The lack of permanent employment opportunities in the public healthcare sector for qualified South African doctors remains an ongoing issue.
The South African Medical Association Trade Union (Samatu) said it had documented a “staggering” 450 doctors who had recently completed their community service and were now unemployed.
Dr Cedric Sihlangu, Samatu’s general-secretary, said the numbers were still increasing.
He said over the years, the union had engaged with the National Department of Health (NDoH) to highlight the dire consequences that its lack of strategy in retaining doctors post community service had on the public health system of the country.
“Each year, successive ministers of health have acknowledged the gravity of this situation and the need to develop concrete strategies that would curb this issue from persisting. However, after so many years we have yet to see a plan from the NDoH which addresses this issue.”
Sihlangu said the NDoH invested substantial resources during the two-year internship and one-year community service of the doctors.
He said during that time the department’s aim was to develop the doctors into practitioners that would deliver the necessary yet lacking quality healthcare services, especially to the remote communities.
“It is perplexing that the department, having made such considerable investments, neglects to nurture and retain these invaluable assets within the healthcare system. This oversight not only undermines the department's commitment to developing medical talent but also abandons the very communities that the NDoH is there to serve.”
Meanwhile, unemployed medical professionals continue to demand placement across the country.
Last week, both doctors and dentists in the Eastern Cape demonstrated outside the office of premier demanding placement.
In addition, unemployed doctors from across the country, including KwaZulu-Natal and Gauteng, embarked on pickets demanding placement in the past year.
However, during an interview with Newzroom Afrika last week, the Minister of Health, Dr Aaron Motsoaledi, said while unemployment generally was “not nice”, there were no resources to hire.
“I don't think anybody in the country, inside or outside of the government, enjoys the issue of people not being employed. The concept of unemployed graduates started long ago. It is not only doctors.
“Yes, there is a shortage of doctors in 90% of the world. We know that very well, but to hire them you need resources,” he said.
Dr Motsoaledi said due to serious austerity measures and crippling budget cuts it affected not only their capacity to hire doctors, but also to perform quite a large number of functions.
“We do agree with the grievances of doctors, but in the final analysis you cannot give a job for which you don't have the means to pay such people and that is exactly the situation in which we are.”
Dr Motsoaledi added that it was a statutory obligation of the government to provide placement in regards to internship and community service.
However, he said there was “nothing called absorption”, thereafter.
“The only people who get absorbed are those fresh from university doing an internship, and then fresh from an internship doing community service. After that you are a job seeker.
“Any other job in the state, whether of a doctor, a nurse or teacher, there ought to be a budget and such jobs get advertised. There is nothing called absorption,” he said.
In addition, when asked about the doctor to patient ratio, which is recommended by the World Health Organisation to be 1:1000, Dr Motsoaledi responded: “Unfortunately, I don't have the figures with me. We don't even look at it, because we know we are very, very far from reaching it.
“As far as I know the only country that has completely reached that ratio, even exporting doctors from elsewhere is Cuba. All the others who are at various levels, depend on the strength of their economy.”
But for qualified doctors the stress of not being permanently employed remains ongoing.
A doctor, 32, who requested anonymity, said he had been unemployed since his community service ended last year.
“I started applying in mid-November, but the few posts I had seen advertised were for people with far more experience than me. The daily stress of not having an income is taking its toll on me. There are bills to pay and mouths to feed.
“It is also extremely disheartening, especially to have gained a specific skill set with as much study and discipline as we have, paired with being told it is a scarce resource and our country needs us. But to then realise it is in fact not a personnel problem in our country but actually a mismanagement of funds problem at the top is soul crushing.”
The doctor said opening his own practice was not an option.
“I don't have the capital that is required and my interest lies away from running a business which is what having a private practice really is. Furthermore, my three years of in-service training opened my eyes to the plight that the everyday man in our country faces. There are really sick people who need our help and I don't want to abandon them by even considering looking for opportunities abroad.”
He said one of his concerns was that the incoming National Health Insurance (NHI) bill was going to change the way doctors are employed.
“I suspect that a certain mismanagement of funds will be involved that will make the lives of the people on the ground significantly harder.
“However, while I don't have the insight to the challenges the health department is facing, I really hope for more posts to open up soon, with the chance for young doctors to make a career for themselves.”
A 31-year-old doctor said not having a permanent job took a significant toll on one’s emotional and mental health.
The doctor, who is currently working as a research clinician on a temporary contract, said she had not been able to find permanent employment since completing her community service in December 2023.
“I have submitted applications to almost every province and all relevant departments. Despite applying for hundreds of positions, I have only received a few interview invitations.
“Experiencing unemployment is always challenging. It can feel as though there is an insurmountable barrier in every direction we look. Certainly, everyone has monthly expenses and financial obligations to fulfill, and being without a job complicates the ability to meet these essential needs,” she said.
She added that studying for an extended period without securing employment could evoke a complex mix of emotions and psychological responses.
“It leads to a range of emotions, including persistent frustration, disappointment, anxiety, uncertainty, and a significant decline in self-confidence.”
The doctor said she had not seriously considered starting her own practice.
“I am passionate about serving the community and making a positive impact in the public sector. I truly hope that one day I will have the chance to do so. Time is passing. I am currently spending an entire year without engaging in the field I studied for, nor am I able to chase my dreams and passions. It is essential for me to begin planning for my future.”
She added that she had also considered pursuing studies in a different field.
“I have often considered changing my profession. However, my parents have made numerous sacrifices to help me pursue my dream of becoming a doctor.
“It would also be incredibly disappointing and disheartening to see all my hard work and personal sacrifices go to waste simply because our country lacks the financial resources to employ doctors, despite the existing shortage.”
The doctor said her concern was the impact of the shortage of doctors on those that are currently employed and people who rely on the public healthcare sector.
“There is a severe shortage of medical personnel. As a result, existing doctors face overwhelming workloads, which can lead to burnout and decreased quality of care. It also makes it difficult for doctors to provide comprehensive services.
“Furthermore, the fragmented healthcare system complicates efforts to deliver equitable healthcare across different population groups. My only hope is that the health department proposes solutions that increase employment opportunities and that they invest in developing the health infrastructure.”
The National Department of Health did not comment at the time of publication.