The government lacks enough doctors to meet the needs of patients who rely on public hospitals and clinics, but cannot afford to hire more, health minister Joe Phaahla conceded on Monday.
About 1,000 doctors who completed community service in 2023 are unemployed, according to Akhtar Hussain, chair of the employed doctors’ forum of the SA Medical Association (Sama). Sama is SA’s biggest doctor organisation.
Much as the government would like to hire all doctors who recently completed community service, it simply lacks the resources to do so, Phaahla said, adding that he hopes they will seek jobs in the private sector rather than going overseas.
“We hope the majority will practice as GPs and give some hours to the public service. We just hope they don’t opt for offshore, but remain in the country,” he said.
“While we regret we can’t immediately guarantee every medical graduate a post after [community service] it is a worthwhile investment. They can use that training ... and establish their own practice or explore elsewhere,” he said.
Medical graduates are required to complete two years of internship and one year of community service before they can register with the Health Professions Council of SA and practice independently. While in the past doctors who had completed community service readily found posts in the public sector, budget constraints on provincial health departments are putting the brakes on new hires.
Provincial health departments are under financial pressure because they have to honour last year’s higher than anticipated wage deal, which was only partially funded by National Treasury. They were also hit by unexpected in-year cuts to their conditional grants, announced in the medium-term budget policy statement in November. The budget crunch has hit personnel-heavy departments such as education and health particularly hard.
Phaahla drew attention to the size of the wage bill in health, saying that the cost of employment is “extremely high — up to 65% of annual budgets in some instances”, adding that the annual package for a medical officer, including allowances, could be as high as R1.5m. A medical officer is the entry-level post for a doctor employed by the state.
Find ways
A total of 564 medical officer posts had been filled since October, 239 were currently advertised, and 375 more will be advertised in the next six months, the minister said.
“Provincial departments of health continue to actively engage their provincial treasuries to find ways of addressing the unemployment of health professionals, including medical doctors,” he said.
While the state has steadily increased the number of healthcare professionals it employed in recent years, they are unable to meet the demand for services, the minister said.
“The trend over the past five years shows an annual increase of medical doctors ... [but] I would be the first to concede that these numbers are inadequate when considering the vast health needs,” he said, adding that the need extends across healthcare professions.
Figures provided by the minister show the number of medical interns employed by the state rose from 1,472 in 2018 to 2,210 in 2024, but this year’s figure is down on last year’s total of 2,365. The number of community service doctors increased from 1,340 in 2020 to 2,101 in 2024.
Last week doctors at Western Cape public hospitals drew attention to the impact of the hiring freeze by the provincial health department, warning that it jeopardised the training of the next generation of doctors and forced patients to wait longer for care than before.
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