A native of Malta, Dr Farrugia has been a physician with Mayo for 30 years. His medical background is in genomics and gastrointestinal disorders and he has held several leadership posts in the Mayoorganisation.

Farrugia is from Balzan, and most of his family still live on the island. His father, who has now passed away, was also a physician and was a pioneer of the blood bank. His mother still lives in the same house in Balzan in which he was born. A family of doctors, Farrugia’s brother, Mark Farrugia, is also a physician. Farrugia proudly says “we have a strong family unit here in Malta”.

His father was “a strong influence” on him taking the medical route as a career path. “His work ethic but also the joy it gave him made it a relatively easy decision for me to become a doctor.”

Farrugia graduated as a doctor from the University of Malta in 1987 followed by a year working at the then public hospital, St Luke’s Hospital. A year later Farrugia left for the United States. His uncle worked in a laboratory in the United States so the connection was already there.

Farrugia’s mentor, Professor Michael Camilleri had also returned from the United States when he was in this last year as a medical student, which also prompted him to move. Farrugia also wanted to do research and he knew he could not do it in Malta at the time so he made the decision to leave.

He also credits his father and mother who always supported him; he says he never saw his father cry except on the day he left. “They gave me the freedom to make my decision while opening the path to make my decision.”

Although Farrugia is very busy with his career, he never misses an opportunity to come to Malta. His family, including his wife and two children, visit Malta at least once a year. His children were only three months old when they visited Malta. Farrugia also combines work with pleasure and has over the years organised several large meetings with Mayo Clinic’s benefactors in Malta.

Mayo operates hospitals and clinics in Minnesota, Wisconsin, Iowa, Florida and Arizona with a staff of more than 68,000 and revenues of nearly $12 billion, treating more than 1.3 million patients annually. Its flagship Rochester campus has topped US News & World Report's Best Hospitals rankings several times, including 2017-18.

Farrugia also teaches gastroenterology and physiology at the Mayo Clinic Medical School.

“I had a wonderful education in Malta,” Farrugia remarks mentioning that he was also educated at St Aloysius College. He felt he was well prepared for a career abroad andsaysthat Mayo Clinic has a remarkably fair culture. “Excellence and merit are rewarded, there are no favours and you only get to where you are based on your own abilities, but it is a team-based environment.”

Although it was not easy becoming CEO of such a large company, Farrugia says “it was more opportunities that led to more opportunities and one day you wake up and you are CEO.” The fact that he was from a small island did not make a difference and it was never held against him. He also felt no bias being a foreigner in the United States.

When questioned about the medical technology and state of healthcare in Malta, Farrugia said he could not comment as he had left the country 30 years ago and had not been much involved since then. His connection is that from the age of 12 onwards,he was a student with now Minister of Health Chris Fearne.

He did, however, highlight a number of issues which he believes are faced by every country, including Malta. Substantive issues include the quality, safety and cost of health care, which Farrugia believes are societal. They are not approaches which can be solved by politicians or individual institutions. The value equation is quality divided by cost and this equation needs to be balanced. To have the latest in healthcare ways need to be found to manage costs.

In the last year, a therapy has been introduced called CAR-T Cell Therapy which could be used on cancer patients with blood diseases with only a month or so to live. Farrugia explains that he has had patients who were near death but after this treatment went into full remission. However, this therapy costs about €300,000 to deliver to one person. It is in cases like this where the value equation must be analysed.

“I firmly believe that every country has to make decisions on how to invest in innovation so that it can drive the top part of healthcare up but at the same time drive the bottom part up. The bottom part is how to deliver consistent care with issues like obesity, high blood pressure, diabetes.”

This requires a transparent culture Farrugia explains and in general, healthcare has not had the transparency it needs. The public needs to know what the outcomes are.

It is important that quality of care continues to improve at a cost that is sustainable for the country. The percentage of money spent on health care as part of GDP varies from country to country and it depends on societal expectations. It requires value judgements to be made and those value judgements can quite difficult.