Doctors in South Africa are caught in isolated collectives serving narrow interests and in a poorly regulated, dysfunctional health-care environment, says Ken Boffard, who retired this month as president of the South African Medical Association (Sama).
Sama, the largest doctor collective, is also in conflict with its Western Cape branch — a dispute that remains unresolved.
Sama’s national membership, meanwhile, dropped from 18,000 in 2013 to just over 12,000 this year — out of an estimated 35,000 registered doctors and specialists. Private doctor membership stood at 6,000 in 2013 and is now 4,000. Those in the state sector were 5,500 in 2013 and now are 2,500.
Other groups are divided among the South African Medical Association Trade Union with about 8,000 members and the Private Practitioners Forum (3,000 specialists plus 3,500 others, including GPs and health-care practitioners). The Academy of Family Practitioners has 525 members.
Boffard, whose term ended on March 7, wonders if the profession can survive. “We’re not singing from the same hymn sheet,” he says and warns that National Health Insurance (NHI) is coming “whether we like it or not”.
He says the profession faces slashed budgets, a paucity of posts, a lack of equipment and proper supervision, huge work pressure, burnout, poor regulation, endemic corruption, emigrating doctors and terrible management in the public sector. “We’re losing half of our newly trained annual doctors to aggressive overseas recruiters. That’s besides our more seasoned doctors who are highly sought after.”
A former Sama board member, speaking anonymously, says: “We’re looking at a battle for the soul of Sama. It no longer represents the interests of its members and is a law unto itself. I find myself wondering whether their behaviour is not that of ANC acolytes, despite their stated resistance to the NHI Bill as it stands.”
Sama, which has fewer than the required 50,000 members, has for decades been unable to get recognition as a stand-alone member of the Bargaining Council. The Democratic Nursing Organisation of South Africa represents it. As a result, state doctors’ salaries have been increased only at the top and bottom ends of the scale.
On the worsening doctor-to-patient ratios, Boffard cites 2012 figures from the Health Professions Council of South Africa. These show 1,000 doctors leaving that year. Annual graduation from all nine medical campuses is 2,200, before community service.
Mark Human, an orthopaedic surgeon and vice-chair of Sama’s health policy, law & ethics committee, says: “We should have 80,000 to 100,000 doctors by now, [based on accumulated annual graduation from medical campuses]. Instead, we have between 30,000 and 35,000.”
The ratio of state doctors to citizens is 0.3 to 1,000, against 1.75 to 1,000 in the private sector.
Boffard cites “push factors” — hijackings, working conditions and/or lack of posts and the “criminalisation” of doctors. Pending and settled medical negligence suits against the state public health sector total R92bn (under audit). His “pull factors” include family already overseas and recruitment by countries including Australia, Canada and the Netherlands.
Canada, he says, is targeting local doctors about to complete their community service, granting them automatic registration. Australia aims at specialists, plus GPs for its remote areas, granting specialists senior registrar salaries until they pass the Fellowship of the Royal Australasian College of Surgeons exam, after which their salaries are on par with locals. “It’ll take you three years to get that — and your Australian passport. Why would you want to come back?” says Boffard.
He says the annual figures for recruitment of doctors are: Canada (350), Australia (300), US (150) and about 100 by the rest of the world.
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