Rugby dad John Robbie rarely says anything I want to write home about on his morning shows, which I listen to religiously. But last week he hit a home run when he said: ”Firing doctors in KwaZulu-Natal is like firing soldiers in the middle of a war.” This was in reference to the government’s dismissal of 400 doctors who were on strike, demanding a 50% increase in their salaries.
In my opinion, great harm has been done to the public health system because of the way the government handled the doctors’ occupation-specific dispensation (OSD) issue. Many doctors, literally working around the clock in state hospitals and who were committed to spending their lives serving the public, now feel betrayed and undermined. After what has happened, many of them will probably leave the public sector and join the private sector, where their skills and time are better valued. Junior doctors who are still new in the field will probably not stay after their internship and will go overseas to continue their careers.
State hospitals are bursting at the seams: too many patients, not enough doctors, not enough medication and not enough equipment. These hospitals are running out of antiretroviral treatment, while HIV/Aids continues to be a dominant killer. This crumbling system is painfully held together by these over-worked and under-paid individuals.
The government was the first to point out the problems in the public health sector, and it promised to ”deal with it”. It committed itself to implementing OSD to address the problems — nurses were first in line to receive OSD and doctors were encouraged to research what their appropriate remuneration should be, and they would be next.
The doctors have done this research, and they want better working conditions, clear career paths, vacant posts to be filled and a 50% increase across the board.
Independent research commissioned by the South African Medical Association (Sama) and undertaken by PE Corporate (a consultancy with specific expertise in salary issues) found that doctors are uniformly underpaid by 50% to 75% when compared with other professionals within the public sector. Currently, state doctors earn a basic salary of between R9 791 and R19 048 a month, depending on their qualifications and experience.
After waiting nearly a year, public-sector doctors recently embarked on an illegal strike demanding that the government implements the promised OSD.
In May, doctors were outraged when the government offered them between 0,28% and 2% in the occupation-specific negotiations dispensation forum. Angry medical practitioners staged daily lunch-hour pickets outside hospitals across the country.
In June, the government stalled and avoided putting an offer on the table until doctors went on another strike. Under pressure, the government tabled what looked like a good offer, but after careful scrutiny doctors rejected the offer, saying it was not what they asked for.
The government then played around with more numbers and quickly tabled another offer.
Another analysis of the government’s new offer by independent analysts PE Corporate, commissioned by Sama, revealed that most doctors would receive less than a 26% increase if the government’s latest offer was accepted. Some would receive increases as low as 1% and 2%.
Interns (the most underpaid and over worked) would get up to a 40% increase; medical officers were offered an increase of between 8% and 25% over two years; senior medical officers would receive a 2% increase in the first year and a 13% increase in the second year; principal medical officers would receive a 4% increase in the first year and a 15% increase the following year; a senior registrar would receive a 22% increase; an assistant manager would receive a 2% increase while a manager would receive a 1% increase; and senior managers and general managers would receive a 1% increase.
Doctors say they are frustrated because they cannot make a living from the money they are paid by government.
They work 26- to 32-hour shifts in the trauma and medicine units. Without breaks.
Internationally, a shift of up to 13 hours is acceptable. After that, studies have found, cognitive functioning goes down to that of a blood-alcohol level of 0,1%. (The legal South African blood-alcohol level for driving is 0,05%). At this level, you’re not even supposed to be on the roads. Imagine being responsible for the lives of patients.
The government’s refusal to fix state hospitals, fill all vacant posts and pay doctors what they are worth is putting the lives of South Africans in the hands of disgruntled, fatigued doctors.