"Doctors won't walk barefoot while still living a (sort of) life"

The last post took a lot of effort to write but didn't prove very popular amongst you all. But, just for continuity's sake, I can't but not write about the recent happenings that took place between the MAM and the government.

Di-ve.com leaked some interesting information last Sunday at 17:30 CEST; information which was worth copying and pasting for a doctor friend of mine to read when bored of studying for her MRCPs. The article title hinted that the government was actually concerned about this exodus of medical professionals, despite less recent claims of its inevitability*, and has plans (inspired by the proverbial case of dangling carrots on a stake in front of a donkey) to plug the brain drain.

Surprisingly enough, this agreement took past MAM (Medical Association of Malta) proposals to make working conditions less disheartening for all doctors in the public sector very seriously. The government was simply waiting for the MAM's approval before signing out an attractively looking package that could make newly graduates consider willingly working for the people on who they'd have studied. Since the salary was, undoubtedly, a major issue at stake, every one's wages have been increased. Consultants are being courteously rewarded do they choose to dedicate themselves to working solely with the government at the expense of their private practice, and the younger doctors might be provided with learning and specialised training opportunities to help them advance in their careers.

Although I was certain that the majority of doctors would have agreed to this package, an extraordinary meeting was still held the following day (Monday 29th October) at Medical School, 20:00 CEST, to allow the MAM and all its interested members to discuss things democratically. Needless to say...

The extra-ordinary general meeting of MAM approved the proposed MAM-gov
agreement.
Votes in Favour = 250
Against = 40
Invalid = 1

thanks

Martin Balzan

MAM - gov Agreement approved - 30/10/2007

These "new and improved" working conditions, as described quite well in the Tuesday (30th October) local papers, will come into play as from 2008 till 2012...something else to look forward to other than the Euro changeover...

* See previous post for further details (I just have to make you read it do I?)

A Tiny Newspaper Review

I admit that this blog will be slightly different (and much longer) than usual. Another note for my regular younger readers, this blog might it be more appreciated by people who would have accessed this webbie from the MMSA (Malta Medical Student Association) website. ;) But, don't let this discourage you to keep reading on. In the meantime, I’d like to thank the person(s) involved for this recent and invaluable source of exposure.

This Monday, there was much discussion among my colleagues regarding how the exodus of junior doctors is, and could further, negatively affect the national health care service. The local press happened to have made "a bit of noise" about the matter in last Sunday’s papers. This explains our hustle on our way to CCU at 8:45 in the morning, and also while waiting for Dr. R. Xuereb, who never turned up to tutor us through the ward round.

The fact that “scarce resources are bleeding away” has been the subject of much debate more than once. I used to listen to Dr. Martin Balzan’s claims of Malta losing more than 50% its doctors (on Bondi+ for example) with much scepticism. So, hearing my friends cite valuable literature resources on the subject caught my interest a great deal.

MaltaToday stated that the majority of final year Medical Students are studying with the hope of doing their housemanship abroad. Alas, I didn’t manage to get my hands on a copy of that juicy piece of news. But, another article on today’s paper of The Times has conveniently extrapolated some of the information printed (for those who are still waiting for the MaltaToday website to be updated with last Sunday’s news). Relevant figures were used as a good introduction to help Lino Spiteri vommit his bile on the poor remuneration doctors are receiving in the public health sector:

“Malta's most abundant resources are becoming rather scarce where it matters most. That is what the growing threat of an exodus abroad from the medical profession is telling. There are many Maltese doctors working abroad. And, as reported by MaltaToday on Sunday, some 35 more would like to join them soon.”

The reasons why this is happening is pretty obvious, especially to people who spend a good part of their day at St. Luke's hospital. Doctors complain of finding it hard to cope with a growing demand for their services, hours-long queues, and patient waiting lists. Working conditions are poor, the pay is low, workloads are heavy, and there's little opportunity for career advancement (an understandable excuse so as not to make everything sound like "it's all about the money").

That same Sunday also saw one of the letters to the editor on The Sunday Times titled “Doctors’ condition at A&E”. This letter drew attention to the fact that the A&E is suffering as a consequence of the loss of its resources, particularly expertise staff, “to other specialities or overseas where working conditions and salaries are better”.

All these ‘reverberations’ in the local press seem to support the MAM in fearing a brain drain among doctors - a brain drain that will severely affect the country, despite these views being belittled by the government. A spokesman for the Health Division said on The Times in March 2005, “that although the possibility of a brain drain does exist, this was not likely to be imminent”. Dr. Deguara sees this phenomenon of doctors leaving the country as the inevitable consequence of us being a small island. Due to its size, Malta limits newly graduates from expanding their medical knowledge, whatever the area of specialty chosen.

“However, it will still be necessary for doctors to go overseas for training as the small size of our population does not offer the necessary breadth to achieve specialisation.”

“Doctors who are leaving the island are almost all junior doctors going abroad for specialist training,”

This doesn’t seem to be bothering the minister so much; at least not as much as the MAM. After all, the number of medical students keep increasing every year. The past 10 years (1995 – 2005) has seen a net increase of 162 doctors in St. Luke’s hospital, despite 50% of doctors have left the country (many of who express absolutely no wish to come back home). Also, the fact that the course opens annually without a numerus clausus since 2001 means that the number of graduate doctors can only keep increasing.

And as the Ministry of Health assures the public of the unlikelihood of us experiencing a sever shortage of doctors (as in the 1970s), Dr. Mary Rose Cassar tries to entice current 3rd year medical students to specialise in Emergency Medicine due to the present staff shortage. As Dr. Deguara counts his blessings, the letter written by Dr Mario Tabone-Vassallo (president of the Association of Emergency Physicians of Malta) reminds everyone that a loss in the quality of adequately trained medics is still at stake. "But isn’t Malta known for it’s superb undergraduate training?", one may ask. Well, we certainly have that reputation (although the medical student of today wonders how the medical student of yesterday made it through the disorganised education system). However, we medics are always told that we never stop learning…that “the day we stop learning is the day we stop practising” (Prof. Josanne Vassallo). Medicine remains an apprenticeship; a skill which muct be attained and not only taught, which my justify the statement below written in the above cited letter to the editor:

“A&E is not the place for junior or inexperienced doctors, because this imperils patient care, quite apart from contributing to delays in the department and risk stressing other physicians.”

But life is a stage full of ironies. With all this talk about Malta potentially suffering from a medical brain drain, one might be surprised to see the real reasons why one of the two urology wards and a paediatrics ward at Mater Dei, together with 13 operating theatres, will not open when the migration process from St Luke's Hospital is completed.

“When contacted yesterday, the president of the Malta Union of Midwives and Nurses, Paul Pace said a shortage of nurses was the reason why new services and extra operating theatres would not be able to function upon migration.”

Bibliography

The Times Some wards, theatres will remain closed Wednesday 24th October 2007
The Times Scarce Resources Bleeding Away Wednesday 24th October 2007
The Sunday Times Doctors’ Conditions at A&E Sunday 21st October 2007
The Malta Independent Half of graduate doctors leave to work abroad – MAM study Sunday, March 25, 2007
The Times Fears of brain drain among doctors 6th March 2005

New Wing at Mater Dei Hospital

A panel of doctors was asked to vote on adding a new wing to Mater Dei hospital. The Allergists voted to scratch it and the Dermatologists advised no rash moves.

The Gastroenterologists had a gut feeling about it, but the Neurologists thought the administration had a lot of nerve, and the Obstetricians stated they were all laboring under a misconception.

The Ophthalmologists considered the idea short-sighted; the Pathologists yelled, "Over my dead body!", while the Pediatricians said, "Grow up!"

The Psychiatrists thought, "the whole idea was madness"; the Surgeons decided to wash their hands of the whole thing, and the Radiologists could see right through it!

The Internists thought it was a bitter pill to swallow; the Plastic Surgeon said, "This puts a whole new face on the matter".'

The Podiatrists thought it was a step forward, but the Urologists felt the scheme wouldn't hold water. The Anesthesiologists thought the whole idea was a gas, and the Cardiologists didn't have the heart to say no.

And in the end, the Proctologists left the decision up to some asshole.

(Complements to a friend of mine who cared enough to share this with me. First sentence has been slightly altered from the original for the purposes of entertainment i.e. no such new wing is going to be added to Mater Dei Hospital).

Muse

My muse seems to be on vacation and has forgotten to send me a postcard. And my fingers have been too lazy resting on the mouse instead of typing on the keyboard. It's been an eventful 7 weeks with nothing in particular to say. A month and a half of busyness severely lacking in 'fun', 'excitement', entertainment and photos.

I didn't get myself sloshed at parties. I didn't even go to parties. I didn't jeopardise any one's furniture when pillow fighting with my friends - I didn't go to sleepovers. I never complained of sunburn - I hardly touched the sea. I didn't visit Dr. Joelle in casualty with a sprained ankle or dislocated shoulders - I didn't get a chance to play football (or netball, or water polo, or diving, or rugby). I forgot how it feels like to live like the Teletubbies over the hills and far away - I didn't go to Gozo (you know...Gozo...the island of the three hills). Instead I took the pleasure of reading other people's blogs to relive that kind of summer, with short postings coloured with loads of photos and double the spelling mistakes.

In the meantime, I took the liberty of tempting my driving instructor to swear at me when I drive too much like James Bond 007 around roundabouts. He says I should use the breaks when I turn corners. Well, maybe it's "a sign" that I was born to work in the A&E and drive ambulances ;).

Yet, it seems that it's going to take me a while before I get my licence, and will power without the money doesn't really get you far (excuse the pun). Hence, I used to spend 40 hours a week fighting against obesity "the Atkins's way". I sold McDonald's burgers with large fries and large Diet Cokes, watch people eat them, wipe the tables and trays and, sometimes, even clean behind customers when all would have been digested and excreted. You see, with some people, stools had a habit of ending up on the floor 10cm away from the toilet. Being quite acquainted with all sorts of biological hazards (blood, stools, urine, sputum etc...), I'd volunteer to take others out of deep shit (literary), whilst letting my other colleague (usually Lucienne) wash and disinfect the toilet. It became routine eventually...Lucienne and I checking out the toilets for any similar surprises, sometimes hidden under a mountain of blue toilet paper. However, despite working a real lot together, there were occasions of communication breakdowns along the way. This once lead to my apprentice, mop in hand and bucket in the other, unlock a previously locked toilet door ("Marquita must have locked it by mistake"), only to find an urgent case of micturition happily emptying his bladder, whilst totally ignoring the very dirty floor just 10cm away from where he's standing.

Well, I had my last shift at McDonald's last week as I started my third year at Medical School three weeks ago, only to end up going to the wards in the morning smelling pretty much like a McDonald's toilet in need of cleaning after a UFO (Unidentified Foul Object) would have landed 10cm away from the toilet seat.