often reflects what government are willing to pay for.

Bison · 20-10-2008 6:28pm

asdasd wrote: »

good for them. That has been a mainstay of the democratic party's agenda in the US for years - force the manufacturers to renegotiate on price.

The major cost of running the health service is Wages. The second major cost is drugs. Where did the 300% increase in costs go to?

The government didn't try to renegotiate with the manufacturers, they unilaterally tore up the pharmacy contract. Then they got their ass kicked in the high court, so now they are after the GP's via the scared old people. Perhaps if they tried the same aggression with the manufacturers as they do with hard working professionals they could save a few Euro for us all.

tallaght01 · 20-10-2008 8:16pm

asdasd wrote: »

YOu are not proving that they are not either. the prices of drugs often reflects what government are willing to pay for.

Well, I was never quite sure what your point was in the first place.

I'm not sure if you're implying there's not more wages or drugs since Harney injected some poorly disseminated cash into the HSE.

asdasd · 21-10-2008 9:40am

Well, I was never quite sure what your point was in the first place.

you didn't understand this!?

"The major cost of running the health service is Wages. The second major cost is drugs."

Why do we even have pharmacy as a "profession" anyway. get a prescription, and give it. How hard is that?

tallaght01 · 21-10-2008 11:04am

asdasd wrote: »

you didn't understand this!?

"The major cost of running the health service is Wages. The second major cost is drugs."

Why do we even have pharmacy as a "profession" anyway. get a prescription, and give it. How hard is that?

Well, it was the point I had difficulty understanding, rather than the sentence.

But when you're aksing why we need pharmacists, then I think there's bigger gaps in your knowledge than what you've posted abve.

asdasd · 21-10-2008 11:58am

But when you're aksing why we need pharmacists, then I think there's bigger gaps in your knowledge than what you've posted abve.

Feel free to explain. I would have thought pharmacy a mere medeival cartel, not dissimilar to the lawyer-solictor boondangle. Here is how things should work in this great internet age.

Doctor recommends medicine. medicine is there in hospital or Doctors surgery. Patient gets medicine.
or

Doctor recommends medicine. Not available yet, so types somthing into computer and gets medicine from source, or sends it to patients address.

People packaging medicine dont know what it is.

Why would this not work?

Tim Robbins · 21-10-2008 12:54pm

I think Doctors are over payed. The question is how much should they be paid?

In the private sector, it's supply and demand that determines price.
If there's low supply all government can do is increase college places so that there is no supply problem. Then the market can decide how much they should get paid like everything else in the private sector.

The problem is that medical care is not like a normal private industry. It is an essential service. I agree with the OP, I'd like to more public contracts for GPs and then be paid a yearly salary. As for how much that should be, inline with what it is in other European countries. I can't see the IMO doing that though.

jaycen · 21-10-2008 12:57pm

Fair play to her but I don't think it will have any effect on the moneygrabbing doctors;
€50 for a GP visit that probably lasts 15 mins, there should be a law against rates like that, in any other profession price fixing like that wouldn't be tolerated.

ceegee · 21-10-2008 1:31pm

asdasd wrote: »

Feel free to explain. I would have thought pharmacy a mere medeival cartel, not dissimilar to the lawyer-solictor boondangle. Here is how things should work in this great internet age.

Doctor recommends medicine. medicine is there in hospital or Doctors surgery. Patient gets medicine.
or

Doctor recommends medicine. Not available yet, so types somthing into computer and gets medicine from source, or sends it to patients address.

People packaging medicine dont know what it is.

Why would this not work?

Such a system would be wide open to abuse: financially it rewards doctor for prescribing + then dispensing the more expensive option of drugs - not to mention enabling the next Harold Shipman to go about his business without any other health professional knowing what he has given to patients

Even more seriously the number of patients dying due to incorrect doses, inappropriate medicines, interactions etc. would skyrocket without pharmacists checking prescriptions.

Doctors are trained to be doctors. They dont have the appropriate training to do a pharmacists job.

tallaght01 · 21-10-2008 1:34pm

asdasd wrote: »

Feel free to explain. I would have thought pharmacy a mere medeival cartel, not dissimilar to the lawyer-solictor boondangle. Here is how things should work in this great internet age.

Doctor recommends medicine. medicine is there in hospital or Doctors surgery. Patient gets medicine.
or

Doctor recommends medicine. Not available yet, so types somthing into computer and gets medicine from source, or sends it to patients address.

People packaging medicine dont know what it is.

Why would this not work?

Pharmacists are some of the most important people in a health service.

Some of their vital roles:

They check patient prescription charts every day for drug interactions, dosage errors etc. It makes much more sense to have a person do this every day, who has expertise in the field. They have time to specifically go through the chart and check it in detail.... they are very good at this, and have much more time to do it than the exhausted intern.
My last 2 pharmacist interaction were:

1) pharmacist had calculated a patient's creatinine clearance for a drug my SHO had written up for a patient. It was a bit high, so she suggested another drug. I agreed. It was well spotted.

2) I wanted to give someone growth hormone. He was having counselling for extreme needle phobia. I rang up our pharmacists for ideas on the best way to deliver the drug. He suggested transdermal patches. Happy days. He sorted them out.

Pharmacists answer patients questions about their drugs, when to take them, what to take them with, how to take them. A lot of dispensing can be done by dispensing assistants.

But pharmacists are very often your last safety net. Getting rid of them would be a disaster for patient care.

tallaght01 · 21-10-2008 1:38pm

Tim Robbins wrote: »

I think Doctors are over payed..

Out of curiousity, how much would you expect to be paid for doing a 72 hour shift, making life or death decision, with maybe an hour of sleep?

jaycen wrote: »

Fair play to her but I don't think it will have any effect on the moneygrabbing doctors;
€50 for a GP visit that probably lasts 15 mins, there should be a law against rates like that, in any other profession price fixing like that wouldn't be tolerated.

I paid my lawyer 80 euro to notarise my medical degree before coming to Oz. Took maybe 1 minute in total.

I paid my driving instructor a better hourly rate than I was earning.
I currently pay my drum teacher a better hourly rate than I get.

inforfun · 21-10-2008 1:50pm

tallaght01 wrote: »

Out of curiousity, how much would you expect to be paid for doing a 72 hour shift, making life or death decision, with maybe an hour of sleep?

To be perfectly honest, i wouldnt like anyone who is up for 70 hours to make a life/death decision on me.

50 or 60 euro is an awfull lot to see a doctor for 10 minutes in order to walk out with a recipe for yet another antibiotics cure.

I live in ireland for 7 years now but i have seen more people on antibiotics in those 7 years than in 30+ years in my own country (the Netherlands).
What is up with that?

asdasd · 21-10-2008 1:57pm

I live in ireland for 7 years now but i have seen more people on antibiotics in those 7 years than in 30+ years in my own country (the Netherlands).

Pharmacists not doing their essential job.

1) pharmacist had calculated a patient's creatinine clearance for a drug my SHO had written up for a patient. It was a bit high, so she suggested another drug. I agreed. It was well spotted.

2) I wanted to give someone growth hormone. He was having counselling for extreme needle phobia. I rang up our pharmacists for ideas on the best way to deliver the drug. He suggested transdermal patches. Happy days. He sorted them out.

No idea what a SHO is? Why could either of you not do this job? Do we need another prefessional to know that if you dont use needles you use patches? Why?

deepimpact · 21-10-2008 2:03pm

asdasd wrote: »

Pharmacists not doing their essential job.

And what job is that?
Seriously, give your own view on a pharmacist's job description.

I'm very interested, as a pharmacist.

asdasd · 21-10-2008 2:05pm

I'm very interested, as a pharmacist.

Surely you would know, then? The original poster said anti-biotics are over-perscribed. Why not intervene, or whats the point of you.

Am interested, as a citizen.

ceegee · 21-10-2008 2:52pm

asdasd wrote: »

Surely you would know, then? The original poster said anti-biotics are over-perscribed. Why not intervene, or whats the point of you.

Am interested, as a citizen.

As a pharmacist, there isnt generally enough information available to you when a patient presents an antibiotic prescription to justify you second guessing a doctors diagnosis. In these situations the role of the pharmacist is primarily to ascertain whether the medication is suitable for the patient (drug allergys, interactions with other medicines), whether it is a suitable dose, etc.

The onus for appropriate prescribing of antibiotics is primarily with the doctor, as they are the ones qualified to diagnose and who have access to test results to aid them in doing so.

Basically, it is the role of the doctor to decide if an antibiotic is required, and the role of the pharmacist to ensure the most suitable antibiotic is given in an appropriate manner

(I realise that this is a vast simplification of both roles but its quite hard to suimmarise these roles in a definite manner)

tallaght01 · 21-10-2008 2:57pm

inforfun wrote: »

To be perfectly honest, i wouldnt like anyone who is up for 70 hours to make a life/death decision on me.

50 or 60 euro is an awfull lot to see a doctor for 10 minutes in order to walk out with a recipe for yet another antibiotics cure.

I live in ireland for 7 years now but i have seen more people on antibiotics in those 7 years than in 30+ years in my own country (the Netherlands).
What is up with that?

Yea, we don't particularly like doing it either. But, one of the carrots at the end of the stick is a well paid position at the end of it.

Many many doctors do a 24 hour shift 1 day in every 3 or 4, and they do a 72 hour shift every 3rd or 4th weekend.

They might do this for 8 or more years. These are some of the most highly qualified people in the country, who work essentially slave labour for the best part of their lives (well I'd regard my 20s and early 30s as the potential fun years). So, you have to reward them.

I don't begrudge a GP earning 150k per year. They're highly qualified,a nd they've busted their balls for the health service.

The reason they give antibiotics is simple. 99% of GPs know they're useless. But you're paying. You should see the arguments people put up when they go to their doctors, and they don't get an antibiotic. I've heard my relatives complaining about ot getting an antibiotic, when their cold has "gone to my chest" or "started getting green phlegm". GP surgery waiting rooms are packed t the hilt in december/january every year. It's full of people with colds.

They're all their for one reason...an antibiotic.

I spoke to a GP friend of mine before, and asked him why he just doesn't refuse to prescribe antibiotics. He said he just didn't have the stomach for the fight anymore. He tried. But he was getting into arguments with 10-15 people each day.

He's only human, so he now prescribes amoxicillin for colds. He's a really good guy, and really really intelligent. He's worked in an infectious disease unit when he was a hospital doctor.

asdasd wrote: »

Surely you would know, then? The original poster said anti-biotics are over-perscribed. Why not intervene, or whats the point of you.

Am interested, as a citizen.

Pharmacists aren't there to query the diagnosis. Pharmacists aren't trained to diagnose. Therefore, they don't ring you up saying "I've had a look inside that kiddy's ear, and I think it's viral.".

If you prescribe an antibiotic, then the pharmacist has to take it at face value that you suspect a bacterial infection.

That is not their "essential role"

Phototoxin · 21-10-2008 3:08pm

yeh, the irish feel shafted if they dont get an antibiotic despite it doing SFA for a viral thing.

That said I thought that E45 each for a vaccination (which I get free being diabetic but the actual giving of the fricking thing..which I could have done myself had I been given it..) for me da and myself would = 90 but they said 60. Thats about E2 a minute for the nurse.. not even the doctor... it was decent of them as they could have charged 90 but all the same it's bloody expensive!

Personally if we had something like the NHS in wales it'd be great but we have one of the worst health systems inthe EU

inforfun · 21-10-2008 3:32pm

tallaght01 wrote: »

Yea, we don't particularly like doing it either. But, one of the carrots at the end of the stick is a well paid position at the end of it.

Many many doctors do a 24 hour shift 1 day in every 3 or 4, and they do a 72 hour shift every 3rd or 4th weekend.

They might do this for 8 or more years. These are some of the most highly qualified people in the country, who work essentially slave labour for the best part of their lives (well I'd regard my 20s and early 30s as the potential fun years). So, you have to reward them.

I don't begrudge a GP earning 150k per year. They're highly qualified,a nd they've busted their balls for the health service.

The reason they give antibiotics is simple. 99% of GPs know they're useless. But you're paying. You should see the arguments people put up when they go to their doctors, and they don't get an antibiotic. I've heard my relatives complaining about ot getting an antibiotic, when their cold has "gone to my chest" or "started getting green phlegm". GP surgery waiting rooms are packed t the hilt in december/january every year. It's full of people with colds.

They're all their for one reason...an antibiotic.

I spoke to a GP friend of mine before, and asked him why he just doesn't refuse to prescribe antibiotics. He said he just didn't have the stomach for the fight anymore. He tried. But he was getting into arguments with 10-15 people each day.

He's only human, so he now prescribes amoxicillin for colds. He's a really good guy, and really really intelligent. He's worked in an infectious disease unit when he was a hospital doctor.

Pharmacists aren't there to query the diagnosis. Pharmacists aren't trained to diagnose. Therefore, they don't ring you up saying "I've had a look inside that kiddy's ear, and I think it's viral.".

If you prescribe an antibiotic, then the pharmacist has to take it at face value that you suspect a bacterial infection.

That is not their "essential role"

The slave remark reminds me a bit of a certain c. ronaldo a few months back. When earning 150k a year i wouldnt call it exactly slavery.

But apart from that, the answer is clear to me.
Thanks.

Could it also have to do with this (and i am looking to my own situation)
My employer demands that anybody who is off sick for 3 days goes to his/her GP and gets a cert.
That is where my problem is.... i dont need to pay 50 or 60 to a GP to hear that i got a cold. I know damn well myself when i got a cold or not.
Do people maybe look for anything they can get from a GP (antibiotics most of all) in order to show their employers they are off sick for a ligitimate reason?

sam34 · 21-10-2008 4:48pm

asdasd wrote: »

Pharmacists not doing their essential job.
QUOTE]

what have pharmacists got to do with the number of prescriptions written for antibiotics? they're not the ones writing the scripts.

sam34 · 21-10-2008 4:53pm

jaycen wrote: »

Fair play to her but I don't think it will have any effect on the moneygrabbing doctors;
€50 for a GP visit that probably lasts 15 mins, there should be a law against rates like that, in any other profession price fixing like that wouldn't be tolerated.

other professionals do charge just as much, as someone else has pointed out...

i paid a solicitor €80 to witness my signature on a document before i moved jobs in the HSE within the same province. took approx 30 seconds, solicitor did not know me, nor ask for id.

i paid my dentist €65 for a check up which took less than 10 mins. no clean&polish, no frills, just a check up.

i paid my hairdresser €90 last wk for 2 hrs work... i dont earn that.

i paid a locksmith €70 for a ten minute job

i paid a driving instructor €35 for an hour, at a time when i was not earning that myself

the list is endless

ZYX · 21-10-2008 4:58pm

tallaght01 wrote: »

The reason they give antibiotics is simple. 99% of GPs know they're useless. But you're paying. You should see the arguments people put up when they go to their doctors, and they don't get an antibiotic. I've heard my relatives complaining about ot getting an antibiotic, when their cold has "gone to my chest" or "started getting green phlegm". GP surgery waiting rooms are packed t the hilt in december/january every year. It's full of people with colds.

They're all their for one reason...an antibiotic.

I spoke to a GP friend of mine before, and asked him why he just doesn't refuse to prescribe antibiotics. He said he just didn't have the stomach for the fight anymore. He tried. But he was getting into arguments with 10-15 people each day.

He's only human, so he now prescribes amoxicillin for colds. He's a really good guy, and really really intelligent. He's worked in an infectious disease unit when he was a hospital doctor.

I disagree completely. I have been a GP for many years and I do not give out antibiotics for everything I see. Poor GPs give antibiotics for colds. Good GPs do not.

sam34 · 21-10-2008 5:02pm

inforfun wrote: »

To be perfectly honest, i wouldnt like anyone who is up for 70 hours to make a life/death decision on me.
QUOTE]

LOL! it's not like the exhausted, overworked, over-burdened doctor, who has not eaten in maybe 8 hrs and is dehydrated because they havent had time all day stop for a cup of tea, absolutely LOVES these inhumane (and illegal) shifts!

it's not nice working those hours.actually, it's more than "not nice", it's pure and utter crap, it is awful. it takes its toll, mentally and physically. it effects yuor family, your friends, your relationships.

being paid for it is teh only good thing about it. but, i, and i suspect droves of my colleagues, would forego the money for a 9 to 5 job. at least these days, doctors get paid for working overtime, unlike the days of the 1980's.

sam34 · 21-10-2008 5:08pm

inforfun wrote: »

The slave remark reminds me a bit of a certain c. ronaldo a few months back. When earning 150k a year i wouldnt call it exactly slavery.
QUOTE]

i'm not a gp, so i wont claim to speak for them. i am a hospital doctor. i have never earned 150k a year, nor have i ever earned two thirds of that. yet i have worked shifts that could certainly be called slavery - 70 mins sleep (in two divided sessions) in a 55 hr period being the one that sticks out the most. at other times, i have frequently worked weekend shifts, such as 48 hrs in a 72hr period. currently, i do one overnight a week, which means that on a specific day, i come in at 9, and i leave at 5 the next day, ie 32 hrs.

but, yeah, you're right, it's all fun and games and we're just wusses to complain :rolleyes:

Tim Robbins · 21-10-2008 5:24pm

ZYX wrote: »

I disagree completely. I have been a GP for many years and I do not give out antibiotics for everything I see. Poor GPs give antibiotics for colds. Good GPs do not.

Isn't there a test though that can be done on saliva to determine whether it is bacterial or viral? It can be done in an instant and is done in Sweden?

Tim Robbins · 21-10-2008 5:26pm

tallaght01 wrote: »

Many many doctors do a 24 hour shift 1 day in every 3 or 4, and they do a 72 hour shift every 3rd or 4th weekend.

This is because we have very sloppy time management and / or because we do not have enough Doctors. Probably both.

inforfun · 21-10-2008 5:49pm

but, yeah, you're right, it's all fun and games and we're just wusses to complain :rolleyes:

I just notice around me that people basically always end up with anti-bitics whenever they see a GP.
And don't get me wrong. I have respect for the work GP's and Hospital employees (well ... apart from management maybe) are doing.

And i suppose those people are not exactly cheering before they start their 72 hour shift.
My problem with that is, that people are allowed to make those shifts while they do have to make the life/death decisions. That is where the problem is, not the people making these crazy shifts.
But i honestly don't think that throwing more money to doctors and nurses will solve that.

Bison · 21-10-2008 6:38pm

Another way of looking at the short GP consultation would be to say that he has used about 12+ years of experience to quickly determine that you have a condition that can be treated without admission to hospital. There are many other occasions where a check-up results in a swift admission to hospital. Would you feel you got better value then?

The fee might seem excessive for a short consultation but whats the other alternative. You can't say "Oh you just have a cold, thats 20 Euro but you owe me 150 for spotting that cancerous growth on your back."

As for antibiotics, thats like saying you always see people coming back from the shop with "groceries". There are lots of antibiotics given for very different reasons.

I seriously disagree with the guy who has just given up explaining and dishes out unnecessary antibiotics. It would help though if there was a public health campaign informing people that antibiotics are not vitamin tablets and are actually not that good for you to take just for the craic. Oh, but wait, we don't have the money for that because the government hasn't run the country properly....

inforfun · 21-10-2008 9:36pm

Bison wrote: »

Another way of looking at the short GP consultation would be to say that he has used about 12+ years of experience to quickly determine that you have a condition that can be treated without admission to hospital. There are many other occasions where a check-up results in a swift admission to hospital. Would you feel you got better value then?

Yeah well, i have experience with a GP who probably acted on experience. My mom fell, hurt her ankle and went to visit her GP. Guy thought by the looks of it it was just some ligaments being stretched (forgive me for not knowing the right words...). Along she went for holidays and when she came back weeks later she still was in pain. Went to the hospital and it apeared her ankle was broken.
GP's are not in the position to work on routine imho

Bison wrote: »

As for antibiotics, thats like saying you always see people coming back from the shop with "groceries". There are lots of antibiotics given for very different reasons.

It might look normal to you, i compared it to Holland (where i am from) and i just noticed here, that a lot of people i know, who visited a GP, came back with antibiotics.

Bison wrote: »

I seriously disagree with the guy who has just given up explaining and dishes out unnecessary antibiotics. It would help though if there was a public health campaign informing people that antibiotics are not vitamin tablets and are actually not that good for you to take just for the craic.
Oh, but wait, we don't have the money for that because the government hasn't run the country properly....

Asking the question is probably answering it at the same time but... do we really need a commercial on tv/radio for everything to warn people that things might not be good??

sam34 · 21-10-2008 10:09pm

inforfun wrote: »

Yeah well, i have experience with a GP who probably acted on experience. My mom fell, hurt her ankle and went to visit her GP. Guy thought by the looks of it it was just some ligaments being stretched (forgive me for not knowing the right words...). Along she went for holidays and when she came back weeks later she still was in pain. Went to the hospital and it apeared her ankle was broken.
GP's are not in the position to work on routine imho
QUOTE]

thats unfortunate for your mother, but realistically, you cannot expect a gp, hospital doctor, or anyone to be right 100% of the time. there will always be human error, nobody is infallible. the unfortunate thing is that when doctors make mistakes, people suffer. if you were a shop assistant and you made a mistake, the worst that might happen is that you scan something twice, or you dont scan something at all. if you're a taxi driver, and you make a mistake, you might take a wrong turn- well, you do a u-ey, correct your mistake and the damage is a bit extra on the meter and a few hundred yards out of your way. unfortunately, the cost is higher when doctors get it wrong.

there are guidelines inplace so that doctors have to update themselves regularly, but this will only reduce error, not eliminate it.

RobFowl · 22-10-2008 1:19am

jaycen wrote: »

Fair play to her but I don't think it will have any effect on the moneygrabbing doctors;
€50 for a GP visit that probably lasts 15 mins, there should be a law against rates like that, in any other profession price fixing like that wouldn't be tolerated.

I,m a GP and we charge 5 for a child and 55 for an adult. Out of that we employ 6 staff , rent a buliding, pay public liability insureance, prodeffional insurance of €5000 a year per GP. Generally out the the fee we charge only 15-25 is actually "profit".
Go to VHI swiftcare and seeing a GP there (usually the Docs there are GP's just finished training or from SA) and you'll be charged 90-120. See a consultant for 5-10 mins €150-250.
Sorry to hear you think 55 is exorbitant but if you can let me know how to provide it any cheaper i'd love to know!
PS Gp's earnings average €100k to 150 , a very good salary but bear in mind that after at least 10 years training (first 6 in college (where you'll end up in debt of up to €60k) the next four in a combination of hospital jobs and GP training positions where the salary varies from 30 to 65k although overtimes is now paid, (it wasn't in the 80s and in the 90's was at 1/2 the normal hourly rate)

2Scoops · 22-10-2008 3:39am

RobFowl wrote: »

PS Gp's earnings average €100k to 150 , a very good salary but bear in mind that after at least 10 years training (first 6 in college (where you'll end up in debt of up to €60k)

How did you manage that? I got through med school without any significant debt, as did most, if not all, of my classmates. Are you talking about living expenses?

RobFowl wrote: »

the next four in a combination of hospital jobs and GP training positions where the salary varies from 30 to 65k

Some would consider that a paid job.

I don't want to get on your case but I think the temptation for many doctors is to overstate the hardship they endured during the early years of their career. Lots of people work hard and deserve their pay and doctors are among the lucky few who are actually rewarded appropriately. The life of a junior doc is crap but it's not the worst. And doctors are paid higher, fresh out of school, than almost any other profession.

RobFowl · 22-10-2008 9:30am

Quote
"2Scopps"
Some would consider that a paid job.

I don't think thats in question ! Not too sure what I said that made you think otherwise

Re the Debt I went through Med school when I paid fees 6 years at an average of £2500 a year and about £2-3000 in living expenses, and that was in the late 80's and early 90's. At graduation I had loans outstanding of £15,000 and that was because I worked through college earning about £4000 a year. (interst payments of about 10% per annum didn't help)
Today 4 years in a post grad course is 50k in fees alone.
I think after getting through Med school the maths shouldn't be beyond you !
PS not sugesting that life as a GP is bad but as A Junior doc was pretty miserable.
The above argument was made to justify a fee of 45-55 euros per consultation, not to get any sympathy.

ergo · 22-10-2008 6:37pm

inforfun wrote: »

Asking the question is probably answering it at the same time but... do we really need a commercial on tv/radio for everything to warn people that things might not be good??

hmm, answer: yes we do! In reference to the information re antibiotics. The public doesn't know. The public (especially the older generation, including my own mother who refuses to believe me and insists "get an antibiotic for that cough" or whatever) needs to be educated.

I agree: good GP's don't dole them out like smarties.

I am working in the NHS where GP surgeries have very useful info leaflets and posters regarding "antibiotics and colds" and that kind of thing. People don't insist on them in the UK like in Ireland. They can accept that it's a viral thing. And yes, I acknowledge they haven't paid a consultation fee and will have to pay a prescription fee for an antibiotic...amazing how that sort of system will change the patient's outlook... :rolleyes:

and why why why, alway alway always, when this debate about overpaid GP's come up it is usually the healthy people who only ever have been to a GP with tonsillitis and ended up with an antibiotic as that was probably their agenda for going to the doctor in the first place, anyway why is it always the example of "€50 for that, what a rip off...".....?

it's never the example of the more frequent presentations like the elderly person on 10 different medications with 3 different problems to be sorted out in the tiny amount of time available. And if that involves a hospital referral or any referral more paperwork

it's never the example of a new onset severe depression who wants to end it all or who spends 20 minutes in tears in front of the GP (easy €50 - what robbers GP's are)

its never the example of a 3 week or 3 month old baby with breathing problems who needs to be assessed, decision made (based on the thousands of kids, sick and healthy, a GP will have seen as part of his or her training and experience) if they need to go to hospital or can go home and not worry about it (another handy €50 euro - looks like we'll be retiring at 40 if this continues...)

and sorry, when i say €50 for each one, well, chances are that at least 2/3 of patients that come through the door have medical cards so no big fee like that anyway (people with medical cards go to the doctor twice as often as people without them)

I am SICK of hearing people give out about GP's, like they have an easy job, or like they just stand and dole out antibiotics all day long, because that's not the reality, that WOULD be easy.

/ends rant

Fionnanc · 26-10-2008 10:25pm

Say you work an everage of an 80 hour week( underestimate) as a junior doctor. You would be better off financially if you took two 40hr a week average paid jobs. Big payoff comes with a consultant post.
If you train as a psychiatrist you can be a consultant in 5 years post med school. The thoeoretical minimum time as a junior surgeon would be 10 years with an average of 16 years being the norm. And the junior surgeon works twice the hours of a junior psychiatist too, but as a consultant they get the same contract! Anmd half the new jobs offered for consultants are in psychiatry.:eek:
Save the state a lot of money and make the current psychiatrists work surgical hours!:D

tallaght01 · 27-10-2008 5:03pm

2scoops, I reckon being a junior doc is pretty low down there in terms of working conditions. Sure, it's not the worst job in the world. But any job that requires people to work 27, 36, 72 hour shifts ona regular basis is pretty miserable. I don't think the job itself is that bad, but it's the conditions. I've said before on this forum that I developed kidney stones at work once as I got so dehydrated on a regular basis from doing 12-15 hour shifts day after day without water breaks. Then when I'd passed the stone in A+E, I had to go back to work, as I knew the remaining staff were gonna be shafted if they were a man down.

There are worse jobs out there, but it can be pretty grim. Doesn't matter what they were paying me when I was hitting my 22nd hour in work. I would have given the cash up ina second just to get some sleep.

And i worked every single xmas, summer and easter holidays, aswell as having a job during the year in my pre-clinical years, and I'm still paying back my student debt.

Ergo, that's a really good post. I think it's important that the public realise what exactly GPs do.
It's hard, as a paediatrician, to get away from the fact that GPs as a group are shocking in their prescriptions of antibiotics. But, in fairness, we're shocking insofar as we overinvestigate patients (you'd be hard pressed to geta trip to hospital without having bloods taken).

I remember being a student and doing GP attachments. I was expecting a world of colds and flus. But on my first day, a kid rolled in with takayasu's vasculitis. Then the next patient had just come back from a SARS area with viral symptoms and wanted to know if they were infected! Next patient was a teenage girl who was pregnant and was under pressure from her family to have a termination, but she didn't want one. The rest of the day carried on like that. It was mental.

Total respect for GPs at this end. Though, they're pretty lazy here in Oz. Well, in terms of their referral letters they are.

Yesterday, in paeds A+E, I picked up a file from the triage tray. It was a kid who previously had leaukaemia. She was in remission. She'd gone back to her GP the other day with chesty symptoms. He did a CXR. It showed metastases. So, he doesn't ring her oncology team. He just sends her up to A+E. What a horible ting to find in the cat 3 box!!!

Fionnanc, I think you'd be doing pretty well to become a consultant shrink in 5 years post med school. You've got one year as an intern. Then there's 2 years as an SHO. You'd have to do your SpR job and get your exams in 2 years!
Plus the psych guys work the same on-call rotas as the surgeons do. The psych docs get called in less often. But putting more psych SHOs and registrars on a rota that's not saturated wouldn't change much.

PLus if we turn everyone into surgeons, who'd read the ECGs and listen to the chests :P

sam34 · 27-10-2008 6:05pm

Fionnanc wrote: »

If you train as a psychiatrist you can be a consultant in 5 years post med school. The thoeoretical minimum time as a junior surgeon would be 10 years with an average of 16 years being the norm. And the junior surgeon works twice the hours of a junior psychiatist too, but as a consultant they get the same contract! Anmd half the new jobs offered for consultants are in psychiatry.:eek:
Save the state a lot of money and make the current psychiatrists work surgical hours!:D

you cannot be a consultant psychiatrist in 5 years post med school!
one year as an intern.
a minimun of 3 years before you can sit teh final part of your membership exams.
then the SR scheme, agaim a minimum of 3 years.

so thats a minimum of 7 years. factor in the fact that not everyone will get their exams at first attempt, the fact that you may not get on the SR scheme at first attempt, the fact that a lot of people opt to do research time,and the fact that some wish to do dual training as an SR and you gat anything from 8 to 10 or 11 years.

as an NCHD in psychiatry, i worked rotas from 1 in 5 to 1 in 8, depending on the hospital. sure, some nights are quiet, but like any job you can get the nights from hell. but the basic rotas have generally been in line with my medical/surgical colleagues.

Tanaiste calls on doctors to reduce their charges

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