Madam, - The president and honorary secretary of the Irish Association of Emergency Medicine (IAEM - of which I am a member) bring clarity to the issue of private fees for emergency consultants and the impact on ongoing contract negotiations (January 29th).
However, they claim offence in relation to Minister for Health Mary Harney's assertion that "private patients would get preferential treatment in emergency departments if [consultants] were to receive fees". The problem is that the moral high ground to which the IAEM aspires has been sullied by a minority of our consultant colleagues in the Irish health system.
Payment for private practice within a system with limited probity in relation to work practice has resulted in a bias emerging: private patients are seen relatively efficiently; public patients may encounter significant access blocks. (Ironically, these access blocks mean that many public patients are referred in desperation from primary care to emergency departments rather than out-patients', contributing to overcrowding. The system is perceived as two-tiered - even though the infrastructure and indeed the ancillary health professionals that staff it are often shared by both groups of patients.
The Department of Health set up this unique public/private service. Proof that the system is more efficient for private patients is the number of taxpayers who opt to take out private health insurance (in effect a double tax) in order to guarantee ease of access to services. Ms Harney may fear that accepting that emergency consultants are entitled to charge private fees (legally we are) would make the two-tiered nature of the system transparent to a degree that is politically unacceptable.
Is there any reason to expect that as emergency consultants we would react to the reward system in a way that is different from our colleagues? Would emergency departments end up with two queues? - Yours, etc,
Dr BRENDAN McCANN, Consultant in Emergency Medicine, Waterford Regional Hospital.
Madam, - During the 19th century it was common for an engineer employed in the public service (such as the city engineer or the county surveyor) to carry on an extensive private consultancy practice as well. However, that option has long since been abolished and for the past hundred years or so professional engineers may choose to work in the public sector or in private practice, but not both.
Perhaps in another hundred years medical consultants will agree to make a similar choice. - Yours, etc,
PJ CASSIDY, Dundrum, Dublin 14.