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Hopeless. Dejected. Anxious.
This is how many community service doctors are feeling about their job prospects for 2021.
They’ve carried the burden of the Covid-19 pandemic, sweating on the frontlines to save lives – some even contracting the virus while on duty.
But come 2021, many will be without work.
Junior doctors in South Africa are battling to find placement at public and private hospitals across the country as their mandatory one-year community service nears completion.
Community service doctors go on to apply for Grade 1 Medical Officer (MO) posts.
However, Covid-19 has left a gaping hole in the system due to a massive lack of funding – creating a worrying jobs shortage and potential mass exodus of junior doctors from South Africa’s already under-resourced public healthcare system.
With Covid-19 sucking dry hospitals’ funding, it means less money for jobs in 2021, at least until the new financial year.
But even so – it does not look promising.
Fret with worry over securing a job for 2021, the 2000 community service doctors are scrambling for the few jobs that are being advertised.
Doctors have their say
POWER Digital has surveyed several junior doctors across the country.
Of those who participated, none have secured work for 2021.
A young doctor working at a district hospital in the Western Cape says she’s doubtful that she will have a job for at least the first six months of 2021.
“As I am still paying off student loans, I will have to start using my savings and hope I get work soon,” she reveals.
This is the painful reality for many community service doctors.
Several hospitals have also resorted to postponing interviews for already advertised posts as the reality of an empty purse kicks in.
Going against medical officers with more years’ experience, community service doctors’ chances of securing work are further reduced.
Over two thirds of participants had not even been offered a job interview.
Over 62% of the survey participants who have been interviewed for MO posts for next year, all say they’ve either received not a single response to their job interview or they’ve been issued with rejection letters explaining that it’s due to a lack of funding.
One doctor says they’ve received no responses from more than 20 job applications.
Over 62% of survey participants have indicated that they know of not a single community service doctor who has secured a job for next year.
Another doctor working at one of the largest regional hospitals in Gauteng says the jobs shortage has seriously impacted her career plans and financial situation.
With plans to specialise, all has been put on ice as the reality of being unemployed sinks in.
Having interviewed for three posts, a young Limpopo doctor says the emotional strain is immense as jobs prospects “don’t look promising”.
A Mpumalanga doctor shares the financial stress this has placed on her: “Financially, it’s very stressful because of monthly expenses e.g. caring for parents, medical aid, paying for a car, food security – especially if one has no dependants – might not be fulfilled.”
The domino effect of a lack of employment for 2021 is another concern for her.
“It limits me from achieving my goals. With a one year delay, what guarantee would there be of me securing a job in the years to come considering I wouldn’t gain work experience next year.”
Applications process
In 2020, many provincial health department vacancies call for a postal application.
A community service doctor working for a national laboratory service explains that postal applications simply “get lost and we are left in the dark”.
“Applications by mail is a complete waste of time, money and paper.
“Of 10 applications that I hand delivered to WC hospitals, none of the HR departments received them as they apparently don’t check the boxes where I was told to hand applications into.
“Of four applications I posted to KZN hospitals, none reportedly received them even though they were sent by registered mail.”
He says the applications have to go digital “where successful submission of applications cannot be undermined by an unreliable postal service, incompetency of HR personal and unused application boxes that are not checked”.
Looming mass exodus?
A young Gauteng doctor working at a district hospital in a township says “having an unsure and undetermined future is terrifying”.
In another survey, 78% of junior doctors said they are considering leaving South Africa to practice medicine abroad.
“It’s disheartening knowing that despite the supposed massive need for doctors, once the compulsory years (community service and intership) are complete, there is no funding for further training and specialisation.
“It’s no wonder doctors are seeking employment overseas. There don’t seem to be programmes in place which ensure they are kept within the system and continue to develop and train further.”
Another Mpumalanga doctor says the lack of jobs will force her to move back home, derailing her plans to become a registrar.
“I applied for more than 20 jobs and only got two call backs for interviews,” adding “I can’t become a registrar if I don’t have experience in my field that I want.”
Vacancies
An inspection of vacancies advertised on national government as well as provincial health department websites shows the enormity of the crisis.
Many provinces have advertised very few MO posts in recent circulars, while others have advertised none.
The Free State’s latest circular, dated 29 November 2020, has not a single MO vacancy advertised. The previous circular had one advertised post for Grade 1 – 3 MOs.
In the North West, where a circular on a hiring moratorium has been issued, not a single vacancy had been advertised in the circulars dated 30 October 2020, 16 October 2020 and 28 September 2020.
The circular from the NW health department about the advertising of posts for employees completing community service states: “The above matter as well as the moratorium on filling posts dated 15 October 2020 refers.
“Based on the current financial position of the department as well as the fact that National Treasury is implementing budget cuts across all departments and provinces over the MTEF at 6%, 9% and 12%, the North West Department of Health is not in a position to advertise and fill any new posts,” it states.
The Northern Cape’s last published vacancy circular is dated 28 July 2020.
Gauteng’s latest circular on national government’s website is dated 29 November 2020. It has no MO vacancies.
The previous circular dated 14 November has a three-month contract for an MO in the family medicine department.
In the Western Cape, the latest circular includes two MO posts for general surgery.
While KZN has the most advertised vacancies, junior doctors raise concern about whether these posts are actually being filled as few have received job interview call backs.
Bursary holders in a pickle
Bursary holders are also being released from their bursary obligations in various provinces, including the North West.
“Bursary holders will therefore be related from their bursary obligations. Kindly bring it to the attention of all community service officials,” the circular adds.
The Mpumalanga health department has also released a circular dated 15 October, indicating that no community service doctors will be retained due to the “availability of funded vacancies” but will have to apply for advertised posts, of which there is very few.
‘Government not doing enough’
The South African Medical Association (SAMA) insists the Department of Health should ensure that the skills of the doctors who are completing their community service in 2020 are utilised by employing them in the public sector.
“Unfortunately there are not enough posts available in the department which is resulting in these doctors embarking on private sector options, which are also limited,” SAMA notes.
The dire shortage of trained professionals in public hospitals necessitates a steady and strong stream of doctors to be available.
Chairperson of the SAMA Employed Doctors Committee Dr Akhtar Hussain says it’s simply poor planning on government’s part.
“They do the training and after that the health department is not looking after them.
“They are not creating enough posts and they say budget constraints but that is not true. They are cutting down posts so that junior doctors are without jobs,” he bemoans.
There is desperate need for adequate long-term planing, which Hussain says has been worryingly absent for years.
“There simply is no long-term planning. They talk but there’s no implementation.
“They keep saying there’s a budget shortage. The trick is that they say we are full but if I resign today, they remove the post and do not fill it so it does not reflect that there are vacancies.”
Poor funding decisions?
Government has forked out R239 million for Cuban doctors brought in to assist in the fight against the Covid-19 pandemic.
Ask doctors working at overburdened Covid-19 wards at public hospitals across the country and many will say they’ve never single a single Cuban doctor.
“There was so much fanfare around the arrival of these doctors but when our hospitals were filled to capacity with Covid-19 patients, there was no help from these Cuban doctors – not even at designated Covid-19 hospitals,” one doctor bemoans.
The R239 million could easily have funded 291 Grade 1 MO posts for post-community service doctors.
Despite numerous attempts to obtain comment via email, phonemail and SMS, the health department has not responded to a list of questions from POWER Digital.
This article will be updated once comment is obtained.
Hussain insists while the pandemic necessitated the urgent on boarding of additional doctors in SA, the money could have been better spent.
“That money should have been used properly. We raised this concern. We couldn’t produce doctors overnight. The Department of Health acted on their own.”
Community service review
A 15-year review on the compulsory community service for doctors in SA reveals that the scheme employs an annual cohort of 8000 young professionals on a 12-month contract – this is not limited to doctors, but allied health professionals too.
The scheme currently employs an annual cohort of 8 000 young professionals on 12-month contracts, who are allocated to public health facilities in different provinces according to the human resources need.
Since the implementation in 1998 of the community service (CS) programme for 12 months of compulsory service for health professionals up to and including 2014, a total of 17 413 doctors of 44 000 CS health professionals completed their year of service in public health facilities in South Africa
The University of Cape Town study indicates that since the implementation in 1998 of the CS programme for 12 months of compulsory service for health professionals up to and including 2014, a total of 17 413 doctors of 44 000 CS health professionals completed their year of service in public health facilities in South Africa.
The report, published in the South African Medical Journal, points out that while CS is an effective recruitment strategy, in the absence of other interventions, does nothing for the development of an effective long-term workforce.
“Few international studies have shown increased retention of doctors after compulsory CS, while one SA study found 16% of CS doctors in one province remaining at the same district hospital beyond the obligatory time.”
POWER Digital
Written by Laila Majiet on 07 Dec 2020 12:15
Article Link https://www.power987.co.za/news/junior-doctors-in-limbo-amid-worrying-jobs-shortage-in-sa/
