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The national government has blamed an influx of medical graduates for the delay in placement of intern and community service doctors.
Each year, junior doctors are left in limbo waiting for placement due to the shortage of funded posts at government health facilities.
“We are tired of tiptoeing around this issue. It is time for things to be said as they are. The Internship and Community Service Programme (ICSP) and national department of health are failing and we demand change.”
These are the sentiments of Dr Tshepile Tlali, chairperson of the Junior Doctors Association of SA (Judasa).
His comments come as junior doctors wait to secure their internship and community service placements at public healthcare facilities across the country from 1 January next year.
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The challenge has been exacerbated over the years.
The numbers
Health department spokesperson Foster Mohale told City Press that 2 504 medical interns and 5 857 allied health community service personnel, including nurses, dentists and pharmacists, have been placed for the 2022 annual cycle.
The department is set to finalise the allocation of medical community service posts on or before Friday, Mohale added. The chairperson of SA Medical Association (Sama), Dr Vusumuzi Nhlapho estimated the number of medical graduates awaiting placement to approximately be around 1 024.
Demands for transparency
Medical practitioners’ associations are demanding transparency from government about the lack of funded posts.
According to Tlali, the lack of funded posts has led to continuous late placement of applicants and many unplaced doctors.
Internship and community service work are prerequisites for qualifying as a doctor in South Africa, a country facing a critical shortage of doctors.
Mohale attributed the issue of the unfunded posts to inadequate budget and an influx of medical graduates.
“The department acknowledges that, since 2018, there has been an influx of South African citizens and permanent residents qualifying from local universities, the Nelson Mandela Fidel Castro Cuban programme and international self-funded students who are required to perform medical internship as a statutory obligation prior to them registering as medical doctors in South Africa,” said Mohale.
These additional numbers have caused a strain on the current fiscus, said Mohale. The delays, in some instances, stem from administrative processes.
While junior doctors and medical associations have called government out for its failure to be transparent about the lack of funded posts, Mohale denied the claims. Mohale said:
Poor management of state funds
Nhlapho slammed government for its “poor management of funds by the state as well as poor planning”, which he believes to be the root cause of this problem.
“A lack of transparency is also a major contributing factor. The state ought to get its priorities right,” he said.
A shortage of funded posts has a direct impact on the standard of healthcare that poor South Africans receive at state facilities.
“By not capitalising on sufficient human capital, government already compromises the very right protected by our Constitution.”
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Sama has, for years, been in communication with government about the perennial challenge of unplaced junior doctors, with no resolution in sight.
“If government was accommodative towards the medical profession, this issue would have been long resolved,” Nhlapho said, adding that the devastating impact is felt by doctors and patients. “Doctors are expected to carry the workload, thus have to work excessive hours. This cannot be fair on them or the patient. This undoubtedly has a negative effect on their physical and mental health.
“The state is failing our doctors.”
Junior doctor in limbo
A doctor who is doing her community service south of Gauteng spoke to City Press on condition of anonymity for fear of reprisals.
She spent months waiting for placement before moving to Gauteng from the Western Cape.
“You submit all your documents before the time, but there is no transparency about how the spots are allocated, how they make their decisions and the weighting of special considerations to either stay in a specific province or move to another in terms of bursaries,” she said.
The doctor revealed that she had spent countless hours trying to get in touch with an ICSP official to answer questions about placement, to no avail.
She said that junior doctors are called at the eleventh hour, leaving them with very little time to prepare for their placements.
“Because the placement comes late, a lot of people do not have time to prepare, find an apartment and move their families. Moving a lot of people during the festive season is expensive because we are expected to [start] work on the 1st or 2nd of January. Either people get reallocated or will appeal or apply for mid-cycle.”
Junior doctor Facebook groups are flooded with complaints by those awaiting placement.
Doctor-patient ratio
World Health Organisation (WHO) statistics reveal that South Africa has eight doctors for every 10 000 people.
Africa suffers more than 22% of the global burden of disease but has access to only 3% of health workers, and less than 1% of the world’s financial resources, WHO data showed.
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