Are doctors resisting change?

In the dying days of apartheid, FW de Klerk called his health minister, Rina Venter, and proposed the abolition of apartheid in state hospitals.

During her subsequent investigations, Venter made a startling discovery: no laws specifically segregated hospitals. Doctors and hospital administrators had voluntarily enforced apartheid.

It was through this prism that I watched the column of white-coated doctors winding their way through Cape Town last Friday, protesting against what they perceived as an attack on their right to earn a living.

That is not to diminish their gripes — but to gain perspective on why they are not heard as sympathetically by the present authorities as they would like.

Many of the changes currently being proposed to the health-care system were mooted in draft legislation and debated in the press since the 1994 elections. They are not revolutionary. Many have been tried in different countries — or even in South Africa at different times.

Successive governments have tried, without success, to stop doctors emigrating, and this government is also likely to fail. In the bad old days conscription was a pretext; nowadays the dreaded “certificate of need” will provide an excuse. Doctors are a mobile group.

The certificate seeks to redress the unequal distribution of private doctors by limiting doctors’ ability to open a practice in an area that is already well supplied. South African Medical Association president Kgosi Letlape has remarked that the move will redistribute doctors to London — and he is probably right.

Doctors that leave citing this law as the reason will be joined by others who have made a very good living out of dispensing medicines and will see their livelihoods diminished by legislation aimed at curtailing this.

They will find the same restriction in many parts of the world, which share our government’s belief that the practice is not good for patients’ health.

Yet others will cite medical schemes legislation and the difficulties in working with myriad medical schemes with different benefit options. They too will have some justification.

However, there is a quid pro quo. If doctors want to be paid directly by schemes, and forgo the hassle of collecting payments from cash-strapped patients, they must accept the limitations of that system.

That is aside from state-employed doctors who suffer long hours, difficult working conditions and lousy salaries. They will probably find it a bit greener on the other side of the hill — for a while, anyway.

The emergence of a social health insurance system will complicate many professional lives, and try a great deal of collective patience.

The changes form part of the profound transformation South Africa is going through. But few would deny, as they could justifiably in the 1950s and 1960s, that the changes are a “good thing”.

Doctors do have a case — in some areas better than in others — and the democratic right to express it in public protests.

Letlape suffered more than most under the old system and is the right person to be leading the protest. As a black ophthalmologist, he was forced to study abroad.

However, we at the Council for Medical Schemes have noted that every change in the health sector has been resisted by interest groups, of which doctors are just one. They are a conservative bunch, not noted for marching against apartheid in hospitals and mounting Aids deaths without adequate treatment, or for better medical aid benefits for their patients.

Although the T-shirts last Friday bore the slogan “Patient care first”, the problems cited by doctors largely relate to their personal finances.

Doctors should be listened to, but it is hard for onlookers to separate the concern doctors feel for patients from self-interest and resistance to change.

Pat Sidley is the head of communications and education at the Council for Medical Schemes

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