With emptiness charges for public sector docs ranging between 5% and 22% — South Africa can merely not afford to have docs with out jobs. (Canva)
When Theresa Brummer completed up her medical diploma at Stellenbosch College, she had a transparent imaginative and prescient for her future: to work within the public healthcare system within the Jap Cape, the place she was raised.
Brummer spent a 12 months at Madzikane Ka Zulu Memorial Hospital in Mount Frere doing her government-required neighborhood service in a public hospital — along with two years of medical internship at state well being services — earlier than she was capable of practise medication in South Africa.
However in the present day, as a substitute of therapeutic sufferers, Brummer sits at residence in Gqeberha scanning job listings.
She is only one of 1 500 to 1 800 unemployed post-community service docs, who can’t discover public sector jobs.
On Wednesday, Finance Minister Enoch Godongwana budgeted to make use of 800 docs similar to Brummer; the remaining 1 000 unemployed docs can’t be helped.
The irony cuts deep: we desperately want public sector docs. In 2024, the well being ministry reported that public well being sector emptiness charges ranged from 5.48% within the Western Cape as much as 22.4% within the Free State.
Total, the well being funds will develop from R277 billion in 2024-25 to R329 billion in 2027-28.
An extra R28.9 billion will go in direction of using 800 post-community service docs with out jobs, in addition to 9 300 healthcare staff.
“Within the final 12 months alone, our public sector well being system misplaced near 9 000 well being staff,” Godongwana mentioned. “We didn’t have the cash to retain or substitute them even after reprioritising funds budgeted for consumables and medicines.”
No provision within the funds was made to make use of about 7 500 well being staff working for nonprofits funded by USAid, who misplaced their jobs after the Trump administration reduce their funding.
Ultimately, Godongwana mentioned, South Africa’s excessive debt-service prices, which can come to R389.6 million within the 2024-25 monetary 12 months, forestall it from spending extra on well being. “This [debt] interprets to 22 cents of each rand we increase in income. It’s greater than what we spend on well being, the police and primary schooling.”
Godongwana mentioned accruals — unpaid invoices within the public well being sector from the earlier monetary 12 months — additionally ballooned to almost R22 billion. “Because of this the cash allotted to departments finally ends up paying for earlier providers and items moderately than for the present wants, setting off a vicious cycle of funds shortfalls, unpaid invoices, and a disaster in cashflow and the planning and predictability of budgets,” Godongwana mentioned.
“That is an untenable scenario that we couldn’t depart unresolved.”
Going additional time
However the well being division additionally says a part of why they’ll’t afford to fill all physician positions within the state sector is as a result of docs’ salaries are too excessive — and that reducing the additional time of these already employed would open up budgets to make use of others.
The division’s Percy Mahlathi, who oversees hospital providers and human assets, instructed Bhekisisa’s TV programme, Well being Beat, in February that docs within the public well being system earn disproportionately larger salaries in contrast with different professionals.
“With the authorized occupation, many first-year staff can be incomes R15 to twenty 000 a month. However our well being service docs, with additional time, are incomes about R80 to 90 000,” he explains. When in comparison with docs in Kenya and Nigeria, South African docs earn in a month what their counterparts make in a 12 months.
Mahlathi says redistribution can be a greater method: “If you happen to use a part of that additional time cash to make use of 10 extra docs, there will probably be much less demand for additional time, and also you’ll have extra palms to take care of sufferers.”
South African docs routinely work 60-hour weeks. A standard work week, in line with the authorities Employment Act, is 45 hours. Medical doctors, nevertheless, receives a commission for his or her additional time, despite the fact that many different workers who earn above the federal government’s earnings threshold of R261 748.45 (for 2025) don’t as a result of the regulation doesn’t require it.
Mahlathi says some provinces have already begun proscribing additional time to eight hours weekly, doubtlessly saving 50% of present additional time expenditures.
Wage buildings
However the South African Medical Affiliation’s (Sama’s) vice-chairperson, Ames Dhai, instructed Well being Beat that there’s greater than sufficient cash to make use of all docs within the nation; the issue lies with the way in which the well being division manages its funds.
In February, Well being Minister Aaron Motsoaledi instructed the well being portfolio committee in parliament that the well being division would want R1.9 billion to make use of 1 500 docs.
“Between 2009 and 2013, near R24 billion was misplaced resulting from corruption,” Dhai says. “So how can the state say it doesn’t find the money for?”
Medical doctors’ salaries aren’t really the fault of docs — the present wage construction was carried out by the well being division itself. In 2009, occupation-specific dispensation was created particularly to maintain expert professionals in authorities service.
Underneath this method, entry-level medical officers earn simply over R900 000 yearly, with salaries rising to greater than R1 million after 5 years. Grade 3 medical officers, docs with not less than 10 years of expertise, earn R1.2 million to R1.5 million yearly. When additional time is added — nearly unavoidable in chronically understaffed services — compensation climbs larger nonetheless.
Graduates outpacing budgets
Medical college students examine for six years earlier than their two-year internship and 12 months of neighborhood service — each of that are paid for by the state services the place they’re required to work earlier than they’ll apply independently.
In line with Motsoaledi, South Africa produces 3 600 docs a 12 months — up from 1 200 in 2011. That is the results of a plan Motsoaledi and the then minister of finance, Pravin Gordhan, got here up with to triple the nation’s annual output of physicians. Universities needed to up admissions and South African college students educated in Cuba — who return to complete their final 18 months in medical colleges right here — elevated from 80 to 1 000 per group every year.
However that signifies that the well being division additionally wants to supply every graduate with a neighborhood service submit every year, and sometimes struggles to. As soon as docs have accomplished their neighborhood service 12 months, Motsoaledi says, the federal government merely doesn’t find the money for to make use of all of the docs the nation produces.
Motsoaledi instructed parliament in February that the well being division had not “anticipated the next financial difficulties, which had severely impacted its capability to soak up new graduates into the workforce”.
Dhai places it merely: “The issue is the state has fallen behind in its obligation to make use of docs to ship healthcare to sufferers in want,” she instructed Well being Beat. “It’s an enormous indictment on the state.”
Holding out for the federal government job
In Gqeberha, Brummer has set April as her self-imposed deadline for securing authorities employment earlier than contemplating non-public apply, and even alternatives overseas.
“I’m holding out that I’ll be capable of work in authorities as a result of that’s actually the place I need to work,” Brummer says. “However you understand, I can’t maintain out eternally.”
This text consists of reporting from Bhekisisa’s Well being Beat programme about unemployed docs, which was broadcast on eNCA on February 24 2025.
This story was produced by the Bhekisisa Centre for Well being Journalism. Join the e-newsletter.