Doctors' working conditions

In November 2007 the Medical Association of Malta (MAM) reached an agreement with the government after a long period of negotiation. Local postgraduate training was entrenched in the agreement to improve standards and to stem the 'brain drain'. It allows for flexible hours and provides for extra hours which staff can work outside the established working day of 7.45 a.m. to 2.30 p.m. from Monday to Saturday.

The agreement also introduced improvements in salaries, commensurate with the hours worked. For the first time a new form of contract that precluded private practice was introduced and this has been taken up by numerous consultants and it is envisaged that these will increase.

To the government's credit, much work has been done to introduce postgraduate training. The general election and the new administration may be the reason why other parts of the agreement have not yet been adhered to. MAM expects that the rest of the agreement will be respected soon and that this will lead to greater efficiency.

In his interview with The Sunday Times (July 13), Health Minister John Dalli mentioned waiting lists and partly attributed these to a 'part-time' hospital and under-utilisation of operating theatres.

Consultants are contracted to work 'office hours', including Saturdays, but many of them work beyond the contracted hours, either because of long operating lists, outpatient clinics or when on call.

Many even carry out elective (scheduled) regular afternoon and Saturday and Sunday operating lists. There are also many non-consultant grade doctors who work long hours, beyond 'part-time', working long shifts through the night, sometimes once every two or three days.

Many of these doctors go unrecognised, many are very experienced and handle complex cases 24 hours a day, seven days a week. Among them are a number of experienced expatriates who have provided sterling service for many years. The waiting lists have increased because the population is increasing in number (including tourists and foreign residents) and age, with vising expectations. The services offered are also continually being expanded.

The number of operations performed continues to increase from year to year and compares very well with foreign institutions, but it has not managed to keep up with the increase in demand. A surgeon does not operate in isolation. More support staff and services are needed if empty theatres are to be used.

MAM has claimed for a long time that it is not enough to invest in bricks and mortar. The health system can improve through increased efficiency with existing resources, but major increases in throughput require substantial investment in resources, primarily human resources.