Cyprus Mail 3 September 2023 - by Elias Hazou
But who’s to blame: a demanding patient or a nervous GP?
By Elias Hazou
The problem of long waiting times to see a specialist in the national health system (Gesy) won’t go away – and even seems to be getting worse.
Often the blame lies with the patients. They ‘abuse’ the system by requesting an appointment with a specialist when perhaps none is needed. But then there are many ‘trigger happy’ GPs who oblige by handing out referrals like candy. And so far health authorities are relying on quick fixes, reacting on an ad hoc basis.
“Normally, one-and-a-half months to two months for getting seen by a specialist would be within reason. Anything more than that is excessive,” remarks Charalambos Papadopoulos, head of the Federation of Patients’ Associations (Osak).
Citing global data obtained from the Health Insurance (HIO) – the agency that runs Gesy – he said that 80 to 82 per cent of referrals issued by GPs are executed within two months.
“What we don’t know from the data, are the dates of the referrals.”
Last week Politis published an expose about the waiting lists in Gesy. The findings were remarkable – but not in a good way.
In late August the paper decided to test the system by placing calls at some 1,000 specialist doctors offering their services within Gesy – both in private and public hospitals. In 20 per cent of the cases, no one ever picked up the phone at the doctor’s office. And in 40 per cent of the cases the journalists needed to call a second time to get through to someone.
Of the physicians who did answer the phone, very few were able to arrange an appointment by the end of the year. Even fewer were able to give an appointment within September.
The worst situation was found among endocrinologists. One private doctor in Limassol said the next available slot was in mid-December. Among the 18 endocrinologists who did answer the phone, he was the only one who could book an appointment for sometime this year.
Then there was the endocrinologist in Limassol who had an available slot no sooner than April 23, 2024. Another one, in Nicosia, suggested that the caller turn to another doctor because the earliest date they could book the ‘patient’ was June of 2024.
To be fair, in Cyprus practising endocrinologists are too few and far between, so maybe that was the sole issue. Apparently not – next the journalists worked the phones with cardiologists, of whom there are an astounding 211.
With the majority of these doctors, the waiting time for an appointment averaged out at four months. Just one physician could see the ‘patient’ in November of this year. There was even higher demand for cardiologists in public hospitals – here, you’re lucky if anyone picks up the phone.
The average duration for getting an appointment with a cardiologist in Limassol worked out to three months; four months in Nicosia, Larnaca and Paphos; and five months in the Famagusta district. In three cases, the waiting time was eight months.
Moving on to gynaecologists, who are a particular specialty as their patients are all female, with the majority of patients (pregnant women) needing to visit at least once a month. Waiting time for an appointment averaged at between six and eight weeks. Of the 165 gynaecologists registered with Gesy, 148 answered the phone. Of those who did answer, 13 offered a slot for three to four months later. In one instance in Paphos, the doctor’s secretary asked the caller whether the patient was pregnant. When the caller said no, the response was that the next available appointment was in March 2024.
A significant percentage of doctors registered with Gesy work in public hospitals. Here, Politis reported, four out of ten didn’t answer the phone, even though the journalists let it ring for a long time.
So the journalists tried the alternative – booking an appointment online on the website of the state health services organisation, or Okypy. There you search for the doctor you want, fill out the form with your information, and apply for an appointment. Normally, within 48 hours someone from the doctor’s office should contact you to discuss booking a slot. On August 22, the journalists attempted to arrange appointments with three doctors at different hospitals. A week later, no one had contacted them.
On and on. One person told the Cyprus Mail anecdotally that when they tried booking with a popular orthopedist at a private Nicosia hospital, they were told the next available slot was three months later.
According to Osak’s Papadopoulos, both patients and GPs – who make referrals to specialists – share the ‘blame’. A great deal of patients seek to get an appointment with a specialist for no good reason. Many GPs meantime like to pass the buck by ‘offloading’ patients on to specialists.
“Some GPs are reticent to provide a diagnosis, taking what they think of as ‘defensive medicine’ a step too far. Others simply grant referrals on the phone – without even giving the patient a lookover,” says Papadopoulos.
“And once they do that, they fill up the system and possibly deprive a specialist’s appointment to someone who might call five minutes later and who has a genuine, pressing need.”
It has to do with the way GPs are compensated. They get paid ‘per head’ – meaning by how many patients are registered with them, and for whom they grant referrals.
Specialists, on the other hand, get paid once they fulfill a referral – examine a patient.
Health authorities have tried to address this. As of this weekend, a new system is in place where 80 per cent of GPs’ compensation relates to the ‘per head’, and 20 per cent relates to performance – the quality of service provided, based on certain measurable criteria. It remains to be seen whether this will have an impact, or whether more loopholes will emerge.
But a major chokepoint has to do with the fact that specialist doctors at state hospitals don’t work afternoons. And these public-sector physicians may account for approximately half of all specialists registered with Gesy.
“Imagine if these doctors worked until 7pm instead of clocking out at 2pm as they do now,” notes Papadopoulos. “They could easily fulfill six to seven slots, maybe more during any given afternoon. Now think how much this would alleviate the situation.”
Naturally altering this regime for public-sector doctors is a hot potato – the trade unions would be up in arms faster than you can say “Nurse!”
Authorities are mulling various ways to tackle the problem of long waiting lists. On occasion the HIO has tried capping the number of referrals which GPs can issue. But that’s a one-size-fits-all approach and, besides, the data show no real impact – no decline in referrals.
Recently Health Minister Popi Kanari suggested that bringing in more doctors could help. For example, via medical scholarships given to students on condition they return to Cyprus and practice here for a certain number of years.
Another idea is to allow non-Greek speakers to practice medicine. Under the current rules, no one may practice medicine in Cyprus unless they speak Greek. Relaxing this rule would attract more people from overseas. This is under consideration at the moment.
“It’s a complex issue with many moving parts,” says Papadopoulos. “There is no one single answer.”
Asked whether Osak have data showing that people’s health has been endangered because of waiting too long to see a specialist, he said no.
“From our data, we aren’t seeing this.”
Osak operates the 1403 helpline which people can call to make a complaint.
