Martin Balzan dismissed claims that his recent retirement was sparked due to a conflict with the health minister. Balzan, who will turn 63, said he wants to call it a day due to personal fatigue and a desire to go back to a “normal life”.

While criticising Jo Etienne Abela’s communication and negotiation style, he lauded him for his drive to invest in heavily-needed infrastructure.

Balzan also praised Mater Dei Hospital’s capabilities but warned of overcrowding and stressed the importance of improving doctors’ work-life balance.

A consultant respiratory physician by profession, Balzan identified car exhaust as a major contributor to Malta’s high asthma rates, and advocated for electric vehicles to combat pollution.

The outgoing Medical Association of Malta president is a senior lecturer at the University of Malta and has published over 70 papers in international scientific publications.

This is the full interview:

MLZ: Have you decided to retire because you are on bad terms with Health Minister JoEtienne Abela?

MB: It’s completely unrelated. I would have retired anyway, even if we never had the dispute. It was a decision I made at the beginning of my term as union president. I will turn 63 this year. I feel tired and I want to go back to a normal life. I gave whatever I could give, and I did my best.

MLZ: In January, you told Times of Malta: “The relationship with this minister is very bad. By and large he does not respect agreements. He does not talk to us.” What is your problem with this minister?

MB: When I say relations are bad, I mean on a union level. If you’re the minister and want our opinion on something, you’d better consult with us before – not after – taking a political decision. It avoids disputes and helps you save face with cabinet colleagues, the prime minister and voters. Every minister has their style, and I prefer ministers who negotiate in private and in confidence. Other ministers usually held these discussions privately.

MLZ: But what the minister wanted to do was refer patients from Mater Dei to private hospitals to help them get the medical care they needed quicker and alleviate pressure from Mater Dei. All your dispute did was make life harder for patients.

MB: Mater Dei has established protocols of patient safety, and that’s crucial for doctors to follow. These protocols were not discussed with us and were not even issued. A patient may come with seemingly mild symptoms, leading to a potential referral to a private hospital for what appears to be minor care. However, these symptoms can often mask a more serious underlying condition. Physicians are trained to anticipate worst-case scenarios, should the patient’s condition deteriorate. In such instances, Mater Dei, with its superior equipment and staffing, is far better equipped to handle critical illnesses than private hospitals. Indeed, private hospitals frequently transfer deteriorating patients to Mater Dei. In fact, the government ultimately limited private hospital referrals to patients with fractures and other minor conditions. The majority remain at Mater Dei, validating the union’s stance. While the minister did not heed our initial advice, I emphasise this is not a personal matter. A productive discussion occurred, and common sense prevailed, demonstrating that prior consultation could have prevented this entire situation.

MLZ: The minister said you took it against him because you applied for a promotion and did not get it. Is that true?

MB: I don’t want to bring my personal matters into union matters. The union decisions were taken among a council of 11 people, all of whom were bringing forward our members’ concerns. And patients benefitted from the agreement we reached for doctors at health centres.

MLZ: You said you don’t like Jo Etienne Abela’s style. Who then, was the best health minister in your opinion?

MB: When I say ‘best’ I refer specifically to handling union relations, not overall performance as a health minister. This minister has demonstrated a significant commitment to infrastructure investment. The strongest union relationships we’ve had during Labour governments were with Chris Fearne, and during PN governments, with Joe Cassar. I’ve known Fearne since school; we’re the same age, our families were friends, and we had an excellent personal relationship. He was also highly politically savvy. While Jo Etienne Abela is equally intelligent, Fearne was more adept at navigating political complexities. He knew how to progress while maintaining positive relationships. Despite his involvement in the hospitals’ deal case, I believe he will ultimately be exonerated, and I state this without any intent to influence the legal proceedings.

I feel tired and I want to go back to a normal life

MLZ: Is our health system collapsing?

MB: I don’t intend to cause alarm. We have strengths and weaknesses. We boast – and I’ll take some credit for this – one of the EU’s highest doctor-to-population ratios. It’s not just quantity; we also have highly skilled doctors. Our doctors’ training and specialisation are among the best, acknowledged even by foreign physicians. Our health services, including nurses and physiotherapists, are highly regarded. The Organisation for Economic Co-operation and Development (OECD) statistics show our population experiences minimal unmet healthcare needs. Our weakness lies in infrastructure. We lack sufficient beds. The emergency department’s overcrowding isn’t solved by adding cubicles; it merely extends the waiting line. We need more ward beds. While the minister promises action, I’ll believe it when I see it, given the eight-year delay of the [Paola] health centre, which should have opened two years ago. We also need more outpatient department beds. I remember Mater Dei’s opening had, at the time, significantly boosted professional morale. It allowed me to finally be heard by the government. Lawrence Gonzi, wanting to highlight the Mater Dei project, rightly invested in it. This led to substantial salary increases, addressing doctor shortages, and significant investment in structured training. I had jokingly told Gonzi he’d bought a Ferrari but wasn’t prepared to pay for fuel. We had a great hospital but not enough doctors. Now, we’re at the opposite extreme: ample doctors, but inadequate infrastructure. The system isn’t collapsing, but we can improve significantly, and it’s not the doctors’ fault. The bottleneck is in the wards.

MLZ: Do you think the healthcare system can take another pandemic?

MB: The government should prepare for the worst-case scenario. Right now, we’re not even at the minimum case scenario. We don’t have space.

MLZ: You have been in the union for 28 years.

MB: I wasn’t president for the first four years. I’ve been running the union for 24 years.

MLZ: And you are retiring next month, at the next election. But you’ll stay on as an honorary president.

MB: I was unanimously nominated by the council members. Then, almost 500 members (almost half of all our members) overwhelmingly approved the appointment with 82 per cent of the votes at the last general council. It’s a ceremonious position, but a recognition of my work. I wanted it and asked for it, and they accepted. I’m not saying my tenure was perfect or without mistakes, but I believe I contributed to the profession.

MLZ: What were the biggest wins and losses of your tenure?

MB: The most difficult moment was deeply personal. It occurred just two hours after we concluded a union council meeting. I received a call informing me that a council member who had just been in the meeting with us, was assisting at a family-owned construction site and was fatally injured when a wall collapsed. He died on the spot. I struggled to believe it and immediately tried calling him, but there was no answer. I was even more moved when his wife asked me to be a pallbearer at his funeral, saying he held me in great respect and wished for me to do so. This profoundly disturbed me. Despite having resuscitated numerous people professionally, with some dying in my arms, no other death affected me as deeply. No other union setback came close. As for the most positive moment, it was securing the first collective agreement with Lawrence Gonzi. This resulted in a significant salary increase for doctors and substantial government investment in doctor training.

The bottleneck is in the wards

MLZ: But if you ask doctors nowadays, they will tell you they work exorbitant amounts of hours and feel they are hardly paid as much as they deserve. What about them?

MB: Just a moment, I was coming to that. For two years, I served as vice-president of the European Doctors’ Association, during which I successfully advocated for five key policy agreements among two-thirds of Europe’s doctors. These policies addressed air quality, basic medical education, and doctors’ wellbeing and work-life balance, among others. Doctors should have a balanced life and not exceed a 48-hour workweek. We previously faced a doctor shortage, with only 60 new doctors every two years. However, for the past 15 years, we’ve seen 120 join annually – a fourfold increase. But if doctors are dissatisfied, they may leave the profession or relocate abroad, wasting valuable investment. We aimed for more, better, and happier doctors. To achieve this, sufficient time for family and hobbies is essential, along with the opportunity to practise within one’s expertise and experience professional satisfaction. So, why are there still disgruntled doctors? This stems from poor planning by leaders in certain medical areas, who should have ensured adequate specialist training over the years. Doctors should engage in private practice by choice, not due to inadequate compensation or lack of specialisation opportunities. The profession naturally places unsocial hours on younger doctors and increased responsibility on senior doctors. However, the issue of overworked young doctors is also concerning; burnout leads to demotivation, and an unhappy doctor is a dangerous one. Nonetheless, we reversed the brain drain, established structured training, and worked to improve working conditions and work-life balance. I believe the vast majority of doctors give their utmost for their salaries.

MLZ: Occasionally, we encounter reports of doctors who, after examining patients at Mater Dei, recommend follow-up consultations in their private clinics. Do you agree with that?

MB: Doctors should give their utmost at Mater Dei. A very small minority engages in the practice you’re mentioning and it’s not right. But discipline is not our job – it’s the employer’s.

MLZ: You are a pulmonary disease specialist, and air pollution in Malta is growing worse, as is construction dust. And it is leading to a rise in asthma. Is the problem getting worse? How much worse, what do we need to do about it, and where will it lead us if we fail to act?

MB: Environment is low on the political agenda because people want to drive their cars everywhere and park right in front of their homes and their workplace, if possible. That means pollution is constantly right under our noses. Even if you’re driving in your car, the air you’re inhaling is likely polluted from the car in front of you. Even worse, diesel in Malta is much cheaper than petrol, and it is much more harmful to the environment. The future is the electric car.

MLZ: So, the biggest culprit is exhaust coming from cars?

MB: Yes, it’s the biggest source by far. Ten years ago we ran a study in collaboration with Italian researchers and we found that most of our asthma is caused by car exhaust.

MLZ: And what about construction dust?

MB: It is harmful to people who work on construction sites and people living around them. But it affects a relatively restricted circle of people. It’s still harmful, but to the people around it. The biggest culprit remains car exhaust.

MLZ: And how does Malta compare to other countries when it comes to asthma?

MB: We have among the highest rates in the world. We’re in the champions league in that regard. Because we are a small country and we are surrounded by cars, even in residential areas. And our buildings are relatively low, where pollution is most concentrated. The future is the electric car, but it’s useless to increase electric cars if fossil fuel vehicles are increasing at a faster rate.

The interview has been edited for clarity and brevity.