KATHARINE CHILD: An easy fix — hire more doctors

As hospitals around SA battle the coronavirus, and exhausted health-care workers bear the brunt of a surge in cases, there is an obvious, if sidelined, way to manage the crisis: hire more doctors at state hospitals.

These hospitals are perpetually short-staffed. Covid-19 has simply made matters worse: doctors are working brutally long shifts, and treating sick patients on ventilators amid a new round of load-shedding.

The government’s own figures reveal a significant shortage of doctors at state clinics and hospitals. According to health department spokesperson Popo Maja, the state human resources payments system reflects 2,104 vacant posts for "medical officers" — the term for ordinary qualified doctors.

What the system doesn’t reveal is whether the vacancies are due to a lack of funding, or because they are in far-flung rural areas that don’t attract applicants.

Still, for more than a decade doctors have been raising concerns about the funding constraints that prevent sufficient doctors from being hired in government hospitals, says Akhtar Hussain, head of the public sector advocacy team at the SA Medical Association (Sama).

Hussain says his frequent searches of the health department’s website show few vacancies are ever advertised.

As Covid cases rose steadily in late 2020, many worried commentators and politicians took to social media to call for stricter lockdowns. But Sama president Dr Angelique Coetzee argued against such measures.

Instead, she called for "a lifting of the moratorium on hiring medical officers". (Hospitals have been told they may not hire further staff — they need both funding and permission from the government to do so.)

"You can have as many lockdowns as you like," she said in a statement, "but not dealing with this critical core issue will catch up with you."

What is needed, she said, are more doctors and other health-care workers at public health facilities.

Another figure illustrates the problem. Last year, 1,369 graduates completed their community service year and qualified as doctors. To date, just 784 have been employed in government facilities.

Hussain says most junior doctors opt for public service because of the work experience, the ability to work in teams and the access to professors’ guidance. But he says he encounters 300 to 500 newly qualified doctors every year who are struggling to find jobs in state hospitals.

If there’s no money to hire them, some may leave medicine and others may emigrate.

Maja says the "provincial departments and national department of health are working with national and provincial treasuries to identify funding mechanisms".

The department will submit a special budget to the National Treasury for funds for the vaccine rollout, he says. If that is successful, it may have funds to hire the remaining 585 newly qualified doctors.

The Colleges of Medicine of SA (CMSA) is the body responsible for all specialist medical exams and for ensuring the country trains specialist doctors.

Though the body seldom enters public debate, it issued a statement in December after it learnt how many state hospitals were not renewing doctors’ contracts for 2021.

According to the CMSA, Robert Mangaliso Sobukwe Hospital in Kimberley — the only academic hospital in the Northern Cape — planned to fill just 12 of its 34 medical officer posts this year.

Prof Eric Buch, head of the CMSA, tells the FM that some vacant posts have since been filled. But, he says, "the information is variable. There has been some employment, and other posts that were expected to be filled have not [been]."

Problematically, there is no central public database that details which hospitals have vacancies. There’s also no database of unemployed doctors in SA (Sama is currently running a survey to capture this information).

According to the CMSA, SA is short of 2,000 doctors in state hospitals, and 3,000 specialists — figures that Buch obtained from the health department’s "2030 Human Resources for Health Strategy", which was leaked to another media publication.

In its December statement, the CMSA warned that unemployed doctors are seeking work abroad — a loss that causes long-term damage to the health system.

It’s borne out by Buch’s own experience. The CMSA provides medical specialists and doctors who have completed diplomas with the paperwork they require when they emigrate. Anecdotally, Buch believes an increasing number of such doctors are calling the organisation.

It comes at a huge cost to SA. "By not training enough of their own doctors, developed countries bleed countries like SA, getting our excellent doctors for free, most never to return. They save billions of dollars and we lose billions of rands of taxpayer money [that’s been invested in training]," the CMSA said in its statement.

SA "should protect the investment we have made in our medical doctors and other health workers to secure the future of our health system".

The government can do this by hiring and retaining doctors in the public sector. If it doesn’t, "the current and future status of our health system is under threat", the CMSA warned. "This is not the time to jeopardise all this."