The Colleges of Medicine of South Africa (CMSA) has warned that austerity measures imposed by provincial health departments are undermining the country’s specialist training pipeline, threatening constitutional rights to healthcare and the long-term sustainability of the public health system.
In a statement, CMSA CEO Eric Buch said it was critical that the pipeline of medical specialists be preserved and that specialist posts be created and filled in the public sector to ensure access to specialist care for the vast majority of South Africans.
The intervention comes amid mounting reports from provincial hospitals and academic departments during 2025 of frozen posts, reduced budgets and operational constraints.
At least 1,800 junior doctors who completed community service were left unemployed at the start of the year due to budget cuts, despite South Africa’s poor doctor‑to‑patient ratio of 0.3 per 1,000 people — far below the World Health Organisation’s recommended 2.5 per 1,000.
Skills exodus
In Gauteng, Chris Hani Baragwanath Hospital has lost all three of its cardiologists and three of its four ear, nose and throat specialists to resignations, leaving entire departments without senior oversight.
Registrars across provinces report waiting years for funded posts, with some working without pay to complete training, while others remain stuck as senior medical officers because registrar slots are unavailable.
These developments follow the Treasury’s 2025 budget, which provided only a 0.8% real increase in non‑interest expenditure after a decade of near‑zero growth, entrenching austerity across frontline services.
The organisation stressed that the freezing or reduction of funded specialist posts compromises supervision and training of registrars, leaving fewer specialists to balance teaching and service delivery.
This is significant because registrars are the future supply of specialists, and their training depends on adequate supervision and academic time.
The CMSA noted that reductions in registrar posts will lower specialist output against epidemiology‑adjusted targets, with data showing that only the Western Cape meets the minimum threshold of 20 surgical specialists per 100,000 population required for safe surgery.
The importance of this finding lies in its demonstration that austerity measures are not neutral — they actively widen disparities and weaken national compliance with workforce planning standards.
The statement further highlighted that diminishing opportunities in the public sector increase the risk of emigration, citing reports that Canada alone issued 350 temporary work permits to South African specialists between January 2020 and July 2024.
Recruitment drives abroad
This trend is compounded by recruitment drives in Australia and the UK, which continue to target South African‑trained doctors and specialists, raising concerns about long‑term workforce retention.
Beyond posts, the CMSA drew attention to operational austerity: shortages of theatre‑trained nurses, functional operating theatres, intensive care beds and essential equipment.
These constraints directly affect the ability of registrars to train and of specialists to deliver safe care. The CMSA cautioned that while cutting salaries may appear to relieve budgets, the hidden costs — burnout, compromised patient safety and increased medicolegal claims — will outweigh any short‑term savings.
The organisation linked the austerity measures to governance failures, noting that billions of rand have been lost to corruption and wasteful expenditure.
The CMSA announced that its health policy subcommittee will survey academic heads responsible for specialist training to evaluate systemic challenges, with the intention of engaging provincial departments of health constructively.
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