Doctors in Gauteng’s public hospitals work up to 100 hours a week for pitifully low salaries. Pat Sidley
IT’S 7am. The early shift at the hospital has begun. But the fresh doctors are working alongside others who have already been at work for 12 hours — and may have to continue for another 24.
Many doctors work between 60 and 100 hours a week — including shifts of 36 hours without a proper sleep break. For this, a registrar (who is specialising) takes home about R4 300, an amount which includes the 16 hours overtime that his employer (the government) recognises. Interns take home R2 500 and senior doctors a mere R4 500.
Many of the patients treated in Gauteng’s public hospitals come from outside the province. A notice in the outpatients department at JG Strijdom Hospital tells patients that they won’t be attended to if they have not been to their nearest clinic first or if they come from outside the area served by the hospital. They are also warned that if they haven’t booked an appointment they may have to queue overnight. The futility of this can be seen in the length of the
One doctor, sometimes two, will see 300 of these patients a day in a screening process to define their problems and sort them for further treatment.
The principal medical officer dealing with the queue at JG Strydom Hospital also has to do shifts in casualty, attending to heart attacks, stabbings and gun-shot wounds. At the end of the month, she will take home R4 500. Her son is to become a doctor soon. She has advised him to leave the country.
“It’s no life,” she says. “You get up at night to get here, and then you get home in the morning only to find you have to get up again to get here. You’re so tired, you can’t think.” She doesn’t believe there is any hope for a change in conditions. Aside from the lack of money, she says the patients won’t stop bypassing local clinics and hospitals. That kind of change will take at least 20 years.
Why does she do it? “I’m a clinician, but I like some academic work. I like working with people and I like to stay up to date.”
Doctors who used to do part-time work at the hospital have left in droves, placing greater stress on full- time staff. Gauteng’s health administration reworked the way they were being taxed, so their R19 an hour has been slashed. This forced South Rand Hospital to close casualty wards at night.
Ian Sanne and Ramon Bonegio are registrars at Johannesburg Hospital’s oncology department. Last week, each worked 100 hours. They will be paid for 40 hours as a basic salary and then get up to 16 hours of overtime pay at a flat rate that of about R23 an hour.
Registrars earn between R4 000 and R5 333 a month before tax. When overtime is added, it too is taxed. This would make an average figure for a registrar with 16 hours of overtime (but who may have worked 60 hours of overtime) little more than R4 264.
Recently the government agreed to pay for another 10 hours of overtime, but they did not send any further funds. As a result, Sanne, Bonegio and their colleagues only occassionally get the extra overtime.
At JG Strijdom’s casualty department, the two doctors on duty worry that, with the immense pressure they are under, they may not always do their jobs properly and may place patients’ lives at risk in the 30th hour on shift in a demanding day.
“It’s a dangerous situation for litigation, and a fear that we have to live with,” one said.
One doctor is from Romania. She is one of the few doctors who will accept the pittance paid and the tough working conditions — and she has done this for 10 years. But her qualifications, which are deemed good enough to treat public hospital patients, are not deemed adequate for private practice. She has to live on what she gets, and believes that no matter how well she does her job, or how many examinations she successfully writes, her limited registration status will stay the same. She’s defensive about the jingoism that has filtered into the debate. “There are good doctors and bad doctors from anywhere. The debate should not be about nationality,” she says. So she, along with all the other foreign doctors in the public health system, keep it going as more and more South African doctors flee the rigours of public service for the greener and more rational pastures of private practice or emigration.