Report warns of GP shortage

MicraBoy

www.irishtimes.com

LUKE CASSIDY wrote:

Ireland is facing a shortage of GP services due to a “bottleneck” in training the Competition Authority has revealed.

In a series of reports published today on gneral medical practitioners the authority recommends an improved supply of GPs and the advertising of their services.

The authority said doctors wishing to become GPs must undertake four years of specialised training in addition to their medical degree and some of this is repeated.

It recommends doctors who have relevant hospital training and experience should, subject to a short orientation course, be allowed proceed immediately to the two years training in a general practice.

“This will result in more GPs being trained as quickly and as cheaply as possible and help alleviate predicted shortages in GP services,” the report said.

In terms of advertising for their services the authority said new Medical Council guidelines published last month have removed traditional restrictions on GPs in this area.

“If GPs respond to this development patients should start to see more information about the services available to them and how much they can expect to pay,” the report said.

Director of the Competition Authority’s advocacy division Declan Purcell said people are delaying visits to GPs as the cost has risen faster than inflation.

“Increasing the supply of GPs quickly, and raising awareness of the services available and their prices, should go some way towards improving access to GP services,” Mr Purcell said.

Part three of the authority’s report into GPs will be published in 2010.

I guess this isn't new news but what do people think of the Competition Authority's suggestions for solving the problem?

Pete4779

It will work, at least with what services people want to pay for in Ireland.

Basically, you will end up paying e.g., €40 to see someone with 2-3 years SHO experience wo may have never been able to get on any training scheme but had a 6 month post in paeds, 6 month post in cardiology, etc.,. No specific training at all

Then, bingo! A week long orientation course and now you have a family practitioner! Crisis averted.

As usual for Ireland, it's health care on the cheap. The consequences are years away, so won't matter much. The other side is mini-hospitals run by GPs that will include pharmacies, physiotherapy, etc.,. They will all function together but there won't be a "standard" of care in all parts.

Jane5

Pete, you should read that a bit more carefully. They are not proposing to dumb down GP training. The moronic situation in Ireland has always been that, even if you had worked for years in General Med, or A&E, you were not given any recognition for this once you went onto a GP scheme, you had to repeat it all.
I once worked with a GP SHO who had been an Infectious diseases SpR (so had done 2 years SHO scheme in gen med, medical membership exams, several years as a registrar covering acute medical call). He was repeating a year of gen med SHO as part of the GP scheme!
Situations like these were commonplace, they DO hold up GPs completing their training (needlessly) and they are, lastly, unfair to the trainees themselves.
Your analogy above: that someone may have worked in cardiology 6 months and paeds 6 months, is ironic. The GP scheme is made up of 6 month rotations in A&E, Paeds, gen med areas including cardiology, Obs and gynae, Psych and Pallliative care. So the person who had done 6 months paeds and 6 months cardiology quite rightly should get one year off of the GP scheme, and rotate in areas he/she has not worked in before instead.

Vorsprung

I agree with Jane.

Exceptions should absolutely made for those people who have higher training. I know a Resp SpR who in her 4th year went back to GP. Also know of a 2nd year ED SpR who did the same, and I've heard of a Cardiothoracics SpR who had finished his entire training, fellowship and all who was waiting so long for a job at home that he went back and did GP.

Medical SHO might have been more relevant for the last 2, but a medical SpR should definately get some time knocked off.

nesf

Seems to be very sensible to me. As was the suggestion to lift the advertising ban.

MrCreosote

Jane5 wrote: »

Pete, you should read that a bit more carefully. They are not proposing to dumb down GP training. The moronic situation in Ireland has always been that, even if you had worked for years in General Med, or A&E, you were not given any recognition for this once you went onto a GP scheme, you had to repeat it all.

Spot on. The training schemes in Ireland are extremely inflexible at the moment. Even now there's no way somebody with say 2 years in Emergency medicine should be made do another six months, when another specialty will be more appropriate. The best training for general practice is GP work anyway. Maybe they should offer GP intern/SHO positions so people can get a taste of the good life...

Pete4779

Ah i see

Makes sense so, but it would obviously require a big step forward with standard minimum experiences and rotations. From what I know in the UK, people with experience in 6 month posts here can do a "GP year" in the UK and then get College recognition?

AmcD

I know there is a shortage of GPs, but fast-tracking GP training is not the solution. Once a GP is fully trained, the problem is getting a job. At the moment there are a lot less GP locum jobs about. Practices are not hiring GP assistants. I can tell this by watching the pattern of job ads in the medical media over the past year, as well as talking to friends who are looking for locum work.

The cost of setting up a brand new private surgery is quite a deterrent. Even if a bank will lend you money to hire and kit out a surgery and pay for a nurse and receptionist and all the usual overheads, there is no guarantee of an income. People don't have as much money now to pay to see a GP and it takes a long time to build up a list of private patients.

The medical card system still remains restrictive. At the moment there is a "loophole", where the HSE is allowing establishing GPs to get a medical card list, if they have been in full-time practice for a year from September 2008. They also have to have "suitable premises". The closing date is 31st January and then the system closes up again.

The benefit of having a medical card list is that it provides a regular monthly income and also allowances towards hiring staff to look after medical card patients.

If the HSE truly wants to increase the number of GPs, I think they will have to seriously look at the following:
1. Make GMS lists more available and accessible for establishing GPs. I expect the number of medical cards is rising, so this will become more important. Currently many established practices are turning away people with medical cards who want to sign on, simply because they already have too many patients.
2. The primary health care teams are certainly slow to take off, but they are the way to go. I technically am part of one. Maybe the HSE will actually start opening centres and employing salaried GPs to work in them. I have reservations about getting the HSE involved in running general practice, but it would be a way of extending GP services.

bleg

Give other health professionals a bigger role.

Ihaveanopinion

nesf wrote: »

Seems to be very sensible to me. As was the suggestion to lift the advertising ban.

I feel this suggestion is fraught with difficulty. If you go to the US, you can see billboards with 'the best doctor in boston'. it would be more a case of who shouts the loudest, gets the most attention. Not necessarily the best option. A key part of the doctor-patient relationship is just that... a relationship. If you are chasing medical care as a marketable asset, it turns medical care into a faceless commodity. Maybe others will disagree with me but I wouldn't like to see that happen.

By all means, make information about doctors, outcomes, audit, etc, etc available but not advertising.

HQvhs

Ihaveanopinion wrote: »

I feel this suggestion is fraught with difficulty. If you go to the US, you can see billboards with 'the best doctor in boston'. it would be more a case of who shouts the loudest, gets the most attention. Not necessarily the best option. A key part of the doctor-patient relationship is just that... a relationship. If you are chasing medical care as a marketable asset, it turns medical care into a faceless commodity. Maybe others will disagree with me but I wouldn't like to see that happen.

By all means, make information about doctors, outcomes, audit, etc, etc available but not advertising.

I have to agree. Opening up advertising for doctors could lead to a whole lot of problems. In relation to advertising, if it ain't broken, don't fix it!

AmcD

bleg wrote: »

Give other health professionals a bigger role.

I think this is a good idea, but I can't see how it would work. Community-based workers already have their hands full. For example the public health nurses are thinly stretched as it is doing child health surveillance, house visits to the elderly etc. Practice nurses also have a huge role in looking after all the vaccinations, smears and so on. It isn't like hospitals where doctors are doing loads of tasks that could easily be done by others (phlebotomy, IV lines etc).

One of the tasks that I would happily give up is the role of pseudo community welfare officer and social welfare officer. Who am I to decide who needs the clothing allowance? I am also fairly worn out with having regular consultations/confrontations with people who feel entitled to long-term sick certs.

nesf

Ihaveanopinion wrote: »

I feel this suggestion is fraught with difficulty. If you go to the US, you can see billboards with 'the best doctor in boston'. it would be more a case of who shouts the loudest, gets the most attention. Not necessarily the best option. A key part of the doctor-patient relationship is just that... a relationship. If you are chasing medical care as a marketable asset, it turns medical care into a faceless commodity. Maybe others will disagree with me but I wouldn't like to see that happen.

By all means, make information about doctors, outcomes, audit, etc, etc available but not advertising.

Sure, but lifting the advertising ban in this instance means not a free-for-all but a loosening of the regulations. I can't imagine regulations being loosened to the quite crazy state the US is in with regards to medical advertising directed at consumers.