Medical card deal: General practitioners treating older medical card patients in deprived areas of Dublin are earning less than half the income of doctors working in better-off areas of the capital, it has emerged.
As a result, younger doctors are no longer willing to work in more deprived areas, where workload pressures are greater, senior family doctors have warned.
Fergus O'Kelly and Kevin O'Doherty, who run a practice on Dublin's South Circular Road, blamed the deal struck between the previous Minister for Health Micheál Martin and the Irish Medical Organisation (IMO) to extend medical card coverage to all patients over the age of 70 for the problem.
Under this deal, doctors are paid two to three times the rate for new "wealthy" over-70 patients than they are for looking after older people who have had a medical card for most of their lives. This is despite the fact that older people living in inner city areas have been shown to experience more acute illness and have a greater range of chronic health problems.
An analysis by the doctors shows that practices in inner city and southwest Dublin earn as little as 56 per cent of the average national medical card income. In the case of one practice, its annual income per patient was €140 compared with a southeast coast practice whose medical card income per patient was €400, reflecting the high number of "wealthy" medical card patients aged over 70 living in its catchment area.
"There is a very real disparity in income [ between doctors in well-off and poorer areas] and this has serious implications. Already GPs in less well-off areas - heavily dependent on people with established medical cards - are finding it increasingly difficult to attract locums, assistants and partners into practice," Drs O'Kelly and O'Doherty said. "Why would younger doctors come to work in more deprived areas, work harder, deal with more acute and chronic illness, more social and psychiatric problems and get paid less for so doing?"
Dr O'Kelly said he was aware of at least three practices in the south inner city for which no doctor could be recruited when vacancies had arisen.
"Unless something is done now to correct this inequitable and divisive scheme, the financial viability of many practices in deprived areas is in serious doubt, leading to a possible loss of service to the more vulnerable sections of the community," he said.
The GPs' concerns were backed up by leading academic Prof Tom O'Dowd, of the Department of Public Health and Primary Care at Trinity College Dublin. "Doctors in deprived areas work as hard but are paid less compared to those working in practices with large numbers of 'gold card' over 70s," he said, referring to the term used in medical circles to describe practices along the eastern seaboard south of Dublin who have large populations of relatively well-off over-70 medical card patients.
Criticising the lack of progress with the primary care strategy, he said GPs "in the trenches" did not know where the system was going.
"There is a sense at present that health policy is driven by political rather than health needs," Prof O'Dowd said.
Responding to criticism that the IMO should be doing more to remedy the over-70s inequity, the vice-chairman of its GP committee, Dr Ronan Boland, said the problem had arisen because of the "manipulation" of the General Medical Services (medical card) scheme by the State over many years.
Acknowledging the manpower difficulties faced by certain urban practices, he said the IMO would be highlighting these difficulties when a scheduled review of the entire GMS scheme begins next month.