The IMO's annual gathering may have been tame but chill winds of change and the Hanly report's implementation indicate turbulence ahead, writes Medical Correspondent Dr Muiris Houston.
Predictably, given he was fresh from visits to Nenagh and Ennis, where the future of hospital services are the subject of intense controversy, the Minister for Health could not avoid Hanly. Significantly, with elections looming, notably for local authorities, he referred to Hanly's "way forward" as a template for hospital services rather than a bible.
With the EU Working Time Directive deadline looming fast, Mr Martin was uncompromising in stating there would be no last- minute derogation or postponement.
But with no extra consultants in place without Hanly and a ban on additional NCHD posts to cover the deficit in doctor numbers, it is difficult to see the Republic not flouting the directive without some compromise on rest periods.
IMO sources hinted this might be possible; what no one was saying too loudly, but all privately admit, is that out-patient clinics and theatre sessions will be cancelled as a result of the 58- hour maximum working week. Yet again, it is the long-suffering patients in our public hospitals who will bear the brunt of bureaucratic inefficiency.
The nearest we got to palpable anger at the IMO's annual gathering was a debate on the Government's failure to deliver on its commitment to provide an additional 200,000 medical cards.
Speaker after speaker referred to the glaring inequities exposed by this failure; tales of patients with asthma who could no longer afford necessary medication and instead clogged up A&E departments, spending unnecessary time in hospital beds, were legion.
Referring to "the deliberate culling of medical cards" and an "increased threshold for a medical card representing less than half the minimum wage", incoming IMO president Dr James Reilly predicted a future tribunal on the issue. How basic medical care was rendered inaccessible to such a substantial number of Irish people by a Government that had equity and access at the core of its health strategy was scandalous, he said.
The 20th annual general meeting of the IMO was a relatively quiet affair. Any thoughts the organisation may have had of celebrating its entry into a third decade disappeared following the recent death of its most influential member.
Dr Cormac McNamara, the Waterford GP and occupational physician, who passed away in March, was president of the IMO in the 1990s. But more than that, he was the person who created the organisation, overseeing the amalgamation of the Irish Medical Association and the Medical Union in 1984.
Cormac's impish face was missing from its usual place in the second row of the auditorium at the Hotel Europe in Killarney. Neither did we hear his perfectly timed and always reasonable interventions in debate about policy.
Several doctors spoke of feeling his spiritual presence. Tribute was also played to Dr Seaghan Ua Conchubhair, the Galway GP who acted as the IMO's unofficial standing orders expert. It was strange to sit through three days of debate without once hearing his familiar voice drawing Mr or Madam Chairman's attention to a minor breach of procedure.
Coming after last year's extraordinary gathering coinciding with a public health doctors strike and a monumental cock-up involving the on again/ off again Chinese immigrant SARS case, this year was never going to top 2003 for excitement.
But just to prove you can never say never in medicine, the sad case of the cystic fibrosis sufferer Billy Burke dramatically entered the arena just before Mr Martin gave his conference address.
Lisa Burke, Billy's sister, was in tears as she handed Mr Martin a letter from him. The Killorglin man finds himself in the middle of two contrasting opinions from doctors at Manchester and Newcastle lung transplant units. He wants an Irish donor's lungs to be made available to the Manchester hospital so that he can be operated on before it is too late.
It is a difficult dilemma for the Minister for Health who cannot get directly involved in differences of medical opinion - especially ones involving doctors in another jurisdiction. In the circumstances, his speech was suitably low key.
Given the "state of chassis" of the Republic's health service, the meeting was remarkably good humoured. But snow on Mangerton mountain as doctors made their way home on Sunday was a reminder that the chill wind of change is never far away.