Sunday Times - Health service affected by medical brain drain - 20/2/2006

Health service affected by medical brain drain
Dr Stephen Fava

The survey conducted by sociologist Professor Mario Vassallo on behalf of The Sunday Times, whose findings were carried last Sunday, shows that the public is generally satisfied with the health services. However, it does show a worrying decline in satisfaction rate from over 80% in previous surveys to only 56.7%.

MAM has repeatedly warned that unless urgent action is taken to attract and retain doctors in the public sector, the service will inevitably deteriorate. Indeed, the areas of dissatisfaction by the public are precisely those that MAM has predicted that will be affected most by the present medical brain drain. It was very logical and easy to predict that as the load of work increases and the number of trained doctors decreases that client satisfaction would deteriorate.

Although there is ample room for administrative improvement unless the country manages to train and retain enough specialists, it will not be possible to reduce waiting times and waiting lists.

The survey also unequivocally shows that the general public believes that major investment in the health service by the government is justified. MAM has always believed that health should figure high in the government's priorities; investment in the public health service is certainly more justified than are a plethora of ill-conceived government projects.

The problem is that while the government has chosen to invest millions of liri in the building of the new hospital, it has, to date, failed to invest a fraction of this amount in human resources.

MAM believes that everyone will agree that even the most state-of-the-art hospital will not be able to offer a good service if it lacks an adequate number of doctors. Hence the expectations of the public for the new hospital, such as general improvement in service quality (52.3%), end of waiting time (49.3%) and increase in the number of services (27%) will not materialise. The government would therefore have wasted millions of liri through an imbalance of its investing policies.

The area where most people want to see an improvement is the appointment system. The long waiting times and waiting lists is a direct result of the medical manpower deficiencies.

Statistics show that the throughput of most doctors is very high and is in fact many times higher than that expected of doctors in other countries; however the system is simply overwhelmed by too few doctors available to see patients.

The survey also showed that the public is very satisfied with the standard of care in the private health sector. The main concern here was the cost. Unfortunately, as medicine becomes more invasive and more high-tech, the costs have spiralled up in both the public and private sectors.

In Malta, we are fortunate that private medicine (including doctors' fees) is still much cheaper than overseas. Indeed, the cost of private medicine is not too dissimilar from that charged by the government (on a non-profit basis) to foreign patients. This shows that high cost of private medicine is due to the intrinsically high cost of modern medicine.

The statement that "one needs to visit a consultant privately to ensure that one is well looked after in the state-run hospital" is totally unfounded. Statistics can easily show that most patients at state hospitals would not have seen their consultant privately and that the standard of medical care, as measured for example by outcome parameters, is excellent for all and sundry.

Health centres
A staggering 91% of the public makes use of health centres. This is ample proof of the high standard and dedication of health centre doctors. No-one would use the service unless he has full confidence in its doctors.

It is not clear what is meant by "absentee doctors". Official statistics show that doctors are among those who least take sick leave. It is likely that what patients are perceiving as "absentee doctors" are actually doctors who have been reassigned as a result of staff shortage. Hence all the areas of dissatisfaction in the health centres, namely long waiting times (35.9%), "absentee doctors" (14.1%) and staff shortages (12.4%) are directly attributed to the severe lack of doctors.

The message
The take-home message from the results is not the "Maltese want a more value for money health service". The public health sector already achieves excellent results at a fraction of the cost of other countries. This is shown by data released by the WHO and by the EU. The cost of private is also a fraction of the cost of that in other countries and is not too dissimilar from that charged by the government (on a non-profit basis) to foreign patients.

Rather the results show that the public continues to have confidence in the standard of medical care given by doctors but is becoming increasingly dissatisfied with effects of the medical brain drain, such as increasing waiting times, waiting lists and long appointments.

They also show that the public believes that the government should put health high in its priorities of spending. Unfortunately, the expected improvements in the new hospital will not materialise unless the government addresses the single most important issue that is still unresolved: that of severe medical manpower shortages.

Dr Stephen Fava, MD, MRCP (UK), M.Phil., FACP, FEFIM, FRCP (Lond), is president of the Medical Association of Malta

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