Belinda Beresford and David Shapshak
The Department of Health has reassigned the posts of more experienced hospital medical officers to make way for inexperienced interns for its community service programme.
Senior doctors charge that funding cutbacks have meant that rather than creating new posts in areas deprived of medical care, the community service plan for doctors has merely replaced more experienced doctors with graduates fresh out of medical school.
The demands of implementing the community scheme are creating undue strain on South Africa’s medical system, already buckling under staff and medical supply shortages, say doctors and health academics.
Community service was designed to provide assistance in areas that medical personnel shied away from – mainly rural. It was also meant to provide a way for doctors to repay the state-subsidised costs of their training, especially as there has been a steady drain of doctors moving to work overseas.
But doctors say the community service scheme is simply rearranging deckchairs on the Titanic. They claim that rather than going to work in areas with little or no medical help, community service medics are disrupting the training of specialised doctors with no net extra gain for society.
South African Registrars’ Association chair Dr Johnny Taitz said the provinces are “not creating new posts but often replacing like with like. [The] number hasn’t changed, just titles.”
“If you send half the people to cushy jobs that already exist, can you blame the other half who are unhappy about getting the short end of the stick?” said a doctor who applied for a Gauteng posting because of her imminent marriage, but was posted to KwaZulu-Natal.
Lack of money is at the heart of the problem, according to Professor John Pettifor of the University of Witwatersrand medical school.
The provinces have received no extra funding to implement the community service scheme. With health budgets already strained, provincial governments have been unable to create new posts for the influx of doctors.
Instead, they have taken over the medical officer positions and relied on natural attrition to provide some vacancies.
According to the Junior Doctors Association of South Africa (Judasa), last year saw 1 182 medics complete their internship. Of these, 1 126 applied for community service, and 1 040 should now be in their new posts.
Those who do not participate will be unable to practice medicine in South Africa, but, according to Judasa, some are moving overseas to further their medical careers.
The medical officer posts in the teaching hospitals attached to universities have traditionally been used to accommodate doctors who consider specialising.
Generally, an initial six-month period allows the department to assess individuals’ skills, and the position can be extended for up to another 18 months by mutual agreement.
This extra period allows doctors to develop skills in the discipline, and to prepare them for registrar posts where they will be required to provide teaching and guidance to interns and medical officers.
Reserving medical officer posts for community service doctors could see a situation where registrars would be appointed with less experience than the medical officers they would be required to supervise.
Pettifor said when the community service plan was first suggested there had been many vacant places in the public health service.
However budget cutbacks meant medical posts had been frozen or done away with entirely, leaving no spare places for the community service intake. Cuts mean medical officer posts for the paediatrics departments of Chris Hani Baragwanath, Johannesburg and Coronation hospitals have been reduced to 36 from 40. Of these, only three posts could be given to non-community service doctors.
Pettifor says the result would be major problems in filling registrar posts, since there would be few proven candidates with practical experience. Effectively the pool of 36 potential candidates had been reduced to three. For doctors not in the community service scheme, medical officer posts had become “like hens’ teeth”, he says.
A Judasa representative says that “by far the majority of doctors support community service, but [have] problems with how it is being implemented. We have to make it work, but we need funds.”
Dr Stephen Hendricks, the Department of Health’s director of human resource development, failed to respond to written questions and numerous phone calls.