as dr Mireille Sweeney first came here in the 1980s as a young doctor from Provence, France, wanting to be ‘cured of her love for Ireland’.
Now, more than 40 years later, she is fighting to save the country doctor from disappearance in her ‘dream job’ – working in a GP’s practice in Ardara in Donegal since 1995 – and has presented a plan to the HSE.
dr Sweeney (61) is one of around 600 general practitioners in villages across the country. However, as more solo GPs head towards retirement, the heavy workload means there may be no one ready to take their place.
The Irish College of General Practitioners (ICGP) even thinks GPs may need to be recruited from outside the EU to fill a national shortage.
dr Sweeney says, “A 50-hour workweek is the norm for me, but that could stretch to 65 depending on whether I represent the GP Collaboration after hours.”
Today’s new GP graduates are more likely to turn to group practices in urban areas where they can have a better work-life balance.
“You’re absolutely right,” she says.
An additional difficulty for rural GPs working alone is finding a deputy to stand in for them when they fall ill or need to take vacations. HSE payments do not cover the full cost of hiring a deputy, which can be six times higher.
as dr Sweeney had to travel for an in-person medical check-up this summer, closing her practice for a day for the first time ever. “I’ve put off checkups in the past. As a family doctor you keep going.”
She wants to emphasize that it is not about additional fees for doctors. “I’m very privileged and in a job that I love.
“It’s about providing a service to rural patients, rescuing burnt-out GPs and making sure areas don’t lose their doctor.”
She met her husband John here and they have four grown children, but she has little free time.
“I’m grandma now. I’ve been stuck lately and had to work my way through grief, pretty bad covid and burnout.
She managed to take a week off in June but it took large organizations and colleagues in other parts of the country, themselves heavily burdened, to represent her.
Before that, her only vacation was a week in February 2020. When she fell ill with Covid-19 in December 2020, no replacement could be found.
She says it goes against what she tells her own patients about the need for a healthy lifestyle that gives them time to relax and de-stress.
Aside from the medical care she provides, there are hours she devotes to up to 300 patient letters a week, scans and blood tests.
“It’s an honor to do what I do, but I’d like to reduce my working hours to three days a week. But who will take over from me when I’m gone?
“I have suggested to the HSE that one idea that might work is to use the co-op service outside of business hours during the day.”
The Co-op comprises existing GPs in South West Donegal who take turns to operate from a Co-op site.
She believes if outside GPs were given an incentive, they could staff the co-op during the day and take some of the patient flow from existing practices, allowing resident doctors to take time off either for a break or illness.
“It doesn’t always have to be the same family doctor.
“There might be doctors who don’t want to commit to a practice that would suit it.”
She has yet to receive a response from the HSE but is certain some constructive suggestions are needed if rural GPs are not to die out.
With more than 1,000 patients on her books – mostly card-holder patients – that would mean she would have to travel farther to access care unless she’s replaced when she eventually steps down.
“Maybe no one will take over. But at least I can say I tried.”
The chairman of the board of the ICGP, Dr. John Farrell said: “Around 700 GPs will retire in the next six years and there is a growing demand for GP services. This is particularly evident in rural Ireland.
“We have increased the number of trainees by 70 percent in the last five years, but this is not enough to meet demand and we therefore need innovative solutions to fill this gap.
“Our own survey shows that only one in five practices can take on new GMS patients and only one in four new private patients. This means many people are now unable to register with a GP.
“We urge the Health Secretary to set up a high-level working group on the future of general medicine to bring stakeholders together to plan for the future.
“This is urgent. Local authorities across Ireland are facing the loss of GPs to retirement. We need more support to help doctors run practices particularly in rural Ireland.
“We will have to recruit general practitioners from abroad to cope with the shortage of jobs and the growing workload in general medicine. The Covid-19 pandemic is putting enormous pressure on general practice, healthcare is becoming more complex and the number of elderly people is growing.”
dr Clive Kilgallen, President of the Irish Medical Organization (IMO), said: “We need to be aware of the fact that our population has increased significantly in recent years and we have a growing older population that requires more complex care.”
In its pre-budget submission, IMO cited a survey showing that 59 per cent of GPs were unable to take time off due to difficulties in obtaining cover money, while 66 per cent were unable to take sick leave.
https://www.independent.ie/irish-news/health/who-will-take-over-when-im-gone-family-doctor-puts-plan-to-hse-in-bid-to-save-irelands-rural-gp-service-41999158.html “Who takes over when I’m gone?” – GP lays out plan for HSE to save Ireland’s rural GP service