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Doctors demand a better deal

Malta’s frontline doctors are disillusioned and dejected. Dr MaryRose Cassar, who works in the casualty ward, tells MARIKA AZZOPARDI why so many professionals are leaving this line of work

We make life-or-death decisions on a regular basis and yet the money we earn is hardly enough to support our families.

These were the words of Dr MaryRose Cassar, who works as the Registrar at the Accident and Emergency Department.

Over the past weeks Malta’s doctors, under the umbrella of their union, MAM, have been venting their frustration over their working conditions and pay. They have already introduced a number of measures as protest action, and others are set to be introduced tomorrow.

The doctors that work in the emergency department of St Luke’s Hospital can be described as the ‘front men and women’, but it seems they are getting the worst deal of all, as Dr Cassar explains.

"We had 18,000 ambulance calls last year and saw a total of 105,000 patients" she said. "This amount includes a lot of people who have to be seen to with urgency."

Dr Cassar stressed that the doctors’ work carries a great weight of responsibility.

"The decisions we have to take are life-saving ones," she said. "We believe we should be appreciated for this."

The doctor explained that there are a total of 30 doctors based in casualty, who work on a shift basis. These are all junior doctors and include senior house officers. There are two Registrars who supervise the staff and treat the patients admitted in unstable and critical conditions.

"We have six shifts and the two Registrars - myself and another person - are only there until 2pm, after which time our job is done by a doctor from one of the wards," she said. "There are three different shifts, one lasting six hours, another lasting eight hours and a third shift of 12 hours."

Dr Cassar explained that this last shift - the night shift – is done by doctors who would have been working for six hours on the previous morning.

"On any shift there is a maximum of eight doctors on duty but only four doctors are working during the night, be it a normal weekday, a weekend, a public holiday or Christmas time," she continued. "This in itself is lop-sided since everybody is aware of the high incidence of traffic accidents during weekends.

"During any one accident you could get two people who are seriously injured. Each patient in such a condition would require a team of three or four doctors performing CPR.

"That means that the rest of the patients awaiting treatment have to hold out until the most serious cases are dealt with. In fact, patients are assessed when they register and are classified according to the severity of their condition."

The high stress levels in this line of work would come as no surprise to anyone, but doctors’ main gripe is that their salaries do not reflect the work they do and the studying needed to be able to practise their profession.

Dr Cassar also pointed out that the doctors have to foot the expenses to sit for examinations and to attend courses.

"A doctor might have to spend the equivalent of four months’ salary (Lm 1,500) just to get their qualification," she said.

It is, perhaps, no wonder that doctors become fully qualified and specialised in their field of study, only to then make the decision to leave government service since the pay does not merit the time and investment expected of them.

Dr Cassar’s sentiments were backed up by Dr Patrick Sammut, vice president of MAM.

"Every time a group of young dedicated doctors start work at the Casualty Department, we find that dedication alone is not enough to keep them working there," he said. "Basically they are all young doctors with as yet no family ties.

"But once they start a family, the pay is not even enough to keep their families. Their only option is to find employment elsewhere."

So how will the public react to the doctors’ views that enough is enough and it’s time to take action?

MAM chief, Dr Martin Balzan, said that so far, people have been understanding, but how people will react to the decision to step up protest action, which starts tomorrow, remains to be seen.

An unofficial meeting also took place between MAM representatives and Acting Prime Minister, Lawrence Gonzi on Friday, although neither side has revealed what was discussed.

From tomorrow, the doctors will be limiting the services they will be providing, only working at certain health centres and changing the timeframe within which the services will be available.

Doctors at St Luke’s hospital will not attend outpatient sessions, including all specialised clinics, such as asthma clinic, diabetes, endocrine, chest and cardiology.

Those that will still open are: mental outpatients, oncology outpatients, anti-coagulant clinic, obstetric outpatients and the pain clinic.

Doctors will be attending to all of their inpatients’ needs and all surgical procedures will be performed as usual.

MAM have advised patients not to attend for their outpatient appointment and to postpone it.

"If a patient feels that his appointment is urgent, he is advised to get a letter from his family practitioner certifying that the urgency of the case and clearly stating why he/she feels that the case is urgent," the association said in a statement. "This letter has to be presented at the outpatients before 8.30am, on the same day of the appointment."

MAM also said that letters will be sent to the respective consultant, in the wards, by a person delegated by the association. It will then be up to the consultant to decide if the urgency is justified.

Patients turning up for the outpatients without a letter from their GP will be referred to the accident and emergency department.

Doctors in the department of paediatrics will not report for the well-baby clinic. These doctors, however, will perform their usual daily duties at the paediatric ward, the paediatric day centre and paediatric casualty.