The Doctors are the Scandal

Every time a crisis point arrives in relation to funds for our GPs the elephant in the living room pulls on its camoflage and goes completely invisible. Here is the truth: our GPs in Ireland are vastly overpaid for what they do.

This country has walked blindly into an economic nightmare and huge corrective measurs will be required to get our public finances off their current devastating trajectory. The politicians are right – there will be a lot of pain. But the FF led government is lying when it says the current budget will deliver the solution with pain shared equally: neither are true.

First, the budget doesn’t even come close to getting our current spending on a sustainable path. The gap is just too big. To paraphrase Heaney, we are using a toy hammer to crack a megalith. It just isn’t enough.

Second, the pain is not, I repeat not, being shared equally. If we could pull up a coloured map on a screen that showed the flow of disposable income to all workers during the past 10 years we’d see about 1.5 million thin channels. They got thicker during the boom, but not by much. We’d then see .25 million to .5 million, thick channels flowing to the pockets of those who are big investors, self employed professions, property developers, highly paid advisors, senior executives, and the top echelons of the civil service. These channels fattened beyond recognition over the last decade.

Back to the doctors. They are now complaining about the government proposal to cut back the payment for the over 70s. True there are inequities in how funds are delivered and the system is obviously a political construction rather than one based on medical needs. But let’s be straight: GPs in Ireland are very very well paid.

Let me take an example. I know a GP in his late 30s who inherited not one single farthing. So his current comfort level was based on his (mainly) income topped up from his wife who is a part time secretary. Here is where the celtic tiger brought them:

He bought a house at 1 million a couple of years ago. They run two fine cars. They took six, yes six, holidays to Europe last year. They put 40k into their pension last year to invest in the future. And he has recently adjusted his hours to work a 4 day week. Admittedly the other 4 days are long. I estimate their combined income comes to close to 300k. Am I wrong? Ok, docs, tell me, not your personal income, but what is the average take home for a GP?

Compare with say a senior manager in an IT firm. She works 80 hours a week and is travelling up to 25 or 30% of the time with all the pressure that puts on family life. Her job could go at any moment. Yet even if she breaks her arse, she will only hope to hit around the 100k mark. Yes, not a bad income and more than double the average industrial wage, but it is a fraction of what the GP earns. Why?

Are doctors running around under severe pressure saving lives? Or is three quarters of their work more about looking into peoples ears and telling them its a virus to go home and rest. Or giving assurances and placebos to pensioners. That cannot be all they do – they have hard cases to deal with and many to a great job. But please, it’s not saving the world.

An OECD survey of medical earnings from 2005 shows Irish General Practitioners earning second highest in the list of 22 OECD countries, with only the US higher. The bottom line – Irish GPs take out huge salaries out of their businesses. Then they say the government is not giving them enough ‘to look after the sick’. Oh pulllease.

A final thought. There is now the joke that the government cannot do a deal with the IMO (ie a tougher deal giving less money for cards) because it is against competition rules. Hold on. Is this the same GPs who refuse to assist competition by advertising prices? Is this the same medical profession which pops up repeatedly in the annex to the report from the competition authority saying the sector is uncompetitive because of barriers to entry. Competition my ass. Sew it to them.

Is all of the debate and despite the crisis, no one is calling a spade a spade. Though some recent measures were made by hannafin our medical profression (like law too) remains absurdly closed and is one of the last sphere to be almost completely immune from the forces which batter the rest of us – like competition and fluctuations in the market. (How many GPs will loose their job in the downturn?). No, the real scandal here is not the medical card issue, it is the scandal of how our medical profression, particularly General Practice, is structured and protected. But if the politicians run scared of the pensioners, what chance they will face up the formidable lobby that is medicine.