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OPINION: Medical voices that matter

Photo by Karolina Grabowska for Pexels.com

Photo by Karolina Grabowska for Pexels.com

Social media is not awash with Irish health professionals nailing their colours to the mast. At least not openly and it’s easy to understand why.

Last month staff from government health service (HSE) hospitals in Ireland discussed the issues surrounding family general practitioner (GPs) shortages but kept their identities on social media anonymous in doing so. Part of the reason for remaining anonymous is the “noise” of published data surrounding discussion of the topic online can get you into (serious) trouble at work.

(We have kept their identity online redacted here.)

“I think a lot of staff are hesitant to post about these things so it’s difficult to get first-hand accounts that aren’t PR filtered,” said one.

“This year was particularly egregious for everyone,” wrote another.

There is the matter of trained doctors working as GPs on government health service or HSE-sponsored medical-card schemes. There is also the matter of private practice GPs who do not engage with the HSE. There is a total number of qualified doctors who work in the medical field and those who work only as GPs. There is the influx of new arrivals to the country who need immediate access to GPs (who don’t work out of hospitals) and the outflux of newly trained doctors leaving for calmer, balmier shores.

“Every loss is felt twice as hard for the loss of skills and the loss of training and these new slots don’t pay off for years,” says one. “I understand that the increase in places over the last ten years means we’re now training more GPs than are retiring. Over time you’d hope that helps, but I can’t see a quick fix. Importing more GPs is probably the quickest option, so it’s good to see more of that, but it’s not ideal either.”

A parliament “Dail” debate on rural GP shortages in March 2024 published online offered little in the way of renewed thinking on the subject last month.  

So far only worsening conditions are being reported, especially in deprived rural areas, despite intense public pressure and demand.  

“I work in hospital. The training programs all, to various degrees, treat you like crap. Some are better than others, but it’s fairly universal that they treat trainees like they should be thankful they’re even allowed in and if that means years of having no social life, exorbitant fees, and unfair hours, then that’s just the cost of training,” writes one of the voices from social media.

GP shortages quickly become a slow game of political football in the hands of politicians vying for electoral capital; while parties provide an empty debate on the topic, air time accounts for electoral votes.  But behind the debate a few things are clear: There is no shortage of qualified doctors in Ireland if data from the government is taken at face value. Consider the National Healthcare Statistics 2024 that states that there were:

  • 20,135 physicians practising in 2023
  • 54.2% of doctors practising in 2023 were General medicine Practitioners
  • of 29,573 licensed physicians in 2023, 43.4% were trained outside of Ireland.
  • Of these, top three overseas-trained doctors came from Pakistan, Sudan and the United Kingdom

In June 2023, the Minister for Health announced an increase in medical training opportunities for would-be doctors:

  • GP Training Places will increase by 35% in 2024
  • Representing a 45% increase in four-year training program intake

“It takes 6 years to train new doctors. 5 years of medical school (usually) and 1 year of internship at minimum before they can get onto the GP scheme. Every doctor lost to burnout takes 6 years to replace. Every increase in population that requires a new GP takes 6 years to train up. And that’s not to consultancy, that’s just to seeing patients as a trainee, assuming there’s a training spot and the interest to fill it. It still takes several years to complete the scheme to practice independently,” a health worker online writes.

While news and social media loudly report GPs shortages, little attention has been paid to specifics of their location in areas of deprivation. Instead, reports focus on emigration issues, unwelcome foreign talent and anti-immigrant culture, of which little seems to be backed up by fact. Published online data can be very misleading too. These figures from the Irish Medical Organisation (IMO) would seem to contradict figures announced by the Minister late last year.

Studies show that areas with greater levels of social and material deprivation had lower levels of primary care access in both numbers of GPs and services.  Also, within primary care, GPs tend to move to more affluent areas.

In Ireland latest figures, from 2022, report that there are 0.69 GPs per 1,000 population. For comparison, the world average for 2021 was 3.93 doctors per 1,000 people across 12 countries. Britain by comparison has a 3.2 practising doctors per 1,000 ratio but this figure is not total GPs but includes them; the NHS provides free primary care to a much larger population, unlike Ireland which only recently in August 2023 introduced free primary care just to the under 7s.

In 2015, Dr Brian Osborne, Assistant Medical Director of the Irish College of General Practitioners (ICGP) published a report on Irish GP doctors working in areas of deprivation. The report, Irish General Practice: Working with Deprivation argues that “chronic underfunding of general practice in Ireland” has left it up to GPs themselves to manage ever-changing demands and that improper investment in primary care has been shown to directly harm population health.

The report also says somewhere between 22% and 30% of practices in Ireland work with areas of deprivation.

The study says “A higher propensity of GP burnout was found among GPs with a high share of deprived patients on their lists compared with GPs with a low share of deprived patients.

“Very often deprivation in rural areas is less visible to the general public but highly apparent to GPs. The specifics are often different from those seen in urban areas but equally as detrimental and under-resourced,” the reports says.

The report also says: “Geographic, financial and social isolation and the closure of once vital rural life including post offices, Garda stations, pubs, schools and GP surgeries has led to ever-increasing difficulties in rural Ireland. In the current system, it is difficult to recruit GPs to work in areas of deprivation.”

There is no financial, professional or personal incentive for GPs to work in these areas. Those who have are coming from abroad.

A HSE staff writes: “My brother’s friend is almost finished, and between hospital/specialist and GP placements he’s been in a half dozen (it seems) workplaces for ~3 month stints which are between 1.5-2 hours of each other by car and impossible without a car. That’s maybe fine if you’re 21 (and there’s a functional rental market…) but it’s not really acceptable to expect it of people who are in their late 20s or early 30s.”

Writes another in response: “No surprise that a lot of the schemes, not so proudly, also have high drop out rates. Though if you talk with the various scheme heads, vice-deans, etc. they all act like this is either a) a mystery or b) some unfixable problem they can’t even begin to approach. Much like Irish government, the prospects of change are grim.”

“This is like trying to bail out a sinking ship using a bucket that has holes in it.”

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