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Since its inaugural AGM in April 2022, the Medical and Dental Consultants Association (MDCA) has gone from strength to strength.

Following in the wake of the inaugural President, Mr Fergal McGoldrick, came Mr John Curran, plastic surgeon. John had an extended term in office during which he oversaw the publication of the Mazars report entitled Clinical Indemnity: Private Practice Under Threat in May 2024, and he engaged extensively with government agencies, health insurers and other stakeholders including the Department of Health, to alert people to the on-going impact of medical indemnity premiums on independent practices.

John also met with Prof Rhona Mahony, the chairperson of the Government’s Interdepartmental Working Group established to look at the rising cost of health-related claims.

Their report was published by the Minister for Health on September 19, 2024. Undoubtedly there is an urgent need for tort reform in an effort to reduce medical indemnity premium costs and the MDCA have identified that as a strategic objective for the association. The MDCA represents consultant specialists of the medical and dental profession who practice primarily in private hospitals and clinics. A large component of our work is to advocate for privately insured patients in Ireland.

With the exponential growth in the number of people paying for private health insurance, there is a corresponding expansion in the number of private facilities and, as a direct result, there is a need for more consultants in full-time private practice.

Beyond any doubt, private practice is a crucial and critical component of the Irish healthcare industry. The private health insurance industry in Ireland has grown exponentially.

There are key pressures facing both health insurers and consultants, particularly in relation to sustainability, profit margins, and the broader economic environment. Unlike its competitors, Vhi’s primary business if health insurance and the margin between subscriptions and claims payout is very tight.

Consultants in private practice, on the other hand, are under even more strain due to drastic cuts in professional fees between 2009 and 2016 (a cumulative decrease of over 20 per cent) and the exponential cost of medical indemnity insurance. Now consultants are facing a “taker it or leave it” offer of two per cent from the insurers in 2025 and a very uncertain future. Effectively, consultants are working harder for less money and therefore if insurers are seeking to reduce costs, focusing on consultants is a misplaced priority.

Over a year ago, through the good offices of board member, Mr Asam Ishtiaq, the association engaged the services of James Norton as our strategic advisor.

James Norton is well known in the industry having previously been the Head of Medical Relations in Vhi and having worked on the Schedule of Benefits for almost two decades as part of the team within Vhi’s Medical Division. Through James’s involvement we have had several meetings with senior representatives of all the four main health insurers and with the Health Insurance Authority. Our objective is to maintain and build up good working relationships with the insurers and, through regular contact and dialogue, to move forward the agenda for independent practice.

Professional fees
This year, health insurers offered an average increase in professional fees of two per cent.

The fact that all three main insurers offer consultants an almost identical professional fee increase is, to say the least, unusual, but notwithstanding, as many consultants in private practice know, this is unsustainable in a vibrant market where staffing costs, rents, the costs of equipment and consumables, and inexorable premiums increase for medical indemnity are ever present.

Increases of this scale do not meet the costs incurred by consultants and, should this continue, then the future for independent practices is very bleak.

Let me put this into some context for you. In June the general rate of inflation was 2.7 per cent. However, looking at the Public Service Agreement 2024/2026 we note that the aggregate wage increases in 2024 is 4.25 per cent and four per cent in 2025.

The aggregate public sector wage increased in 2026 will be two per cent. According to the Irish Congress of Trade Unions, the average wage increase in the private sector for the three years (2024/2026) are 3.6 per cent, 4.1 per cent and 3.4 per cent respectfully.

Most practices are having a difficulty holding onto good and experienced staff as medical secretaries and nurse managers (and other specialist staff) are highly sought after internationally and in other industries here in Ireland. To retain good staff, independent practices must match these wages increases or risk losing their key staff.

But one of the most significant impacts on independent practices over recent years has been the huge increases in medical indemnity premiums. The average medical indemnity premium stands at around €100k per annum but the market is risk rated and premiums variable considerable amongst the specialities.

For many independent consultants this is a huge concern which might well determine the future for private practices. Whilst we in the MDCA hold the insurers in high regard, the situation is becoming unsustainable and could ultimately signal, over time, a race to the bottom for independent practices and for patients.

Whilst some of the insurers (and private hospitals) are reporting solid financial performances and healthy profits, the same cannot be said for consultants in private practice.

It is obvious to patients and health insurance subscribers alike that when it comes to delivering high-quality healthcare in private hospitals, this is substantially provided by independent consultants, that is, consultant-delivered care rather than consultant-led care as is the case in the HSE. The doctor/patient relationship is as strong as it ever was and it is at the very heart of private healthcare in Ireland.

In our meetings with insurers they often refer to the sustainability of their businesses but they need to realise that without strong and vibrant independent practices, they have no product.

If independent practices are allowed to slowly dissolve, undoubtedly some consultants and private hospitals will end up chasing the high volume, high return procedures or services and the health insurers will not be in a position to offer their customers cover for access to the full range of medical, surgical and diagnostic services that subscribers expect.

To our mind, independent consultants cannot withstand another year of professional fee increases that bear no relationship to the cost drivers affecting our practices.

If faced with a series of professional fee increases lower than three per cent over the next few years, independent practices will simply cease to exist or, if they do survive, they will be concentrating on the provision of low-cost non-emergency medical and surgical services provided in rooms.

Not only have these health insurance companies a responsibility, and indeed a moral obligation, to ensure that the private healthcare system is sustained and grows to meet the demands for modern medical and surgical care, but they must also ensure that the primary providers – the consultants – are appropriately remunerated.

Some people in the health insurance industry seem to have forgotten or simply do not know that the loss of private maternity and neonatal services at Mount Carmel and the Bon Secours, Cork were precipitated by the exponential cost of medical indemnity insurance for those involved.

However, this time around, it is not just one or two specialities that are at risk but the entire private healthcare system.

Consultant-delivered independent practices are the corner stone of the private healthcare sector, and their success is imperative to the continued growth and financing of the Irish private medical insurance market.

It is a symbiotic relationship. But given the substantial cuts in professional fees in past years (which were never readdressed), consultants in private practice do not have the ability to absorb further cuts in their incomes caused by professional fee increases that are unrealistic and that do not match the exponential costs faced by independent practices. The sustainability of health insurance companies cannot be at the expense of consultants, the ultimate care givers.

Independent consultants, as self-employed professionals, are among the highest calibre in healthcare. They are innovators, highly driven, and possess a strong inner motivation with a clear sense of purpose. Through persistence and hard work, they maintain a strong patient focus and consistently deliver high-quality care.

Being self-employed, independent consultants often work longer hours and achieve greater efficiency and productivity than many of their counterparts in the public system. As such, they play a vital role in alleviating pressure on the Health Service Executive (HSE).

The Department of Health recognises that private healthcare is essential to the present and future of Ireland’s healthcare system.

However, if current conditions continue, independent consultants are at serious risk – placing the sustainability of the private healthcare system itself in jeopardy.

Health insurance consumers may be forgiven for being utterly confused by the range and number of healthcare plans (over 300) on offer in the market. These consumers pay an average of €2,000 per adult for their healthcare cover, in the belief that this will get them rapid access to private healthcare when they need it most.

Any reduction in the number of independent practices or in the range of services available risks making health insurance a far less attractive proposition. A weakened product offering, combined with the nationwide roll-out of Sláintecare, could pose a significant challenge for health insurers.

For its part, the MDCA will continue to highlight these issues to all industry stakeholders and hold the relevant authorities to account.

Independent consultants currently act as the main advocates for patients who pay for private healthcare and their continued presence ensures that privately insured patients retain full access to specialist medical and surgical services. If independent consultants were removed or marginalised, the effects could be

A major reduction in patient choices, since private patients would have fewer consultants to choose from.
A shrinking of private healthcare services, since the infrastructure and service variety rely heavily on consultants working independently.

In practical terms, this could push more patients into the public system, increasing waiting lists and limiting the appeal of private health insurance.

In conclusion, independent consultants are not only important for those who can afford private cover, but also for balancing capacity across Ireland’s healthcare system.

Helen Hegarty
BSc BMBS MSc FRCS
President of the MDCA
www.mdca.ie

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Survey highlights inhibitors to consultants achieving their best potential
Three-in-ten MDCA members intend to retire at 65 years of age or earlier, according to a new survey by the organisation.

Whilst the vast majority of respondents are not planning on leaving private practice now, many cited mental stress or burnout and poor work/life balance as significant inhibitors to consultants achieving their best potential.

Other factors cited for preventing respondents from providing excellent care were their interactions with both private hospitals and private insurers and increased practice costs particularly medical indemnity.

Many cited mental stress or burnout and poor work/life balance as significant

Most consultants said they were paying their support staff in line with, or greater than, public sector wages increases. However, respondents believe that their overheads will increase by more than 10 per cent – with some indicating a 15 per cent rise – this year.

Finally, in dealing with the health insurance companies, the respondents cited a litany of issues that are challenging for independent practices, amongst which were:

Delayed payments.
Multiple procedures ground rule.
Independent procedure marker and IP designated procedure codes in general.

The lack of medical advice and knowledge available to the claims assessors, the slow response to queries, the administrative burden of challenging claims and claims audits and the fact that procedure codes do not reflect modern practice were also cited as having a significant adverse effect on independent practices.

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Introducing Helen Hegarty
Initially training as a scientist at Monash University in Melbourne, Australia, where she majored in Microbiology, Molecular Biology, and Physiology, Helen went on to study Medicine at Flinders University in Adelaide before completing her internship back in Melbourne. Soon afterwards, she left Australia to pursue surgical training in the UK, beginning in Colorectal Surgery and then moving into Urology at some of the country’s leading hospitals. There, she developed a strong interest in urinary tract reconstruction and incontinence.

She went on to complete a Master’s degree in Urology, focusing on Neuro-urology, and after finishing her specialist surgical training, undertook two fellowships in Houston, Texas—at the MD Anderson Cancer Centre and Herman Memorial Hospitals. These fellowships concentrated on reconstruction, pelvic oncology, and male and female bladder dysfunction, including neuro-urology.

She returned to the UK as a Consultant from 2009 to 2013, where she established the Pelvic Floor Unit and developed services for bladder dysfunction, incontinence, complex urological reconstruction, and minimally invasive pelvic surgery, along with setting up the urodynamics laboratory. She also designed and developed a new Urology outpatient department. During this time, she played a key role in introducing the then-novel enhanced recovery pathways for patients undergoing radical prostatectomy, radical cystectomy, and nephrectomy, and contributed to the development and support of the cancer centre at Southend, serving patients across East Anglia and Essex.

In 2013, Helen was invited to move to Ireland to continue her specialist work. Since then, she has applied her expertise in urinary tract reconstruction, bladder dysfunction, and incontinence, and was instrumental in developing urodynamics services at the Mater Private in Cork and the UPMC Whitfield. She is also currently contributing to the establishment of a complex pelvic floor dysfunction centre in Cork.

Throughout her career, Helen has worked closely with colleagues across multiple specialties. A keen sportswoman in her early years in Australia, she has always valued teamwork and continues to foster a strong collegial approach in her medical practice.

With 30 years of experience as a practicing doctor and having worked in leading international centres, Helen has a deep understanding of both the universal challenges faced by doctors and the unique issues encountered in Ireland. She firmly believes that doctors are indispensable in safeguarding and improving the health of patients, and emphasizes the vital role of physicians as patient advocates—an aspect of the profession that must never be undermined or eroded.