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State hospital doctors are angry at the Health Ministry’s proposals for health reform. MAM secretary-general Martin Balzan tells MATTHEW VELLA why the national health service can be a pain in the neck for doctors
The Medical Association of Malta’s secretary-general Martin Balzan has some not too fine words for a report issued by the Health Ministry on reforming the entire sector – “it’s the work of a sick mind”, he candidly states without pausing for irony relief.
 “This document means that the government is baring its teeth at the doctors. I’d say that the report was drawn up by some technical advisors. The Minister should really pay attention to who he is getting advise from.”
That the profession finds itself hounded once again by forces beyond the confines of the wards of St Luke’s Hospital, is nothing new. Balzan declines from discussing the individual items in the report, given the confidentiality the MAM has been entrusted with on the report’s detail. However, the self-importance with which the MAM often imbues its hard-working cohort is because, according to Balzan, it seems that many doctors are already giving an excellent and efficient service without having their backsides prodded by a health reform paper that considers total redeployment of the medical staff, a government which has blocked all promotions and limited funds at St Lukes.
The MAM has also managed to encourage its most senior officials to stop their private practice.
The biggest revelation Balzan makes comes in the form of a brain drain which according to Balzan, not one to beat about the bush about the problems faced by doctors at the state hospitals, is that of all 1999 medical graduates, 70 per cent have already settled in the UK, and some in Australia, to seek a better job, with better conditions, and of course a better salary.
“Look, I know that we cannot have British salaries, those run at around GBP 85,000 to GBP 100,000. But Castille decided to stop all appointments just like that, that is, after having doctors completing four years of higher specialist training, to proceed to a higher rank, you have Government saying ‘no more promotions’. Overnight, they started to look for jobs abroad.”
With the health reform proposals proposing a restriction on private practice for senior consultants, Balzan wants to set the record straight.
“In Parliament recently, Health Minister Louis Deguara mentioned that two persons whom he said were engaged for Lm45,000 gross each, a cardiac surgeon and neurologist, had preferred to revert to their Lm8,000 salary with the government when their contract was up for renewal, because they preferred to have no restrictions on their private practice. He continued to say that it was no wonder that doctors complain about being hounded by the tax compliance unit.
“We wrote to the government saying that if the minister wanted to offer that kind of salary - Lm45,000 yearly before tax - a call for applications should be issued and I assure you, the majority of consultants would apply for such a salary. That is our challenge to the Health Minister, because there are a number of doctors who would settle for that kind of money with total dedication to SLH.”
Of course, as he concedes, with private practice, the sky’s the limit. It is possible to make that kind of money if you have a good clientele. “I think that if somebody wants to do private practice they should be given that liberty. Everything has a price. If there is somebody who is ready not to do private practice for a sum, then there is a sum for that kind of deal. As MAM, we are in favour of a nucleus of people being totally dedicated to public service.”
However he laments what he sees as a devaluation of the profession. “These are the problems which afflict the medical profession, which we consider to be a large sponsor. A surgeon is paid Lm4.50 an hour - less than a painter - so for an operation of three hours, a surgeon pockets Lm10 to Lm15. I don’t think that even accounts for the repair of a couple of chips in a computer, let alone a major operation. The consequence is that to earn a decent living, a doctor turns towards private practice.”
According to Balzan, nothing has changed since the Ministry for the Eldery and Health conglomerated. Instead, he points out that things have moved backwards. “The problem of overcrowding is still there. Do we have enough chronic geriatric beds for the population? The answer is ‘no’, otherwise old people would not wait six months to be taken to a home, and instead are kept at SLH. Is it correct to have people lump their elderly in the state hospital, so they can benefit by selling off their homes for thousands? I know there are genuine social cases, but the consequences are that other patients end up suffering.
“SLH has a very short mean duration at 4.6 days, which means we are very efficient. So where is the problem? It’s at management and policy level. The new hospital will have 850 beds, where at SLH we usually go up beyond the 1,000 mark. Let’s not just say that doctors are only interested in private practice.”
Balzan also complains there are limited funds in general for staff and medicine after a series of cuts. According to the health reform proposals, units within the entire health sector will now be accountable through audits and budgetary control. However, as long as demand for the service remains unlimited, he sees little point for financial limitations which render the practice harder to carry out. “If you go to a ward, out of 30 beds you will find 14 taken up by social cases, and that nurses are lacking, because not enough are being employed. There is an unlimited load on the health service and there isn’t enough money to cater for the demand. It does not make sense to impose a financial limit on a service where you cannot limit the demand. This is where planning comes in, to render the service sustainable. There are cases where the wear-and-tear of instruments means that these are not replaced because of financial limits.”
Despite all limitations, the service at SLH remains one of the finest according to the World Health Organisation. That is why, some doctors, or rather most of them, may feel justified at taking umbrage at the attempts by the tax compliance unit to hound them into declaring their accumulated wealth as they shuffle from St Luke’s to private clinics and hospitals. Doctors today share tax-evader number one status along with… panel beaters.
“Our profession was singled out, apart from panel beaters. The fact that doctors were singled out bothered many. Apart from that, when doctors started being tackled, the TCU had many unreasonable expectations and blanket concepts, such as that all doctors earned the same kind of money, when in reality there are wider realities. This has been addressed slightly, however I am expecting that tax compliance should be based on the kind of expenditure people make.”
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