After two years of negotiations, Malta’s medical health service is to be equipped with better paid, and happier doctors.

The Maltese NHS has enjoyed a top five spot in the World Health Organisation for its accessible, free service. But doctors have lamented their low salaries and inaccessibility to further training opportunities.

Now they believe Malta’s brain drain to countries like the UK – itself having undergone its own nationwide reform seven years ago under Tony Blair, and partly a reason for our drain – can be stemmed. Martin Balzan, the secretary general of the Medical Association of Malta, says a new agreement on doctors’ salaries can just about achieve that.

But just a month ago, Malta’s young doctors were not even completing their two-year stint in the government hospital after graduation. New graduates were signing up for registration abroad. As Josanne Vassallo, the editor of the Malta Medical Journal warned in September, “Previously we lost graduates who had proceeded abroad for postgraduate training and then opted to pursue their career and profession overseas. We now see newly graduate doctors leaving our shoes to work in EU countries such as the UK.”

Much as this seemed to be an international endorsement of Malta’s excellent graduates, Vassallo warned of doctors’ shortages at all levels in future. Since 2000, over 200 Maltese graduates went to work in the UK alone attracted by better wages and conditions in the NHS and private hospitals. Another 35 new graduates had also applied this year after graduating.

Dr Balzan says the new salary increases and the start of postgraduate training programmes may finally turn the tide. The increase are indeed generous, in some cases a doubling of salaries for consultants by 2010. But finally, new graduates can be assured that they can specialise in their areas with postgraduate training programmes which are to start in the coming year. The new agreement, which government clinched with doctors right after the Budget, addresses the grievances previously echoed by many of those who left Malta to pursue their career abroad.

What the public stands to win is the increased presence of their doctors in the state hospital. Whereas before consultants were free to pursue their private work, they are now being paid higher and are expected to work in the afternoons – one way in which a year-long waiting list could be cut further, Balzan says.

The highest-paid doctors, consultants, who this year will be earning Lm13,011 and who choose to work solely for the State will be paid Lm28,080 by 2010. They will work for five mornings and four afternoons a week – with another three sessions as may be required. Added together, these 12 sessions will form part of the work the state-only consultants will have to provide. And they will also have to tutor new graduates and forfeit any private work.

Those consultants who choose to keep their private work will earn Lm18,693 by 2010, up from their Lm11,359. The deal includes the six mornings they work for the State, the Lm3,000 they get for tutoring, and some Lm1,500 from on-call allowances when they are required on a 24-hour basis.

Despite the increase in salaries, many doubt how many senior doctors will be ready to depart from their private practice, a lucrative earner which in certain cases outstrips what the State pays. Dr Frank Portelli, the chief executive of St Philip’s Hospital, agrees. “No surgeon with a well established private practice will forgo his private practice for the State wage, because they earn much more. The people who will be retained by the State are those who don’t have a private practice.”

But Martin Balzan says the government’s role is not to compete with the private sector. “Both public and private healthcare are complementary to each other. Patients have a choice, while the government can rely on the private sector to take part of the burden of waiting lists whilst ensuring its doctors can retain their right to work in private practice.”

But Balzan says that from a total of 150 consultants, some 30, 40 currently with a private practice will be taking up the State’s offer to give up their private work. The majority are expected to juggle their private and public work.

“But they can still agree with the State to be contracted for a fixed number of sessions throughout the year. That represents the difference between the two types of salaries, and it should ensure more operations taking place in the afternoon. It is an incentive to keep the operation theatres working longer. But who has a steady private practice which has taken years, maybe five years to build up, could be expected to keep that practice going.”

In the long-term, Balzan argues, doctors who left Malta after graduation may return wealthier and accept to work in the State service.

“I think the agreement translates in greater quality care, partly by the increase in salaries and partly by the provision of postgraduate training. We can keep our doctors here – even health centre doctors working in the accident and emergency department will be getting a Lm4,500 increase for their 44-hour week. These are effectively the ‘gatekeepers’ of our health service, and they have been take care of as well,” Balzan says.

And indeed, Malta’s State GPs have been crucial parts of the national health service despite the dismal conditions in which they work, while authorities insist that health centre doctors should see one patient every four minutes. According to a study by family medicine specialist Dr Mario Sammut, doctors in primary care claimed they were “unappreciated and neglected”, blaming poor pay and career progression – the obvious culprits. Doctors complained that patients were not respectful of their professional role, while the administration was uncaring and indifferent to their opinion.

Junior doctors now will continue to work from 7.45am to 2.30pm, Monday to Saturday, with the consultants then deciding on how many doctors are then needed for the afternoon sessions. In such cases, junior doctors have been given the option to be paid extra or have a morning off.

One unnamed GP at a health centre says the increase is welcome although not the ideal standard, surely not at par with higher salaries in richer countries like the UK. That is why 40 doctors voted against the agreement in the MAM general meeting. Another 250 voted in favour.

But Martin Balzan is hopeful that this agreement restores the much needed confidence of those curing the nation’s illnesses. “This wasn’t an agreement we just struck up in a matter of weeks. It took two years to conclude, and it is a win-win situation for patients and doctors.”