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Fragments of representation

I’ve spent the last two years in Britain and America. Britain has 238,916 registered doctors. The US has 970,000. While various interest groups within specialties apply, in the public consciousness, when you want to speak to doctors in those countries you speak to the BMA or the AMA.

By comparison, Ireland has 17,378. If you were a Government body in Ireland and you wanted to speak with doctors as a group, who would you get in touch with?

You might start with the IMO, but then you’d realise that in fact if you wanted to speak to consultants, you might be better off talking to the IHCA which commands a majority of members there.

Then if you wanted to speak to GPs, you could talk to the NAGP just as easily. You wouldn’t speak to NCHDs as such, you’d speak at them. And if you absolutely had to, maybe you could have a chat with them in front of their bosses, lest they’d say anything awkward that might upset you.

So why don’t we get onto the Royal Colleges (by the way, ‘Royal’? In 2015? Are they all based in Meath or something?).

Confused yet?

In fact if you were an ambitious, young, dynamic person in the Government, with a little bit of inside knowledge of how medicine and medical politics in Ireland works — were such a hypothetical person to exist — you might think there were such a surfeit of people to talk to, you could just go around chatting to all of them, until you found someone who would tell you exactly what you wanted to hear.

I freely admit to having no idea whether the IMO brand will ever recover from the toxicity conferred upon it by recent scandals

Hell, you might even get them to give you standing ovations every time you went to speak with them. Now, wouldn’t that be something.

As you may know, this page had a little bit to do with the NCHD strike of 2013. In so far as it did, it merely inspired a few interns to set up a grass roots social media movement to put a halt to their own exploitation. This snowballed into a national media story, with broad popular support from a public that is and was considerably more intelligent than it will ever be given credit for.

Since then, general practitioners and even consultants have shown a degree of militancy and unwillingness to be meek and cowed in the face of a hostile Government and media. Those interns and SHOs who set up the ‘24 No More Movement’ completely changed the terms of engagement between the State and doctors.

Now though, from this remove it appears that unedifying turf wars between organisations threaten to wreck the progress that has been made. You have the IMO, densely cloaked in controversy, a union for all doctors but without much unity. You have the IHCA, a sort-of union for some of the doctors that definitely isn’t a union. The colleges, who definitely aren’t unions but want to do the things unions are supposed to do for some of the doctors without being a union. Then you have the NAGP, which wants to be a union for some of the doctors but isn’t allowed to be a union as such, so they went away and joined another union which is actually a union, but who has nothing to do with doctors.

Even more confused yet?

I know people in all of these organisations. They are excellent, selfless people of the highest calibre who are doing what they are doing because they truly believe it’s the right thing to do. What pains me though is if you locked them together in a room, they would probably have little truck with the suggestion that what unites them is far greater than that which divides them. Each organisation has its own principles and raison d’etre but when two have overlapping interests and sit down with the Government, their conflicts can all too easily be triangulated, which is to the detriment of all concerned.

I spent several years on an IMO committee because I believed passionately at the time in an organisation completely independent of the State, funded by, and representative of, all doctors from medical students up. I still do, although I freely admit to having no idea whether the IMO brand will ever recover from the toxicity conferred upon it by recent scandals.

In the absence though of a single body, is there scope for a loose confederacy or umbrella organisation, which respects the individuality of all the parties but facilitates exchange of ideas and co-operation to the benefit of all doctors?

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