The era of the family doctor making out-of-hours house visits may be at an end

syklops

To be honest, as a recent thread seemed to show, I thought the era of the family doctor making out of hours house calls was already at an end, but thats a different discussion..

Now normally, of all professions, I have always felt that Doctors should be given all the help they want, because to become a Doctor, they had to work really hard through secondary school, and really hard through college, and really hard after college, and so deserve good monetary rewards(I'm not saying other professions dont work hard btw).

However, I have to say I am finding it really really difficult to sympathise with Dr Ken Egan from Ballindine, who is saying that if the out of hours call out fee is reduced from 93.24 euros to 45 euros, he will be telling people who call him to call an ambulance instead, because he will only get 45 euros for it.

"I have to make a living. If it's not going to pay me, I have to look at that."

I have to say Ken. At 45 euros per visit to the GP, in a normal 8 hour day, you are going home with upwards of 500 euros before tax, and before you do any out of hours calls. I am basing this figure on the fact I have never in my life spent an hour being seen to by a Doctor. Assuming a Doctor sees 1.5 patients in an hour that is 540 euros.

Now I don't earn alot. Neither do various members of my family who spend a lot of time at various doctors and when it comes to health, I/we dont believe in quibbling over money, so it really disheartens me to see Doctors like Ken quibbling over a reduction of 48 euro to a fee. As I think about it, there are two reasons why I feel disheartened. The first being that if he does not get called out very often, then it is only a reduction of 50 euro or so, and the second being if he gets called out say 10 times in a week, then it means before, he was earning as much as 900 euros a week extra on top of his normal salary. Like I said, I am finding it really difficult to have sympathy.

Here is the article in full from the Herald.

FAMILY doctors may end out-of-hours house call-outs because of a major drop in the fee paid to GPs to make the trip.

The fee cut, from €93.24 to €45, took effect after the December Budget and is threatening the viability of general practice in rural areas, according to members of the Irish Medical Organisation.

The cut could also lead to an increase in patients attending hospital Accident & Emergency departments if doctors decide to cut back on house calls.

Doctors at the IMO's general meeting at the weekend warned that the era of the family doctor making out-of-hours house visits may be coming to an end.

Dr Ken Egan said he had been called out to fires and "to all kinds of local stuff" because it would take an ambulance 30 minutes to travel from Galway to where he is now based in Ballindine, between Claremorris and Tuam.

But in light of the fee reduction, he would be more likely to advise that patients call an ambulance "rather than driving 30 minutes to see someone for €45, which is the same as what I get for seeing them out of hours in the surgery."

LIVING

"I'm not going to say I'm not going to see you because I'm not getting paid, but I have to think of the patient who's coming in to me (in the surgery) and the house call I have to do and I will stay for the patient coming in.

"I have to make a living. If it's not going to pay me, I have to look at that."

Dublin-based GP Dr Ray Walley said the cuts were "a savage imposition on rural doctors" and could lead to great reliance on the ambulance service, which typically costs more than €1,000 per callout.

Dr Michael Kelleher, based in Lahinch, Co Clare, said it was going to disincentivise new blood coming into rural general practice.

"No young doctor with half a brain is going to set up where they will lose money," he said.

Dr Aonrai Finnegan, based in Ballinsloe, Co Galway, said the house call was "a fundmental part of general practice" but its days were effectively numbered.

It is estimated that cuts in professional fees paid to GPs introduced in December will make annual savings of €48m.

Irish Rural Link, a lobby group representing the marginalised and disadvantaged in rural areas, said patients were entitled to a service, regardless of what a doctor was paid.

Claasman

Sure who else is going to pay for their free third level education...

Joey the lips

How many out of hours calls do they make.... Not 8 hours worth and if i worked for 8 hours and then done another 8 hours of calls i would want to be paid well.

I think out of ours docs are on the decrease due to "d doc" more likely.

that and the fact that those working tend to live with problems now because they cannot afforrd it.

galwayrush

They will never refuse hard cash.

syklops

Joey the lips wrote: »

How many out of hours calls do they make.... Not 8 hours worth and if i worked for 8 hours and then done another 8 hours of calls i would want to be paid well.

I think out of ours docs are on the decrease due to "d doc" more likely.

that and the fact that those working tend to live with problems now because they cannot afforrd it.

Your post makes no sense to me. Can you rephrase it?

rubberdiddies

Joey the lips wrote: »

How many out of hours calls do they make.... Not 8 hours worth and if i worked for 8 hours and then done another 8 hours of calls i would want to be paid well.

I think out of ours docs are on the decrease due to "d doc" more likely.

that and the fact that those working tend to live with problems now because they cannot afforrd it.

Isn't d-doc just a Dublin service?
Also I presume the fee reduction only applies to medical card holders, ie: the people that the government are paying doctors fees for.
Surely the docs can still charge the higher call out fee for non medical card holders

syklops

rubberdiddies wrote: »

Isn't d-doc just a Dublin service?
Also I presume the fee reduction only applies to medical card holders, ie: the people that the government are paying doctors fees for.
Surely the dice can still charge the higher call out fee for non medical card holders

D-Doc is a dublin service, but I think he was reffering to all the other Docs, e.g. West Doc, Clare Doc, etc.

Daft naming convention IMO.

rubberdiddies

syklops wrote: »

D-Doc is a dublin service, but I think he was reffering to all the other Docs, e.g. West Doc, Clare Doc, etc.

Daft naming convention IMO.

Ah ok thanks.
This is where I'm confused though. I presumed that cos we had d-doc the local docs don't do an after hours service and just refer you to d-doc instead? Obviously I'm wrong so

syklops

rubberdiddies wrote: »

Ah ok thanks.
This is where I'm confused though. I presumed that cos we had d-doc the local docs don't do an after hours service and just refer you to d-doc instead? Obviously I'm wrong so

Thats what I thought too.

suitseir

galwayrush wrote: »

They will never refuse hard cash.

I NEVER give my GP cash.....always a cheque!!! That way, they have to LODGE it to their account!!!!!

I recently looked for a PRINTOUT of doctor's visits to include fees for the OH in order to include it in the tax return.........still waiting!!!!!!

easyeason3

If you need a doctor to be called out then I'm assuming you or a family member is genuinely sick enough to need them.
Cost doesn't really come into it.

I'm more pissed off at what they charge for a visit to their clinic that lasts about five minutes & you get charged €50 for the privilage of being herded through like cattle in a mart.

opinion guy

rubberdiddies wrote: »

Ah ok thanks.
This is where I'm confused though. I presumed that cos we had d-doc the local docs don't do an after hours service and just refer you to d-doc instead? Obviously I'm wrong so

Who do you think staffs the d-doc ? Or West doc ? Or whatever it is-doc. Its usually staffed by the local GP's in a rota system. The advantage to them being they are then only on call every now and then - as opposed to always on call before someone invented the d-doc service.

CrazyRabbit

could lead to great reliance on the ambulance service, which typically costs more than €1,000 per callout.

Seem that ambulance drivers could do with a pay cut if it costs €1,000 per call out!

wild_cat

CrazyRabbit wrote: »

Seem that ambulance drivers could do with a pay cut if it costs €1,000 per call out!

I think that might be down to insurance costs and to prevent hoax/stupid call outs.

ScumLord

syklops wrote: »

I have to say Ken. At 45 euros per visit to the GP, in a normal 8 hour day, you are going home with upwards of 500 euros before tax,

Doctors do have expenses you know. All that medical equipment doesn't come from santa clause.

I agree asking for €50 just to see a doctor regardless of time is steep but the medical equipment is far from cheap.

I know GPs make a lot but I would reckon a lot gets swallowed up in that insurance stuff they need to have

maglite

He clearly has no appreciation for the role of an emergency ambulance, Maybe he should advise people to get a taxi.

syklops

ScumLord wrote: »

Doctors do have expenses you know. All that medical equipment doesn't come from santa clause.

I agree asking for €50 just to see a doctor regardless of time is steep but the medical equipment is far from cheap.

What medical equipment?

ScumLord

syklops wrote: »

What medical equipment?

All the medical equipment that doctors use?? What kind of doctor are you going to, never trust one that operates out of a shed and uses cutlery.

syklops

ScumLord wrote: »

All the medical equipment that doctors use?? What kind of doctor are you going to, never trust one that operates out of a shed and uses cutlery.

A stethoscope and those wooden sticks they stick on your throat? Seriously what equipment?

sundodger5

i think some other professions have call out charges, how much do plumbers charge? similar to the doctors afaik. i would put doctors as more skilled and my health more important.

ScumLord

syklops wrote: »

A stethoscope and those wooden sticks they stick on your throat? Seriously what equipment?

There's needles, bandages, some big thing that looks like a crane, I have no idea what it does. Just about everything is use once and probably needs to be to a certain standard which means it's going to be expensive.

Just because you don't get the use everything at the doctors disposal doesn't mean the doctor doesn't need to have all those things on site. Your paying to access a professional and all their equipment. Your not paying to just say hello and use one disposable wooden stick.

It's the same as going into Supermacs. Your not just paying for the burger your paying for everything in the kitchen, their advertising and staff costs.

You wouldn't go to a doctor that operated without any of these things, you wouldn't take them for professional.

opinion guy

syklops wrote: »

A stethoscope and those wooden sticks they stick on your throat? Seriously what equipment?

Right so stuff they might bring on the road:
Stethoscope, auroscope, opthalmoscope, BP monitor, blood sugar measuring thingy, bag mask, iv equipment (needles, cannulas, drips etc), drugs - these can be expensive and need to be replaced to keep them in date even if not used, perhaps some other random stuff that i can't think of - maybe airways and stuff. In the office even more stuff - an ECG machine alone will set you back a few grand. If they have portable one for road even more probably.

opinion guy

sundodger5 wrote: »

i think some other professions have call out charges, how much do plumbers charge? similar to the doctors afaik. i would put doctors as more skilled and my health more important.

Try hiring a locksmith out of hours. AFAIK its like 150 minimum

28064212

syklops wrote: »

A stethoscope and those wooden sticks they stick on your throat? Seriously what equipment?

Scumlord's right, what kind of doctors are you going to? Off the top of my head, things like ophthalmoscopes, syringes, liquid nitrogen, defibrillators and blood pressure monitors

syklops wrote: »

I have to say Ken. At 45 euros per visit to the GP, in a normal 8 hour day, you are going home with upwards of 500 euros before tax, and before you do any out of hours calls. I am basing this figure on the fact I have never in my life spent an hour being seen to by a Doctor. Assuming a Doctor sees 1.5 patients in an hour that is 540 euros.

Some fairly huge assumptions there. Top of the list is the fact that a huge number of visits to GPs are by medical-card holders, for which GPs get paid per-patient, not per-visit.

Dr Egan certainly does himself and his profession no favours with his comments, but the era of out-of-hours calls should be over years ago. Doc-on-call systems are the way it should be. Even in a two-doctor town, being on call is a huge burden.

syklops

OK, I think the point of the thread is slowly going off course.

I wanted to discuss the doctors complaining about the reduction of the after hours call out fee from 92 euros to 45 euros. Maybe I should have put this in a disclaimer at the start of the thread.

I am not:

(A) Begrudging them getting paid
(B) Begrudging them getting after hours fees
(C) Suggesting they do not deserve the money they get for the work they do

Doctors do have expenses you know. All that medical equipment doesn't come from santa clause.

I agree asking for €50 just to see a doctor regardless of time is steep but the medical equipment is far from cheap.

Fine, I concede the point that medical equipment is expensive and the Doctor has to cover the costs of these.

This After Hours Call out fee is paid for by the HSE to the doctors. I just wonder how much money does this reduction mean for each Doctor, and therefore how much money will it save the government, and therefore us.

I mean, how many after hours call outs does a doctor do in the course of a week? Is it so common that it is basically his bread and butter? Or is it so rare that it is a surprise bonus? Can anyone fill me in?

28064212

syklops wrote: »

I mean, how many after hours call outs does a doctor do in the course of a week? Is it so common that it is basically his bread and butter? Or is it so rare that it is a surprise bonus? Can anyone fill me in?

Certainly wouldn't be his bread and butter, nor would it be rare. The important thing is not how many calls he actually has to do, it's the actual state of being on-call. What it means to be on-call:

• You always have to be accessible via phone
• You can't have a drink
• You can't go too far away from your area (for example, you couldn't take a trip up to Dublin for a concert)
• You can be called out at any time of the night (do you know what kind of effect getting up at 3 in the morning has when you finished work at half 6 and have to be in at 9?)
• Want a weekend away? You'll have to get a locum in to cover

syklops

I know what its like to be on call, and I know what getting up at 3am to go do something is like. Never got 90 extra euros for it though.

28064212

syklops wrote: »

I know what its like to be on call, and I know what getting up at 3am to go do something is like. Never got 90 extra euros for it though.

You don't think your salary reflected that being on call was part of your job?

syklops

28064212 wrote: »

You don't think your salary reflected that being on call was part of your job?

I was well paid in my role and part of my role was being on call. I didnt get extra money everytime I had to go out to do a job though, but that is neither here nor there.

At this point it is clear that most people think that the Doctors should get 90 euros after hours call out fees paid to them by the HSE for after hour call outs. That seems to be the general consensus so I will concede the point.

Ray Palmer

When I worked on-call it was a pain. I was paid more than the doc was being paid if the phone rang. I was also paid to be on call and the phone didn't ring. I would not be on call for a night at €45 and never had to go anywhere.

When work tried to change the on call rates I simply said I would be available for the rates they were suggesting. A new guy ended up with the on-call duties as everybody else refused. They gave him a terrible rate and he handed in his notice within a year as he could never get off call. The rates returned to what they were and people took a fair share of on call duties.

ScumLord

syklops wrote: »

Fine, I concede the point that medical equipment is expensive and the Doctor has to cover the costs of these.

This After Hours Call out fee is paid for by the HSE to the doctors. I just wonder how much money does this reduction mean for each Doctor, and therefore how much money will it save the government, and therefore us.

I mean, how many after hours call outs does a doctor do in the course of a week? Is it so common that it is basically his bread and butter? Or is it so rare that it is a surprise bonus? Can anyone fill me in?

I would assume that the kind of patients that would need a doctor to call out to them would be older people or anyone who would have difficulty in leaving the house. I would also guess most of these people would have medical cards.

I think doctors may be becoming detached from their patients because there's simply to many of them. Our town only has one doctor and she doesn't always charge you for visiting her, she has some discretion depending on the situation. But she's part of the community she's treating her friends and neighbours I would say sometimes it's hard to ask a person for money even though they are taking your time.

opinion guy

Ray Palmer wrote: »

When I worked on-call it was a pain. I was paid more than the doc was being paid if the phone rang. I was also paid to be on call and the phone didn't ring. I would not be on call for a night at €45 and never had to go anywhere.

When work tried to change the on call rates I simply said I would be available for the rates they were suggesting. A new guy ended up with the on-call duties as everybody else refused. They gave him a terrible rate and he handed in his notice within a year as he could never get off call. The rates returned to what they were and people took a fair share of on call duties.

What did you do ?!?!

Laisurg

This kind of moaning annoys me, does this guy know that doctors in Ireland are paid a fair bit more than doctors in other european countries... and this whole ''i have to make a living'' thing is bull****, he'll still be loaded whether they cut the call out fee or not.