The Department of Health’s eleventh-hour placements of junior doctors for 2021 job postings mark another year of a bungled placement process. It’s also left junior doctors scrambling to make relocation plans just as the year-end shutdown kicks in. 

By the second week of December, there were still 159 candidates facing the uncertainty of whether they would have jobs, come 1 January. Their years as interns and community service doctors are requirements to complete their medical training. Without ticking these boxes they are legally prohibited from working in private practice. 

Interns and community service doctors are meant to give young graduates paid, hands-on experience. For the public healthcare sector, it boosts much-needed resources, especially in the most under-serviced areas in the country.

For many, as the weeks dragged on and as deadline after deadline lapsed, the frustration and anxiety turned to despair. They started the hashtag #doctorsinlimbo, hoping to pressure the department to act. They also organised Whatsapp and Telegram groups for a flow of information between them.

One doctor told Maverick Citizen by the middle of last week that he would have to wait tables if he didn’t secure a posting. Another doctor said she would have to move back to her family home in the rural areas because she didn’t have money to continue living in the city. Others spoke about possibly having to study short courses. All were stressed, disappointed and angry at being let down by the DoH’s inefficiency and mismanagement. 

Young doctors who spoke to Maverick Citizen said the placement process had amounted to being “shown the middle finger”. They have been extended scant professional courtesy with no proper communication and when their situation began looking dire, there was no effort to effectively resolve their issues. They’ve had to rely on call centre agents who are only able to give them ticket numbers and references. They said the ICSP (Internship and Community Service Portal) has been clunky and doesn’t update information. Their universities are unable to intervene and the Junior Doctors Association (Judasa) cannot either. Judasa at least, they said, is more communicative and responsive, giving them updated information via social media. 

Worst of all, they said now that the last-minute placements had been finalised – on Thursday, 10 December – the department considers its job done. These junior doctors were given just two days to accept the postings. Effectively, they could also not do post swaps with their counterparts at this late stage. Meanwhile, there is no responsibility from the DoH, still no communication or firm commitment or strategy on how it intends to sort out the problem so it doesn’t recur next year.  

Popo Maja, the Department of Health’s spokesman, did not respond to media questions sent to his email and his two WhatsApp numbers. 

The junior doctors who spoke to Maverick Citizen have asked to be identified by pseudonyms. They are speaking anonymously because they said a culture of bullying exists. There is an entrenched hierarchy and those who speak out are victimised and labelled troublemakers. It creates a culture of silence even as they enter the public health service that will benefit from a cohort of critically aware professionals. Even Judasa’s tweets are laden with threats, stating “be warned the media will seek to distort the view of junior doctors to suit their narrative”. Judasa did not respond to queries from Maverick Citizen.

“Everything is just broken,” said Anele. She is one of the doctors who was waiting for an intern position till the end of last week. 

“I am going to have to go back to my home because I can’t afford to stay in the city and wait and be third or fourth rounded. It’s very disheartening because I feel like after six years of study I have just hit a wall and nobody cares and I really wanted to be able to start contributing at home. And even as I am sitting here, what really matters in the end is the patients in those hospitals who really need us to be there,” she said of her situation in the middle of last week. “The DoH has to do better”. 

She said the department should have been making plans from the beginning of the year, based on numbers of final-year students. They also had final numbers by the time the doctors had to submit their applications in July. 

“They knew this all along, we did our part, we have been patient, but they have done this in a haphazard way and they keep saying it’s the algorithm. But these problems occur every year and I can tell you it will be the same next year. 

“Everything needs to be fixed – from the website (frequently frozen and not updated, or having to be viewed with different browsers or different devices) to hospital managers and CEOs and the whole of the DoH, in fact. Many young doctors really do care, we want to make a difference, especially in a time of Covid. We are not being spoilt because we are saying it’s not right to be treated in this way or to be expected to work in hospitals and facilities where the systems are so broken we can’t treat patients properly,” she said.  

Another junior doctor, Sam, who also heard of his fate only on Thursday, said that his relief now doesn’t let the DoH off the hook from planning so poorly and not communicating properly.

Sam was posted to a province that was not among his top three choices. He said he will adapt, but now is trying to make last-minute arrangements for his father to be able to relocate with him.

“My dad lost his job and my mom has passed away. Last year my sister was funding my studies but she is no longer in South Africa because of Covid. I will have to move my dad with me so that I can at least be close to him, but we have to do this all now before the end of the year,” he says. 

Sam is disappointed at the first real taste of working for the state. He said it’s an experience that leaves a bitter taste in his mouth. It discourages interns and community service doctors from committing to stay in public healthcare for longer periods. 

Sam added: “I know so many young doctors who have left the country or just want to leave the public service as soon as they can.”

The time period for community service is continually reviewed and the value of a system that builds in a high turnaround of staff that short-circuits continuity of care remains contested. Young doctors – lowest on the pecking order – often encounter inept management at hospitals, poor leadership and outright bullying.

A South African Medical Journal article published in November 2018 quoted an Econex study that found there are “25 state doctors per 100,000 people in the public sector and 92 doctors per 100,000 in the private sector, which translates to 16% and 60% of the world average ratio (152 doctors per 100,000 population)”.

Junior doctor Kopano said waiting for placement feels like “we have been forgotten and [are] totally alone in this. We don’t know where we stand”.

She said they had to rely on rumours as they’ve in limbo. They also watched their colleagues who received postings celebrating while they remained “graduates without jobs”, beholden to “the algorithm”. Kopano said the mental health burden in the past few weeks had left her feeling “hopeless and tired”. 

Professor Steve Reid, director of the University of Cape Town’s Primary Health Care Directorate, said that it’s become a yearly bungle – “it’s very late to tell professional people about their work situation for next year and they have known the numbers for months”.

There are complexities in the placement systems though, with not enough posts because there is no budget to pay the salaries. 

“There are students trained in Cuba returning to South Africa who swell the numbers. And there are also graduates who play a waiting game, not taking up a post they’ve been allocated, and some who just don’t show up, so they become part of what adds to the numbers in the system.”

Reid acknowledges the personal stories, saying that after 22 years, the community service model is still plagued by glitches and controversy.

Whether community service benefits individual growth and development or not, or helps the public health service is also debatable.

The time period for community service is continually reviewed and the value of a system that builds in a high turnaround of staff that short-circuits continuity of care remains contested. Young doctors – lowest on the pecking order – often encounter inept management at hospitals, poor leadership and outright bullying.

This, coupled with working extremely long hours, often with dire shortages of basic resources to save lives, is unlikely to foster perseverance, resourcefulness, or instil a culture of giving back.

But Reid says community service in an unequal South Africa remains necessary because it redistributes highly skilled human capacity to areas where the need remains most dire. 

“There are many problems in the placement system and I know of cases where students have been in limbo for over two months. But over the years we have also heard of many doctors, who despite the hardships, come away from community service with incredibly positive experiences – even life-changing ones,” said Reid. DM/MC