With vacancy rates for public sector doctors ranging between 5% and 22%, South Africa can simply not afford to have unemployed doctors. (Canva) 
When Theresa Brummer finished up her medical degree at Stellenbosch University, she had a clear vision for her future: to work in the public healthcare system in the Eastern Cape, where she was raised.
Brummer spent a year at Madzikane Ka Zulu Memorial Hospital in Mount Frere doing her government-required community service in a public hospital — in addition to two years of medical internship at state health facilities — before she was able to practise medicine in South Africa.
But today, instead of healing patients, Brummer sits at home in Gqeberha scanning job listings.
She is just one of between 1,500 and 1,800 unemployed post-community service doctors who can’t find public sector jobs.
On Wednesday, Finance Minister Enoch Godongwana budgeted to employ 800 doctors like Brummer; the remaining 1,000 unemployed doctors can’t be helped.
The irony cuts deep: we desperately need public sector doctors. In 2024, the health ministry reported that public health sector vacancy rates ranged from 5.48% in the Western Cape up to 22.4% in the Free State.
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Overall, the health budget will grow from R277-billion in 2024/25 to R329-billion in 2027/28.
An additional R28.9-billion will go towards employing 800 post-community service doctors without jobs, as well as 9,300 healthcare workers.
“In the last year alone, our public sector health system lost close to 9,000 health workers,” Godongwana said. “We did not have the money to retain or replace them even after reprioritising funds budgeted for consumables and medicines.”
No provision in the budget was made to employ about 7,500 health workers working for nonprofits funded by the United States Agency for International Aid, USAid, who lost their jobs after the Trump administration cut their funding.
In the end, Godongwana said, South Africa’s high debt-service costs, which will come to R389.6-million in the 2024/5 financial year, prevent it from spending more on health.
“This (debt) translates to 22 cents of every rand we raise in revenue. It is more than we spend on health, the police and basic education.”
Godongwana said accruals — unpaid invoices in the public health sector from the previous financial year — also ballooned to nearly R22-billion.
“This means that the money allocated to departments ends up paying for previous services and goods rather than for the current needs, setting off a vicious cycle of budget shortfalls, unpaid invoices, and a crisis in cash flow and the planning and predictability of budgets,” Godongwana said.
“This is an untenable situation that we could not leave unresolved.”
Going overtime
But the health department also says part of why it can’t afford to fill all doctor positions in the state sector is because doctors’ salaries are too high — and that cutting the overtime of those already employed would open up budgets to employ others.
The department’s Percy Mahlathi, who oversees hospital services and human resources,
