# GP's - Charges for Follow up Visits



## 782378 (13 Feb 2008)

I Brought my 9 month daughter to the doctor on Saturday as she had a bad cough, sore throat and high temperature. The doctor listened to her chest said she was teething and that there was nothing he could do for her. I was chaged 50 Euro for this 2 minute visit. 

On Monday night her symptoms got worse so I brought her back to the same clinic on Tuesday morning. A different doctor thoroughly  checked her out this time and said she had a bad throat infection and needed antibiotics. This Doctor charged 30Euro for this follow up visit. 

When I advised the second doctor that she had already been in clinic for same complaint a few days earlier and in my opinion should not be charged again, he told me that he was justified in charging for the second visit as the symptoms were not obvious on the first visit and therefore this was a seperate consultation. 


My question is, Is the clinic justified in charging 50+30 for these two visits even though in my opinion it related to the same symptoms?


I really think this is a scam as this is the second time this has happened in the last year, I would change doctors if possible but there a no other ones in close proximity.


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## ClubMan (13 Feb 2008)

Not sure how much consolation it will be but you can probably claim _MED1 _tax relief on the _GP _consultation and prescribed/recommended drug expenses.

Some _GPs _charge the full rate even for follow ups.  Others don't. I was with my _GP _for the second time in a few weeks recently. His receptionist (and wife) checked and said _"oh - I see that it's follow up visit - that'll be €20" _(full rate is €45). I explained to her that it wasn't actually a follow up but about a separate/new matter (chest infection) so I didn't mind paying the full rate. She said _"ah - you'll probably need antibiotics anyway so let's leave it at €20"_.


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## Margie (13 Feb 2008)

I appreciate where you're coming from.  I also have a nine month old daughter and I would be highly concerned if she had a cough, high temperature and sore throat and was told by her GP that there was NOTHING he could do, teething?  What?  Cough - honey and glycerine syrup to ease cough also aiding sore throat.Calpol or neurofen for temperature or tepid bath to bring down temperature.These are the things my GP has recommended previosly and also if there was no improvement over night to go back the next morning.  i would be fuming over the lack of advice and the cheek to charge another €30 then.


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## Sylvester3 (13 Feb 2008)

Sometimes the GP's seem a bit surprised at the charges themselves. I had an emergency call out last year when I developed heatstroke on the Saturday night/Sunday morning. My wife went to the out of hours surgery afterwards to pay the charge, which was €70, and the doctor mentioned how expensive it seemed to be, in a surprised manner (according to my wife,anyway).


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## gipimann (13 Feb 2008)

The Medical practice I attend used to have a reduced "follow-up consultation" charge, but abolished it when they last increased their prices (about 12 months ago).   A second consultation costs the same as the original - €50 - no matter what the reason.


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## Margie (13 Feb 2008)

I was speaking to a nurse recently about the cost of getting a doctor to do a call out.  Her reply was 'well I suppose when you think of how much it costs for a call out for your washing machine etc., it's not that expensive'.  ???


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## ClubMan (13 Feb 2008)

Margie said:


> I was speaking to a nurse recently about the cost of getting a doctor to do a call out.  Her reply was 'well I suppose when you think of how much it costs for a call out for your washing machine etc., it's not that expensive'.  ???


Not a totally unreasonable argument? Especially since an appliance maintenance person will often have a fixed call out charge and then charge for parts and labour on top?


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## Margie (13 Feb 2008)

Are you serious, have you got children?


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## ClubMan (13 Feb 2008)

Yes and yes.


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## Sylvester3 (13 Feb 2008)

ClubMan said:


> Not a totally unreasonable argument? Especially since an appliance maintenance person will often have a fixed call out charge and then charge for parts and labour on top?



If only they could fit me with new parts.... 

30 this month. feeling old...


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## ClubMan (13 Feb 2008)

If one is on 41% tax then a €50 _GP _charge benefits from €20.50 tax relief thus costing a net €29.50. For those who have private health insurance cover including day to day medical expense refunds they could get €20 or €30 of the initial fee back which would leave the remaining €30 or €20 subject to tax relief meaning that the net cost would be €17.70 or €11.80. Those who have cash plans may fare even better.


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## 782378 (13 Feb 2008)

My argument really is: If the first GP had took the time to do a thorough check (he didn't check temp or even look in her throat) rather just listen to her chest with stetiscope that maybe I would not have needed the follow up and antibiotics would have been prescribed earlier. 

In fairness to the second doctor at the clinic he checked her temperature looked at her throat and and spent time assesing her before his prognosos that she had a bad throat infection.

It seems like a win win situation for doctors to make money.

I know some people go to the doctor for the sake of it and doctors can be dismissive of these hypocondriac types, however I feel if you go with a genuine complaint and it is not dealt with sufficiently on the first visit that you shouldn't be charged for the follow up visit.


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## ClubMan (13 Feb 2008)

Sounds like your main complaint is with a doctor allegedly not doing their job properly. Why not make a formal complaint and then switch doctor?



782378 said:


> I would change doctors if possible but there a no other ones in close proximity.



I don't understand...


> I Brought my 9 month daughter to the doctor on Saturday as she had a bad cough, sore throat and high temperature. The doctor listened to her chest said she was teething and that there was nothing he could do for her. I was chaged 50 Euro for this 2 minute visit.
> 
> On Monday night her symptoms got worse so I brought her back to the same clinic on Tuesday morning. A different doctor thoroughly checked her out ...


If you were happier with the treatment meted out by this doctor then why not switch to them?


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## 782378 (13 Feb 2008)

It is not a specific GP'S office, It is a medical clinic and there is a different GP on duty depending on the day or time you visit the clinic.  You don't get a choice and only have the option of visiting whichever GP is one on duty at that time.


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## ClubMan (13 Feb 2008)

I see. I thought that it might be a single surgery with more than one _GP _on regular duty.


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## rob30 (13 Feb 2008)

Did you go to an out of hours clinic, or a day time GP surgery? The out of hour clinic, not being " owned" by the GP you are seeing, is a difficult one, as the GP working there that day may not be in a position to waive the fee. 
If it was your own GP surgery, I am sure you can bring it up with them again. Clear the air, and resolve the issue.


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## brid1977 (13 Feb 2008)

Good advice from rob30 to speak to the surgery again as with a small child its very likely u will be back into the doctor again soon. What do you mean by its a scam?


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## Purple (16 Feb 2008)

brid1977 said:


> What do you mean by its a scam?


Good question.
ClubMan has pointed out that the net cost for GP visits can, in fact, be quite low. I do think that €50 for a follow up visit is quite high. Mrs. Purple is a GP and she doesn't charge for any follow up visits.
On the other hand I think that €70 for a home visit is very good value. Try getting an accountant or solicitor to visit you at home at 4am for €70 (or even €170)


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## amtc (16 Feb 2008)

My local doctor is a clinic such as this and charges €55 for a visit, and €30 for a return within a week. 

I was at my doctor's Monday and was told I had a chest infection and the doctor gave me a cert for work until Thursday. There was no way I could go back to work Thursday (believe me I have only just persuaded the mammy that she can go home) so I rang for another cert. 20 euro! to write the words 'ci' on a piece of paper! I didn't have to be seen again so the doctor didn't have to do any work!

The same clinic has been charging me €55 per visit for a recurrent urinary infection and last time the doctor (different one from above) told me she had 'drawn a blank'. C'mon!


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## Purple (16 Feb 2008)

amtc said:


> My local doctor is a clinic such as this and charges €55 for a visit, and €30 for a return within a week.
> 
> I was at my doctor's Monday and was told I had a chest infection and the doctor gave me a cert for work until Thursday. There was no way I could go back to work Thursday (believe me I have only just persuaded the mammy that she can go home) so I rang for another cert. 20 euro! to write the words 'ci' on a piece of paper! I didn't have to be seen again so the doctor didn't have to do any work!
> 
> The same clinic has been charging me €55 per visit for a recurrent urinary infection and last time the doctor (different one from above) told me she had 'drawn a blank'. C'mon!



Go to a different GP.


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## rob30 (17 Feb 2008)

I got a bill from my accountant recently, equivelent to 10 GP visits in costs. I do accept that a service has to be paid for.
An average GP pays roughly 7000 euro a year, just to insure against malpractice ( they get none of this subsidised by the HSE, as they are contractors). To remain on the medical council register costs another 400 euro. The required membership of the irish college of GPs is laos in the order of 1000 euro.Then on top of that is premises, disposbles such as scalpels, needles, syringes, sterile equipment, refridgeration and staffing costs and their public liability. Educational meetings and journals also need to taken into account.
All that has to be paid for, before personal income is taken out.
A " free" note from a GP is all well and good, and anyone can argue that the incremental cost of a consultation or professional opinion is very low, but remember that a doctor is professionally liable for everything that they write or do. 
There is variability among GPs on pricing. I can see this myself. And dont forget, you are within your rights to negotiate follow up costs in advance.


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## amtc (17 Feb 2008)

I never thought about 'negotiating' a visit charge. I suppose I am from the school of thought that a doctor is always right/respected member of society. One of my doctors I saw was actually in my class in school and there was no way I could call her by her first name when seeing her recently in a professional context.

Is there anything that requires charges to be displayed, by the way, such as the old ODCA used to for pubs/shops etc?

I suppose the point that both the original poster and myself had is that if the service was provided properly in the first place - her daughter being diagnosed correctly and my doctor realising that there is absolutely no way I would be cured within 3 days - the second visit/contact wouldn't have been necessary. I hope I get better soon, am turning into an angry young woman!

By the way to the person who suggested another GP, I should tell you my nightmare story of a GP visit in a walk in clinic in town. The poor doctor had obviously just split up with the love of her life, cried all over me, and told me every bit of her story. I had never seen her before nor since. Now she was a perfectly nice woman but I didn't feel like paying 60 euro for this when all I wanted was a cream for eczema!


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## Samantha (20 Feb 2008)

I must be very lucky as my GP don't charge anything for repeat visit related to the same condition.


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## truthseeker (20 Feb 2008)

It can be very difficult to just 'go to another GP', I recently woke up with a very simple yet very uncomfortable ear condition on a Saturday morning, my GP doesnt work weekends so I tried to find another local one to see me and was told by 5 different receptionists - 'oh the doctor isnt taking new patients, only existing'. 
I ended up waiting it out until the Monday to see my own GP.


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## gebbel (20 Feb 2008)

rob30 said:


> An average GP pays roughly 7000 euro a year, just to insure against malpractice ( they get none of this subsidised by the HSE, as they are contractors). To remain on the medical council register costs another 400 euro. The required membership of the irish college of GPs is laos in the order of 1000 euro.Then on top of that is premises, disposbles such as scalpels, needles, syringes, sterile equipment, refridgeration and staffing costs and their public liability. Educational meetings and journals also need to taken into account.
> All that has to be paid for, before personal income is taken out.
> follow up costs in advance.


 
Very insignificant outgoings in comparison to what a typical GP will earn! Hardly a reasonable justification for an expensive 2 minute follow up charge.


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## markowitzman (20 Feb 2008)

> Very insignificant outgoings in comparison to what a typical GP will earn


  can you enlighten us as to what the typical gp earns and what their hourly costs would be?


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## brid1977 (20 Feb 2008)

The approx 10,000 euro mentioned above + nurse's salary + secretarys salary + rent/light/heat etc is insignificant? How much do you thinks GP's earn? GP's have to charge for their time, the OP's issue was with treatment received as well as cost of return visit. At the surgery where I work a price list is displayed at reception and in the waiting room so patients are clear on charges when they sign up - return visits are charged for at a reduced rate. A GP would be a miracle worker if they could cure everyone on the first visit.


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## gebbel (20 Feb 2008)

markowitzman said:


> can you enlighten us as to what the typical gp earns and what their hourly costs would be?


 
No I can't exactly but they can charge €55 per visit for a consultation that might last 5 minutes, and follow up visits can, as this thread suggests, almost cost as much.....you do the rest of the math .


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## ClubMan (20 Feb 2008)

gebbel said:


> No I can't exactly but they can charge €55 per visit for a consultation that might last 5 minutes


Or it might last a lot longer.


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## markowitzman (20 Feb 2008)

> No I can't exactly but they can charge €55 per visit for a consultation that might last 5 minutes, and follow up visits can, as this thread suggests, almost cost as much.....you do the rest of the math


Using your rationale it takes me 5 minutes to fill the car with diesel at the garage and this costs more than 55 euro.........and follow up visits cost the same?
I self serve, I am dealt with by a minimum wager, I will probably make a discretionary purchase or two to boot and every so often spend a few euro on car wash.
Why oh why do some think that spending less than a fill of petrol for one's health is such a "rip off" and a good % of these costs are reimbursable?
Had plumber for five mins last week for 80. Five minutes to get new tyre.........165.


> you do the rest of the math .


Don't need to........with medical inflation running a 2-3 times inflation year on year I know the maths!!!!!!


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## truthseeker (21 Feb 2008)

ClubMan said:


> Or it might last a lot longer.


 
An absolute max of 20 minutes in my GPs practice, if you are still there after 20 mins its pointed out to you and you are told the visit is over.


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## ClubMan (21 Feb 2008)

Do you accept that sort of policy on the part of your _GP_?


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## ubiquitous (21 Feb 2008)

truthseeker said:


> An absolute max of 20 minutes in my GPs practice, if you are still there after 20 mins its pointed out to you and you are told the visit is over.



If this is true, I wouldn't be surprised if this particular GP ends up facing a serious negligence or malpractice claim. It would be impossible to apply such an "absolute max" in all cases, especially where it might endanger the patient.


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## truthseeker (21 Feb 2008)

ubiquitous said:


> If this is true, I wouldn't be surprised if this particular GP ends up facing a serious negligence or malpractice claim. It would be impossible to apply such an "absolute max" in all cases, especially where it might endanger the patient.


 
I agree, i am fortunate enough never to have had anything serious enough wrong that may have warranted more than 20 minutes, however judging by the fact that appointments frequently run late there must be some leeway in it.

However - i would say that the general case is that you are allotted 20 mins as a max for an appointment (in my GPs practice), as friends of mine who also use the practice have experienced same.


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## truthseeker (21 Feb 2008)

ClubMan said:


> Do you accept that sort of policy on the part of your _GP_?


If my memory serves me correctly there is a notice up in the waiting room stating that appointments are 20 mins long - so I have never felt hard done by as I know going in that Ive got 20 mins.


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## Caveat (21 Feb 2008)

I've never heard of a recommended or enforced appointment duration.

Either way, have to say I've never felt pressurised to end my GP visits.

I'm sure I've been there up to 45 minutes on occasion.


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## gipimann (21 Feb 2008)

A GP I used to use advertised an additional charge if the consultation exceeded 15 minutes.   A notice was posted in the waiting area to advise patients.  The notice also advised of additional charges if more than one patient was seen in the same consultation (presumably parent & child or 2 or more children scenarios).   

Never experienced it myself, but after a few months, the notice disappeared, so I wonder how successful it was!


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## z103 (21 Feb 2008)

well for an 8 hour day at 3 visits (20mins) per hour and €55/visit, I would calculate:

8*3*55 = €1320/day

For a 48 week working year, this works out at 

48*40*3*55 = €316800

(our local GP is on about €200k, it was in the newspaper a few months ago)


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## ClubMan (21 Feb 2008)

leghorn said:


> well for an 8 hour day at 3 visits (20mins) per hour and €55/visit, I would calculate:
> 
> 8*3*55 = €1320/day


Does this _GP _not take lunch? Or ever have gaps in their appointment schedule? Or take time off from clinics to do other work in the practice? Or do house calls?


> For a 48 week working year, this works out at
> 
> 48*40*3*55 = €316800


Even if this (wildly optimistic in my opinion) estimated *revenue/turnover *was indicative so what? You'd need to then take into account costs and overheads before jumping to conclusions about profits or salary etc.


> (our local GP is on about €200k, it was in the newspaper a few months ago)


Under what circumstances did the newspaper publish your _GP's_ salary details? Or were you mistaken and it was actually some other figure (e.g. _HSE _payments or something like that)?


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## ubiquitous (21 Feb 2008)

Fwiw, the stress and pressure of GP work means than none of them can work a 48-week year without running serious risks to their own health.


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## gebbel (21 Feb 2008)

leghorn said:


> our local GP is on about €200k, it was in the newspaper a few months ago


 


ClubMan said:


> Under what circumstances did the newspaper publish your _GP's_ salary details? Or were you mistaken and it was actually some other figure (e.g. _HSE _payments or something like that)?


 
That figure would only account for monies received under the medical card scheme. Cash payments are not included in that figure, and I have been reliably informed that these may well equal the published amount. Obviously this is a GP with a well established and very successful practice.


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## brid1977 (21 Feb 2008)

I'm a GP (relatively junior) and I earn 90,000 euro gross per year. It took me 10 years to train and the job is intensely stressfull so I earn every penny. The 200,000 mentioned above is gross income from the GMS - the HSE publishes lists every year of money paid to GPs who have medical lists. A GP earning 200,000 per year is most likely paying another doctor to work as an assisitant out of that 200,000.


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## z103 (21 Feb 2008)

> Does this _GP _not take lunch? Or ever have gaps in their appointment schedule? Or take time off from clinics to do other work in the practice? Or do house calls?


It was just a rough calculation. I'm sure that not all visits are 20 minutes long, many may be only 10 minutes. Of course this estimate is gross income. Doesn't anyone work a 40 hour week any more? (apart from me)



> Under what circumstances did the newspaper publish your _GP's_ salary details? Or were you mistaken and it was actually some other figure (e.g. _HSE _payments or something like that)?


Actually I think it was to do with defaulting on Income tax payments. It was a few months ago, and I don't have the article to hand.

I don't have a problem with how much GPs earn, by the way. Just estimating figures.


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## Complainer (21 Feb 2008)

brid1977 said:


> I'm a GP (relatively junior) and I earn 90,000 euro gross per year. It took me 10 years to train and the job is intensely stressfull so I earn every penny.


Just for curiosity, would you be able to explain the stresses involved?


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## ClubMan (21 Feb 2008)

leghorn said:


> It was just a rough calculation. I'm sure that not all visits are 20 minutes long, many may be only 10 minutes. Of course this estimate is gross income. Doesn't anyone work a 40 hour week any more? (apart from me)


I'm sure that they do. But my point was that a _GP's _working week involves a lot more than just seeing patients in practice.


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## brid1977 (22 Feb 2008)

Complainer said:


> Just for curiosity, would you be able to explain the stresses involved?


If I mess up people could die!


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## Complainer (23 Feb 2008)

brid1977 said:


> If I mess up people could die!


Ah come on, that's a bit of a cop out. If I mess up driving home from work, people could die. That doesn't make the drive extremely stressful. 

I don't know much about GP's, but I'd have thought that most of the work involves coughs and sniffles, and referrals to a consultant for the serious stuff. I'd really love to hear more details on the stresses involved.


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## brid1977 (23 Feb 2008)

This thread isn't helping my stress levels either, it has drifted very far from the OP. Do a search for 'mysteryguize GP song' on youtube and that should help answer your question re GP's stress.


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## ClubMan (23 Feb 2008)

Yes - the thread has gone off the rails so I am closing it.


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