What's happening to the Irish family doctor? Dissatisfied and disaffected, their leaders have clashed with the Minister for Health. GPs, 20 years ago, were usually men, practising on their own. All is changed, writes Richard Hannaford
At 70-years-of-age Dr John McCurdy is thinking of retiring. He still opens his surgery door 8.30 a.m. every day and operates a "no appointment necessary" system. The practice, in Malahide, has been in the centre of the village for more than 100 years. "I started in 1965 with the local doctor, and I did everything. I did stitching, took off lumps, and delivered babies," he says.
For 20 years he and three other local practices joined up at weekends in an "out-of-hours" rota that provided cover for each other. "We would ring each other up on Monday and say we saw so and so we kept the practices intact."
That ended about five years ago and since then Dr McCurdy has been looking for someone to take over the business. But so far he's had few takers. "I had one doctor work with me for two years, but she left and is now doing locum work," he says, "No one wants to do what I do."
Dr McCurdy is one of a large number of single-handed practitioners throughout the State who are either about to retire, or who are looking to scale down their practice.
And while in theory there are enough newly-qualified GPs to replace these doctors, for some reason that's not happening.
Its nine o'clock in the morning and already the reception area at the Pearse Street Medical Practice, in Dublin's inner city, is full of patients.
Most have medical cards and the problems associated with living in a deprived area of the city. In the back room of the old Georgian house, Dr Niall Ó Cleirigh sees the usual assortment of ailments - bad chests, skin rashes, and babies who are not doing so well. By the time the day is over, he will have seen more than 50 patients single-handedly. "Getting help is very difficult," he says. "Especially in an area like this where there are social problems and at times difficult patients, and the situation with locums is at crisis point."
Many of these stand-in doctors come from abroad Australia, New Zealand and South Africa - and naturally enough they don't want to get involved in running the practise. But neither, it seems, do the newly qualified Irish GPs.
"They do not want to become partners, they do not want to do all that paperwork and back room stuff, they only want to do sessional work," says Dr Ó Cleirigh. "The days of the single-handed practise are coming to an end."
As well as running his own practice, Dr Ó Cleirigh is chairman of communications for the Irish College of General Practitioners. Its figures show that while the majority of younger GPs are women - most of those nearing retirement are men; among them, a large number of family doctors who work on their own.
Examining his list of student GPs at the Department of General Practice in Trinity College Dublin, Prof Tom O'Dowd notes that of the 10 training places he has to offer each year, nine have gone to women. In fact, women outnumber men in all GP training schemes in Ireland by a ratio of nearly eight to one.
Historically, general practice was a male preserve and the influx of women is helping to rectify that.
But there are concerns that the pendulum may be swinging too far. Even at undergraduate level, figures show that seventy per cent of medical undergraduates are women. It's not clear why men are not better represented.
"A lot of selection for medical places at University and for postgraduate studies is based on interview, and young men do not interview as well as young women," Prof O'Dowd suggests .
Whatever the reason, this so-called "feminisation" of the profession, seems to be changing the way family doctors work. A survey of female GPs earlier this year found that more than 10 per cent intended to leave the profession, but 90 per cent said they would opt to work part-time in the future. Fifty per cent said they were not prepared to do out-of-hours work. *
But it's not just the women who are voting with their feet. The shortage of qualified doctors has led to an increase in salaries and conditions. In rural counties, established practices may have to pay as much as €80,000 for a family doctor to do a basic four-day week. In Dublin, it can be as much as €100,000.
With costs increasing, and the number of GPs who are prepared to do all the jobs their predecessors did falling, the implications for patients is clear: fewer practices, possibly charging higher prices, and relying on locums to do the unsocial bits they are unwilling to perform.
All in all, it could spell the end of the traditional Irish family doctor.
* Implications of the Increasing Female Participation in the General Practice Workforce in Ireland published in the Irish Medical Journal March 2004 Volume 97 No.3