Analysis: A doctor's wish to continue treating medical card patients after she turns 70 has focused debate on GP retirement ages, writes Fiona Tyrrell.
With growing doctor shortages and new research indicating that a majority of GPs wish to work beyond the normal age of retirement, calls have been made for changes to the GMS contract, which requires GPs to retire at either 65 or 70 years old.
GPs who signed the GMS contract prior to 1989 agreed to retire at 70 and those who signed the contract after this agreed to retire at 65. Once a doctor reaches retirement age they can choose to continue with their private patients.
It is also not uncommon for a doctor to make arrangements for a younger doctor to come into their practice to take over their list.
As an assistant doctor, they can continue to see their medical card patients. This will only work in group practices and not in single-handed operations.
A survey published last month by the Irish College of General Practitioners (ICGP) revealed that the majority of GPs wish to continue practising beyond the normal retirement age.
Entitled The Structure of General Practice in Ireland 1982-2005, the survey indicated that 88 per cent of those surveyed would consider working beyond the normal retirement age, given certain safeguards.
Factors that would entice a GP to work beyond the age of 65, according to the survey, include part-time working hours, no out-of-hours work, flexible working hours and increased pensions.
Even going on current work practices, of the 475 respondents to the survey, 16 per cent of GPs said they planned to work beyond 65. More interesting, however, was the response from older GPs - only 26 per cent of GPs aged 65 plus said that they wished to retire before 65.
The study's findings took many by surprise, according to Prof Tom O'Dowd, one of the authors of the study and professor of general practice at Trinity College Dublin.
The perceived wisdom before this was that "doctors wanted to get out and get out fast", he says.
It is interesting that the desire to work after 65 was more prevalent among older doctors, according to O'Dowd. Reflecting perhaps a high level of job satisfaction, he suggests.
The retirement requirements in the GMS contract are the "clearest example of discrimination on the grounds of age by a Government department", according to Michael Kilcoyne, chairman of the Consumers' Association of Ireland. It also simply doesn't make sense, he says.
"Clearly if a doctor is good enough to treat a private patient, they are good enough to treat a medical card patient."
Aside from criticism of being ageist and inflexible, seen against the backdrop of a growing shortage of doctors, the current retirement requirements raise many questions about manpower management.
Fás has predicted a GP shortage of 1,000 by the year 2015.
HSE figures indicate that there are only five out of the total of 2,210 GMS doctors whose retirement is due within the current year.
However, chairman of the ICGP, Dr Eamonn Shanahan, estimates that in the region of 800 GPs, about one-third of the total number of GPs, will reach retirement age in the next 15 years.
The willingness of GPs to work beyond the normal age of retirement augurs well for improving the current manpower problems in general practice, O'Dowd and his fellow authors argue.
"This can be done by increasing the number of entrants to general practice and by the retention of existing general practitioners together with schemes to keep ageing doctors active for longer," according to the report.
Labour health spokeswoman Liz McManus has called on the Minister for Health to change the retirement age requirements to tackle the growing shortage of doctors. "We can't afford to lose them," she says.
Automatic assumptions should not be made about people's competency because of their age, she argues. The issue could and should have been dealt with by the Medical Practitioners Bill, which is long awaited but still unpublished, she adds.
Dr Eamonn Shanahan, chairman of the Irish College of General Practitioners (ICGP), agrees, pointing to the "significant shortage of GPs throughout the country".
"As long as a doctor is competent and maintains their level of continuing medical education, they should be allowed to continue to work. There are many older doctors who are ready, willing and able to work and means should be found to allow them to work," he says.
The issue, however, highlights the lack of competency assurance, according to O'Dowd. "Doctors worry about their competency as they get older and would like to be assured of their competency," he says.
He hopes that this will be addressed in the new Medical Practitioners Act.
Dr Martin Daly, chairman of the Irish Medical Organisation's (IMO) GP committee, says the retirement age of 65 set in the late 1980s was in keeping with the public servant contract throughout the State.
"The IMO is conscious of a general societal shift towards people working later in their lives and we are open to proposals in that regard," he says.
He believes a balance needs to be struck between the needs of younger doctors to get into practices and get GMS lists and the wishes of older doctors who feel they can still contribute to the public service.