OUT-OF-WORK DOCTORS
Joe Phaahla: Budget constraints to blame for unemployed medical graduates
Following a public outcry over the high number of unemployed doctors in the country, Health Minister Dr Joe Phaahla said the department did not have the money to employ them, but that more posts would soon become available.
‘As government, we would really wish for a situation where all graduates who have completed all these statutory requirements of internships and community service can get immediate employment in the public health sector, but of course, they do face a number of challenges in that regard,” said Health Minister Dr Joe Phaahla.
Phaahla was speaking on Monday at a media briefing to address issues related to the employment of medical doctors and other health professionals in the country. This comes after unhappiness over doctors who have completed the statutory community service programme but remain unemployed.
Read more in Daily Maverick: I’m an unemployed doctor, like many medical peers, despite SA’s health skills shortage
Training and deployment
Medical school graduates must complete two years of internship training at designated health facilities accredited by the Health Professions Council of South Africa (HPCSA). After this, they have to do a year of community service in a facility designated by the National Department of Health in consultation with provincial health departments.
“The hospitals which are designed for community service are slightly different from the internship because the internship is regarded as practical skills training and that’s why it is designed by HPCSA… the purpose of introducing community service was to improve clinical skills and also provide services in the underserved areas,” said Phaahla.
Teaching hospitals and central hospitals are eligible to train interns but cannot be used for community service as they are not considered to be under-serviced.
“For community service, it will be rural hospitals, township hospitals and other marginalised areas,” he said.
Once a doctor has finished community service, they are registered with the HPCSA in the Medical Officer Independent Practice category, meaning they can work independently without supervision, including as a single private practitioner.
Phaahla clarified that the issue of funded posts did not affect the training of medical doctors. He said all graduates who were eligible for an internship had been placed as well as those who had finished their internships and were eligible for community service.
“I want to say unequivocally in terms of internships and community service – which we regard as a statutory obligation by the state – we don’t have graduates fresh from medical school who are stranded in terms of getting internships. Those posts are funded and everybody eligible has been allocated,” he said.
This is possible due to the human resources training and development grant.
“We do allocate to provinces. That amount is protected, it is ring-fenced, and provinces also do add because this category of doctors also provide very valuable services at the facilities where they are working,” said Phaahla.
The current issue
Unlike internships and community service, which are statutory requirements and subject to placement by the department of health, medical officers can make individual choices to either specialise, enter private practice or stay in the public service.
“Because it is not organised in the same way as the statutory obligation, we don’t have the data – once people exit community service they are free,” said Phaahla.
The department relies on information and numbers collated by medical associations and unions such as the South African Medical Association Trade Union (Samatu) and the South African Medical Association.
At the beginning of January 2024, Samatu submitted a list of 825 medical doctors who were deemed to be unemployed. The department checked the list against the public service payroll system and it was found that out of the 825 doctors on the list, 694 had only just completed their community service on 31 December 2023.
Most have applied for medical officer posts in the various provinces, while some doctors on the list still need to complete their community service obligations, said Phaahla.
“We have to check with provinces where there are available posts and provinces have to advertise the posts… we then work with them to identify where there are vacancies and we share that information with organisations and unions representing doctors,” said Phaahla.
Provinces face significant challenges due to budget constraints.
“There is a lot of pressure on the budgets… another challenge came with the 7.5% salary adjustment agreement at the Public Service Bargaining Council,” he said.
Read more in Daily Maverick: Health minister warns of negative impact of ‘cost containment’ on quality of healthcare services
Up to 65% of annual health budgets in some instances is spent on health worker salaries. Provincial health departments also pay doctors for overtime work and offer rural allowances for doctors working in these areas.
“The risk in terms of this is that it crowds everything, in terms of medicines, linen, clinical equipment like x-rays, ultrasounds… everything you need to run the services becomes quite crowded,” said Phaahla.
More trainee doctors
Phaahla said the number of doctors being trained had increased.
“There has been a continuous improvement in the qualification of doctors and their employment in the public service,” he said.
In January 2018, there were 1,472 medical interns and at the beginning of 2023, there were 2,365. There are 2,210 medical interns for 2024.
“You can see the level of growth – these increases over these years have happened despite the funding constraints,” he said.
Phaahla said there were 1,340 doctors completing community service in 2020, and in 2024 there were 2,101.
“You can see from that, just over 700 increase in the cohort of new doctors who have come into the service as either interns or community service,” he said.
“We would have wished that even as they complete their training, it would be good if they were spoilt for choice, but the pressure on the fiscus is there, which makes it difficult.”
Phaahla said that medical negligence claims also contributed to budget constraints.
“We are doing everything possible to reduce the medico-legal claims. Last year, one province paid R900-million in medico-legal claims. If we reduced that, it would free a lot of the money,” he said.
Provinces placing doctors
Phaahla said they were working with provincial health departments who were also engaging their provincial treasuries to find ways of addressing the unemployment of health professionals, including medical doctors.
All the provinces have identified posts that have already been advertised or indicated which posts will be advertised in the coming months.
“As we speak, across provinces we have been able to find 239 posts which are there for the uptake. Gauteng, Eastern Cape, Free State and Mpumalanga have quite a number of those,” said Phaahla.
In the next six months, 375 posts will be advertised.
Limpopo has been unable to release posts as there is an ongoing court case between the Limpopo Department of Health and the South African Medical Association Trade Union.
“Limpopo tried to fit some more opportunities by reorganising the overtime component to structure it so that it can spread the money out to more people so they can have more people employed, but then the trade union is challenging that,” said Phaahla.
“When they [Limpopo Department of Health] wanted to advertise, their provincial treasury advised them not to advertise because the matter is still in court.”
Phaahla said they would like the process to be seamless so that once an individual had completed their internship and community service, they would be free to look for any available opportunities.
“It is multi-pronged. We are working with provinces and identifying vacancies so that we can advise those who approach us about where they can apply,” he said.
Cholera cases
The country has recorded 46 suspected cholera cases and five laboratory-confirmed cases between 1 January and 1 February 2024. These included two cases in Limpopo and one in Gauteng. All cases had recently travelled to Zimbabwe.
“Last week, Limpopo identified two [infected] siblings in the Blouberg local municipality. There are other people presenting symptoms so we are working with the province to identify and trace contacts in the family and the surrounding areas so that we can find the source,” he said.
Phaahla said there was no need for panic as the country was not experiencing a widespread outbreak. However, the department called for people to maintain proper personal hygiene, and especially children at home and in schools. DM
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Medical negligence claims volumes are directly linked to level of health service failure.
High claims = high levels of service failure.
The ANC is failing our people.
Again.
A rotten incompetent ANC government that cannot even find placements for desperately needed doctors and community service interns. The same rotten ANC thinks it can implement NHI – all on can expect from the ANC is even more stealing and zero service delivery. ANC instant billionaires eating their country and people one stinky burp at a time.
Want to see the first sign that the wheels have come off?
8 hour wait to see a doctor sitting on a broken hip with a qualified doctor sitting on her thumbs at home.
My BIL has to wait 6 months to get a specialist appointment, friend at work, her husband had been waiting to be placed for specialisation, he is now leaving ZA. No hope for a future here, especially being the wrong shade of african.
Budget constraints nonsense its all the criminality and theft going on in this dept as well as ridiculously high salaries for the unqualified. Cut that all out and arrest thieves and those inflating tenders and there will be millions left to employ medical professionals. Always pathetic excuses from anc.
It is not the budget, its the ANC & corruption.
There is 1 doctor tp 4000 patients. We are unable to pay doctors now, imagine what the situation will be when NHI is implemented, the ratio will be ridiculous
Budget constraints for doctors, but all the money desired for Nkandla fire pools and other parliamentarian home upgrades, no constraints for VIP protection units, and apparently no constraints on the profits allowed to any supplier who will pass backhanders to the ANC or ANC supporters. The priority of the ANC is clearly not the health of South Africa’s people (or their education, or safety, or water)
Agree Geoff – the ANC must go – their incompetence has been proven. They are a danger to the South African society!
The reality may be even worse.
Budget constraints due to fraud and corruption? No mention of that. No mention of the unskilled people in management who are not capable of managing a budget. R1 200 000 per annum for a doctor doing Community Service. Community Service means serving the country and your fellow human beings. Cut that salary in half to R600 000 per annum, they will still have a good life for that short period of time and then you can employ double the amount of doctors doing their Community Service.
That’s a good point.
R1.2M per comm serv doctor seems a lot. But are you aware of the inhuman hours we work? 90+ hours per week, every week. 20,000+ steps per call? We are not even paid for all the overtime they work, because the overtime hours are capped. Yet a doctor is expected to perform like a robot – never get tired, never get hungry, never need the loo, never het sick. We are overworked, and many of us would prefer smaller salaries for less work hours per week and more sleep.
The economy is in low gear due to the government’s policies and failures (Eskom, Transnet, corruption and crime being the main culprits); low economic growth = low tax revenue = small budgets. Kapish?
And you would wonder how on planet earth they would want to implement the NHI? Viva ANC
The first step here is to calculate the number of doctors per population,budget for that,and deploy human resources when they are ready to work.
I also wonder how the number of policemen,teachers,nurses ,Sassa clerks etc etc needed is being calculated,budgeted for and deployed.
Oh,I forgot,they haven’t made an allowance for the health economist in the first place.
Mr Kuhn obviously does not know anything about community service with comments like cut their income and “they will still have a good life”. A member of my family is doing community service in an area miles from anywhere. She has to drive 45kms each day to and from what can hardly be described as a hospital. The road has signposts all over about how dangerous the area is. The workplace has no oxygen, and no x-ray machines and very little medicine. She is treated like a two year old by the hospital manager who expects her to work overtime and rest up on a trolley in the passage. These community doctors work under the most appalling conditions where HIV is rife. They have put in 8 years of really hard work to qualify. They deserve our respect and most certainly their pay.
Might it not be an excellent idea to send all the cuban doctors (who are costing a lot) back to Cuba … and then maybe we could afford to pay our own South African trained doctors – who also speak local languages and so communicate better with their patients?
Cuba’s health and education systems are collapsing. After decades of treating their citizens as prisoners they finally allowed Cubans to travel abroad, only to find a mass exodus of doctors and teachers. The Cuban medics in SA are essentially slave labour, not allowed to bring their families with them and paid a small fraction if what the SA taxpayers fork out.
The Minister is avoiding the issues somewhat. You still need to be able to fundnewposts.
How is it possible to have “unemployed” graduates. Something horrendously wrong with the education system, perhaps its tome to push for more “basic” skills like technical studies ,mechanics,plumbers,builders all the careers that ACTUALLY make the country GROW.
I’m with you on that – we desperately need tradesmen & artisans – which with the current level of education more easily attainable than all the unemployable graduates …….
The ANC manage to find millions to send a massive delegation taking Israel to the world court, but cannot find the money to pay doctors that we desperately need for the SA population – what a disgrace !
Here’s an idea, clean up the overly fat, cumbersome, hugely inept and obese Cabinet by doing away with a few of those portly politician’s who don’t do any work and use that money to pay the newly qualified doctors instead.
Who’s meant to treat people in the NHI if we can’t employ doctors?
Witchdoctors?
The sangomas prefer to be treated by medical doctors, as our “muti” is stronger. They have a great belief in an IV drip. They don’t take their own medicine.
Ha ha 🙂
The budget constraints are as a result of decades of ANC incompetence. These are the symptom, the real cause of all these problems is the ANC. Nothing more, nothing less. Put the blame where it’s due, this is your fault, man up and own it, it’s yours and your fellow cadres in crime.
Just cut all the over paid ANC politicians salary’s by half(they steal & loot enough) & there VIP protection budget! Then Boom, there’s enough money to get our country almost back on track!!! Plus if you cut the huge salary’s of the unskilled friend’s & family that have been employed in government!
Send all those doctors to the UK where there is a dire shortage of medics.
A clear case of charity not begining at home. The money that was sent to Cuba purpotedly for the doctors they sent over here could have been far better spent on hiring our own doctors. In fact it’s an abomination.
A clear case of charity not begining at home. The money that was sent to Cuba purportedly for the doctors they sent over here could have been far better spent on hiring our own doctors. In fact it’s an abomination.
The Minister of Health has admitted that the government has no funds for medical officer posts to accommodate all of those doctors who have completed community service and wish to continue in the public service. I am aware of this lack of funded medical officer posts for at least 10 years. Do they still have funds for new students to study medicine in Cuba?
Our Minister of Health blames budget constraints for the lack of doctor placements. Frankly, I’m skeptical. The justification for budget constraints rings hollow in the face of a corrupt government. There are numerous instances of money being squandered and lining the pockets of ministers, which could be reallocated to essential services. Our country grapples with severe staff shortages, directly impacting healthcare delivery and, consequently, public health. This, in turn, hampers economic growth as the populace’s health deteriorates. Surely, the government understands this. Unfortunately, the focus seems to be solely on doctors. Many other professionals face job placement challenges—I see Clinical Associates pleading for work on LinkedIn, and physiotherapy friends struggling to secure positions. This exacerbates South Africa’s brain drain, forcing educated individuals to emigrate due to the scarcity of jobs. Moreover, it worsens economic strains and condemns the already vulnerable public to deteriorating health. It ultimately boils down to misallocated funds.
This is not a true reflection of the numbers of doctors without posts. If you count the number of newly qualified South African doctors working in Ireland and the UK – many because they are unable to find posts locally, not because they want to leave – this number will multiply! The other place we find these newly qualified doctors is in the emergency rooms of private hospitals. What sort of “policy makers” insist that universities radically increase their intake of medical students 10 years ago and doesn’t make provision for their entry into the workforce when they are qualified?
We are losing our brightest young doctors and the rest of the world is welcoming them…
Cut you and your cronies massive salaries and stop liberating funds then maybe just maybe there will be enough money. But then again we are more likely to see a pig jump over the moon.
Budget constraints!?! Please! Just acknowledge the fact that anc cadre deployment and corruption is so expensive that there is no money left to do real health work. IDIOT!