Doctors’ agreement ‘not flawed’, Medical Association chief says

The president of the Medical Association of Malta has criticised former health minister Louis Deguara for "never listening" to doctors' opinions on the current overcrowding problems plaguing the national health service.

"Former minister Louis Deguara never listened to what us doctors had to say and never implemented any opinions which we put forward. This has led to the current problems in the health sector," Martin Balzan told MaltaToday in a reaction on comments by Deguara, who described a 2007 collective agreement signed with medics during his time as minister as "flawed".

In comments to MaltaToday, Balzan attributed the current problems within the health sector to Deguara, insisting that the former health minister never listened to what the doctors had to say.

In previous comments to the media, Deguara had said the health division had not agreed with the final agreement because "it was seriously flawed".

Deguara went on to add that the department only signed the agreement because of "orders from above", without specifically referring to the Office of the Prime Minister.

European Commissioner John Dalli, who was Deguara's successor as health minister, also confirmed this statement. While he chose not to comment on the agreement itself, Dalli told MaltaToday that officials within the health department had claimed that they had been instructed by superiors to sign the agreement.

Hailing the agreement, MAM chief Martin Balzan said that it had helped the health sector to improve. "Since the implementation of the agreement, Malta started seeing a reduction in doctors choosing to work abroad instead of here. Before, the health sector used to suffer a 50% brain drain of graduating doctors. This has not only been reversed, but more migrating doctors are choosing to return," Balzan insisted.

The agreement had invested heavily in post-graduate training, something which Deguara "was very reluctant" to back, Balzan claimed. "He used to fail to understand that doctors were leaving because they wanted the opportunity to study and specialise. We are very happy that he [Deguara] was overruled," Balzan said.

He also said that the agreement served to create incentives for higher outputs. "The contract is not time-based, but output-based. This has led to an increase in operations," Balzan said.

"Surgeries increased consistently since the 2007 agreement by 10% per year. The number of outpatients visited has doubled to over 400,000 per year."

On primary healthcare, Balzan said the setting up of GP training, specialising in general practice, has increased consistently with 12 doctors per year: "Altogether in the last four years, more doctors chose to become general practitioners than in the previous 10 years."

Reacting to criticism that the current agreement has increased the doctors' pay, but not their working hours, Balzan insisted that modern contracts are output-based, which as a result see more operations taking place.  "Operating theatres nowadays continue till 6pm and 8pm, while before they stopped at 1pm," he said.

Criticism was also raised on the fact that morning operations lists spill into the afternoon's list. While the nurses' union believes the solution is to improve work practices, Balzan believes the solution is an increase in staff complement.

"The overrun is the result of an increased number of operations. Not all operations take the same time. There is an average time, but one should also be aware that operations could be problematic and complicated and take more than expected," he said.

"But the doctors' accord ensures flexibility and more output... that is why the use of operating theatres has improved."