doctors
Mungo Soggot
The Department of Health is locked in dispute with South Africas top academic medics over controversial plans to ban public health service doctors from doing private work
The department has tabled its plan with the Public Service Bargaining Chamber and held its latest round of talks with medical profession representatives this week.
Its proposed ban, the latest in a string of dramatic changes to the health system, could trigger a flight of doctors into more lucrative private practice.
Many state doctors have stuck with the public sector until now because they have been able to boost their salaries with private work.
Deans from all South Africas medical faculties, which employ about 80% of all public sector specialists, have banded together to fight the departments plan. One said the move which could force up to a third of some universities medical departments to close could have disastrous consequences.
Tim Wilson, the health departments chief director for hospitals and academic health service complexes, said this week: Our view is that it [limited private practice] should be abolished as soon as possible. He added that the central bargaining chamber will discuss how quickly the ban should be phased in.
The previous government began allowing state doctors to have a limited private practice in 1992, but since then there have been widespread allegations of abuse of the system, with some doctors neglecting their public health jobs.
Wilson says it is very difficult to monitor how doctors allocate their time, confirming that there is widespread anecdotal evidence that the system has been abused.
He said the department is concerned about fears that some hospital departments will suffer severely from the ban. However, he says it is inappropriate that doctors should operate private practices from the shelter of full-time state salaries.
The dean of the Wits University medical faculty, Professor Max Price, said that at this weeks meeting with the department, doctors insisted that the dispute go to mediation.
Price said they were offering alternative solutions to simply shutting down the system. He said the deans agreed the system was being abused but suggested the department investigate how to monitor it and clamp down on abuse before burying it.
He said the department had, for example, never given medical faculties the legal tools to audit doctors practices. He and the other deans also suggested that the department allow universities to operate internal private practices offering private patients a service from the university hospital. These kinds of operations are already being run at the universities of Cape Town and Orange Free State.
Price said a Wits University survey showed that about 30% of its specialists would resign if the ban was imposed, warning that these resignations would came from a few select fields where there was a particularly large gap between private and public sector pay.
He said the orthopaedic, urology, plastic surgery and radiology departments at Wits could all collapse as up to 90% of specialists in those departments would probably move to the private sector.