- The Ministry of Health announced on Monday that the number of unemployed doctors who recently qualified has reached nearly 700.
- Health Minister Joe Faala said the province can't afford to create vacancies because medical workers are paid so much.
- The ministry works with states to staff and pay doctors and other medical professionals in public health departments.
Nearly R900 million in medical malpractice claims paid out in just one South African province in the recent financial year would have been enough to employ 694 of the country's documented unemployed doctors. Health Minister Joe Faala announced at a press conference on Monday.
Faala did not name the provinces, but according to the Auditor General's 2023 report, the Eastern Cape paid out approximately R867 million in insurance claims in 2021, while newly qualified The salary bill for the 694 doctors (2023) would have amounted to approximately R367 million. R838 million.
But Faala acknowledged, “This is a contradiction. We are dealing with the amount of money being paid out on insurance claims, and at the same time we are not able to hire people to help reduce it.”
In 2024, the SA Medical Association trade union, which monitors health workers' rights, informed Mr Faala that there were at least 800 unemployed doctors on record. Faala said a recheck of the list against the state's employee database revealed that these doctors had completed community service on Dec. 31, reducing that number to 694.
One example is Sanhera Sukhdeo, who graduated at the top of her class from the University of KwaZulu-Natal in 2023. In early January, she wrote in the Daily Maverick: But I'm not alone. Most of my colleagues are in the same situation as me. ”
In response, Percy Maharati, deputy director of human resources at the National Health Department, said: “The problem facing state health departments, which are major employers, is that they are struggling to get adequate funding. All governments are feeling the current fiscal strain.” The impact of sectors and countries on health service resources. ”
Faala said 239 medical officer positions are currently available, with another 400 expected to be filled in the coming months. (A medical officer is an entry-level general practitioner who works in the public health sector). Most positions are located in Gauteng, Mpumalanga, Free State and Eastern Cape.
Ironically, South African universities have increased the number of trainee doctors by about 60% (from 1470 to 2365) in less than 10 years to address the shortage of doctors in government hospitals and clinics, says Faala. he said. , but the National Treasury has not increased the state health department's budget at the same pace.
As a result, even though there are many vacant positions, there is no budget to hire the growing number of graduates. (A resident is a medical student who has earned a degree, but she must complete two years of practical training at a government medical facility under the supervision of staff working at a state hospital.)
Faala said the state health department spends 70% of its budget on health workers' salaries, but it's not enough.
In 2021, approximately one in seven physician positions in hospitals were unfilled, and one in five physician positions in clinics were unfilled.
This shortage of specialists in the public sector, and given that more than 70% of South Africans use government facilities, means that there are approximately 3 doctors for every 10,000 patients in the public system.
As the number of medical students trained by universities increased from 2018 to 2023, the state would need to come up with the funds to pay for an additional 895 interns over five years, which Faala said would translate into salaries. It turned out that the amount was just over R800 million. R900 000 per intern per year (this includes overtime).
Faala said the number of community service doctors, who earn around R1.2 million a year (R1.3 million if working in rural areas), also increased by almost 60% between 2020 and 2024 (from 1340 to 2). 101), meaning the government had to spend an additional R913 million on their salaries.
Mr Fahra said the pressure on the health department's wallet was further exacerbated by the 7.5% salary increase for public health staff negotiated between the government and trade unions in 2023, which would increase the number of new staff that could be appointed. warns that this means a decline in
“We received approximately 65% of the additional costs [caused by the salary hike]. That gave us some cushion, but we still needed to find the remaining 35% within our budget. ”
Mr Fahra warned that the public sector would not be “automatically populated” with qualified doctors.
[While] we want it [employing newly qualified doctors] To make it seamless, you should consider the following: [a doctor is] Other than regulated training or community service, [they] It's pretty much the same as any other profession. [you’ve] After completing all the training, [apply] Where are the opportunities?
Is the health system in crisis?
Asked whether the department's funding problems were pushing the public health system into crisis, Faala said that what he called a crisis was “really a choice of expression.”
But in December, the Deans' Committee, which represents health science faculties in universities across South Africa, said graduates must complete a compulsory one to two year stint, whether as doctors or other health professions. , warned that social service positions could not be filled. Nutritionists, dentists, physical therapists, radiologists, and others could do just that in the future.
why?
They said in a statement that insufficient funding for social service positions affects the quality of patient care, especially in rural areas, the very communities that in-service training programs are meant to support.
Read | Young doctors are at a loss as Fahala says there is no budget to hire all graduates.
“We already don't have enough supply. [these types of] Appointments in our system-wide services and community services are often the only care our people receive,” said Dean of the Faculty of Health at the University of Cape Town and Chair of the South African Medical Directors Committee. Lionel Green Thompson told Bexisa.
Lack of funding affects not only doctors but staff across all medical professions.
Since 1998, all new graduate health workers, such as dentists, physical therapists, radiographers, dieticians, and environmental health workers, have completed one year of community service in a public hospital or clinic before being considered fully qualified. It is mandatory to do so.
The policy was introduced to ensure that people using the state's health facilities, especially those in rural areas, also have access to professional rehabilitation care.
But more than that, Greene-Thompson explained, the medical school is concerned about the fact that unfilled positions are common.
Indeed, Mr. Fahra acknowledged in Monday's press conference that “the pressure on the ficus did not happen overnight.”
finance and training
The Dean's Committee said in a statement in December that it was concerned that the budget cuts would impact the quality of training for health science students and have a knock-on effect on service delivery at state facilities.
Already, community service placements are determined by institutional needs, with less focus on training and upskilling new health workers.
Especially in rural facilities, it is difficult to retain staff due to poor conditions such as non-functioning hospital and clinic equipment, too few staff members, and poor roads and difficulty in obtaining supplies. As a result, there are not many medical personnel on-site.
Therefore, many of these facilities rely on work done by recent graduates doing community service work.
Read | Faala said the state health department plans to advertise 375 jobs in six months.
Universities have responded to the government's call to increase the number of health science graduates, but states are struggling to match that supply with available positions, Green-Thompson said.
“We called [in the past] “This is to give us greater control over the financial resources needed and the growing number of new graduates,” he says.
Professor Greene-Thompson said that despite the possibility of being sent to areas where support is needed, graduates sit at home and many of their patients work in specialist professions such as speech therapists and occupational therapists in the public sector. It added that the home would remain inaccessible.
In fact, as Faala says, “We're not in the best of situations. We wanted to be in a position to hire anyone who wanted to serve.” [in the public sector]”.