The Emergency Medical Recovery Act (EMRA): Ireland's bold healthcare initiative for the next decade?

Objectives  To help resolve Ireland's ongoing struggle to provide adequate numbers of physicians engaged in direct patient care, a modification in tax policy is proposed. The number of licensed practitioners entering the country is low and the proportion of Ireland's own domestic medical graduates who establish practices in other jurisdictions appears to be growing. The resulting manpower shortage has exacerbated the healthcare crisis in Ireland. Against this background, a variation on Ireland's existing income tax code is proposed to address the problem. Methods  Section 195 of the Republic of Ireland Taxes Consolidation Act 1997 codifies exemption of artists from paying tax on specified income derived from their creative works. Irish Revenue Commissioners currently make rulings on books, plays, musical compositions, paintings and sculpture to determine eligibility for a tax exemption covering the first €250 000 of earnings obtained from qualified artistic work. Provisionally titled the Emergency Medical Recovery Act (EMRA) 2011, the current proposal would take the income tax exemption already provided to artists and extend this to eligible full‐time physicians practicing exclusively in Ireland. Key findings  To qualify, practitioners would be obliged to work in some cases at locations established by the State offering a minimum of four (4) non‐holiday scheduled clinical consultation days per month where free medical services are provided to Irish citizens or permanent residents. Unlike the existing tax exemption for artists which is of indefinite duration, the tax incentive for physicians by EMRA would be for 10 years only. Conclusions  This assessment of EMRA's social and economic implications for Ireland includes particular emphasis on comparisons with the familiar ‘artistic exemption’ already available. Correction of Ireland's high‐skill medical workforce problem, and by extension, improving access and quality of care to Irish patients, would be direct and immediate derivatives of EMRA. The condition of Ireland's healthcare system is inexorably linked to the supply of highly qualified physicians who provide direct, full‐time patient care; previous efforts to improve the situation in Ireland have not been successful. In contrast, enactment of EMRA would help assuage the Irish physician manpower shortage.