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Newly graduated doctors are in limbo as Department of Health fails in its duty to place them in service


Hloni Bookholane, MBChB MPH is a doctor from South Africa and a graduate of the Johns Hopkins Bloomberg School of Public Health. He is the author of Becoming a Doctor: Learnings and unlearnings about life and the politics of medicine. Follow him on Twitter @HloniBookholane

Five weeks before their supposed start date at work, the medical practitioner allocations for internship and community service for 2022 have not been released.

Doctors are in limbo. Every year, without fail, the South African Department of Health fails to allocate medical graduates and junior doctors to their respective posts as promised.

This is an annual problem; in December 2020, there were 146 intern doctors who had yet to be placed three weeks before their supposed first day of work as newly minted clinicians. The uproar inevitably created a movement on social media to draw attention to this recurring problem with the hashtag #DoctorsInLimbo; still, the government remained silent.

In 2021, nothing has changed. Graduating medical students and junior doctors in South Africa face the perennial problem of a health department that has become inconsiderate and unreliable in their eyes. The National Department of Health, through the Internship and Community Service Programme portal, tries to administer the allocation of medical interns and community service doctors and allied health workers. Every year, this process is predictably frustrating, anxiety-inducing, and demoralising.

The Junior Doctors’ Association of South Africa has deemed this system a failure. What should be a pleasant part of a long and demanding degree, the harbinger to all the celebrations to come, is often what tempers the excitement of the momentous occasion of graduating from medical school.

There is a known shortage of doctors working in the public sector in South Africa. As the burden of disease continues to rise, notwithstanding the Covid-19 pandemic with which we are still faced, South African public hospitals remain understaffed.

Disgraced former Health Minister Zweli Mkhize stated in Parliament in 2019 that “the primary reasons why the Republic [of South Africa] has a shortage of doctors and nurses is the fact that the public health sector budget has not been increasing in real terms for the past 10 years, impacting on the number of staff that can be appointed.” 

As such, there is supposedly no money to employ the much-needed doctors in the public sector. This provides little solace to the medical graduates and junior doctors who must complete mandatory medical internship and community service in the public sector to register with the Health Professions Council of South Africa (HPCSA) as independent practitioners.

If there are satisfactory explanations for this perennial problem beyond provincial budget freezes, whether formal or informal, many medical graduates and junior doctors would like to know. If there are none, then this problem will continue into the foreseeable future and they will face the poor job prospects of doctors who have just completed community service.

Moreover, 2020 was the biggest medical intern allocation programme in history. The number of medical graduates outweighed the number of posts available to employ them. Yet, in the 2021 medical internship application cycle, there were, unsurprisingly, hundreds of medical graduates who went unplaced. This included graduates who were not citizens but permanent residents who have studied at South African medical schools; they are further disadvantaged in this unreliable system simply because placements of South African graduates is prioritised.

In this regard, the South African government added insult to injury when it spent R172-million (approximately $11.5-million) to pay for Cuban doctors, while its own medical graduates and junior doctors remained unemployed because there was apparently no money. It was offensive when it wasn’t absurd, confusing, and devoid of reason and logic. 

At the time of writing, five weeks before their supposed start date at work, the medical practitioner allocations for internship and community service for 2022 have not been released. One can predict that when the posts are released, many will go unplaced into the new year. Medical graduates and junior doctors who are not registered as independent practitioners with the HPCSA cannot work in any capacity as medical professionals in the country.

The national Department of Health and the South African government are both the barrier and the solution to the training of independent medical practitioners in the country. What ought to happen to the medical graduates and junior doctors who go unplaced every year? Whose responsibility is it to ensure that these people are allocated to training facilities to become independent medical practitioners?

The medical schools and their faculty, the internship-accredited facilities, and the doctors who supervise the training of medical graduates and junior doctors at these facilities execute their responsibility with due diligence.

The South African government has one job: to facilitate this training through funding posts for trainees who cannot work anywhere else in this country as doctors. That is, to ensure, pursuant to the rules, regulations, and legislation governing the training of medical practitioners, that these trainees are all allocated to a facility which will provide this training. It cannot be that people go into medical school and get trained only to be told that the jobs the government mandates them to complete are limited to a few (lucky) applicants and graduates.   

The Sisyphus-like path to independent medical licensure in South Africa should not be the way it is. If medical internship and community service are to remain compulsory aspects of medical training in South Africa, the responsibility surely rests squarely on the national government to ensure that there are enough posts, every year, for graduating medical students and junior doctors going into community service.

With ongoing human resource shortages in our public hospitals and misuse of funds for an inexorable global pandemic, faith in the government from current and future doctors is nearly, if not entirely, depleted. There is an urgent need and responsibility for the South African government to address the continual failures of the health system.

Doing so will be the sine qua non to thwart the next crisis which is fast approaching: medical graduates leaving South Africa to train elsewhere, resulting in an even greater shortage of doctors on the front lines. DM




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