Specialist Family Physicians (SFPs) – highly trained doctors devoted to whole-person care – are banding together to challenge the might of private medical funders who, they say, are crushing their profession and short-changing patients.
For years, writes Chris Bateman for MedicalBrief, these unsung specialists have been mistaken for ordinary general practitioners (GPs) and paid accordingly. Yet SFPs complete four extra years of postgraduate training to qualify – the same as any other medical specialist. Their expertise strengthens the foundation of the health system by managing 80% of conditions that would otherwise burden hospitals.
Still, funders treat them as second-class citizens.
“We’re recognised as specialists by the Health Professions Council,” said Dr Sheena Mathew, vice-president of the South African Academy of Family Physicians (SAAFP). “But in private practice, we’ve had no voice. Funders keep us shackled to GP rates. It’s like working with our hands tied behind our backs.”
The unequal battle
In the public sector, SFPs earn on par with other consultants. But in private practice, Discovery, GEMS and Polmed pay them barely 30% more than GPs – and even that modest increase is inconsistently applied. Other schemes still classify them outright as general practitioners.
The result? A cadre of deeply qualified specialists forced into 10-minute consultations and unable to use their full skill set. They’re barred from prescribing specialist medicines or ordering advanced imaging such as CT and MRI scans, even when treating complex chronic conditions.
“Funders get more value from us but pay less for it,” says Mathew. “It’s demoralising.”
A fight for dignity
To push back, SFPs have hired Healthman Consultancy to quantify their true worth – and to prove that their model of care saves funders millions. Early next year, they’ll propose pilot projects to demonstrate cost-effectiveness.
They have also lodged their objections with the Council for Medical Schemes.
Health law consultant Elsabé Klinck calls the discrimination “unethical and unconstitutional.”
“A patient seeing a Specialist Family Physician should receive the same benefits as one seeing any other specialist,” she insists. Her colleague Alton Samuels adds: “It’s about equality and professional dignity. There’s no rational basis for this bias – it’s economic gatekeeping, plain and simple.”
SFPs typically spend 30-45 minutes with each patient, taking a holistic approach that includes mental-health screening, pap smears, obesity checks and chronic-disease management. They prevent hospital admissions by catching problems early and treating the root causes.
They’re also at the forefront of “hospital-at-home” innovations – digital platforms that deliver hospital-level care in patients’ homes, cutting costs dramatically.
“By managing more at primary level, we free up hospital specialists for patients who truly need them,” said Mathew. “When the NHI comes in, we’ll be central to care.”
Yet despite their alignment with the National Health Insurance vision, the current NHI Bill doesn’t even mention them.
The system’s blind spot
Deputy director-general of health Dr Nicholas Crisp has described SFP skills as “like gold” for the NHI – but without structural recognition, their value remains untapped.
Economists blame a vacuum of regulation in the private sector, where specialists can charge what they like, creating entrenched financial interests. Every discipline protects its turf, and SFPs, who refer less and manage more, threaten that hierarchy.
“Why would a young doctor study four extra years only to be treated like the GP they were before?” asks Dr Shola Irinoye, a Pretoria-based SFP. “We’ve been sidelined by the system.”
He describes the everyday ‘disrespect’: hospitals telling patients SFPs aren’t specialists, medical aids addressing letters to “Dear General Practitioner,” and colleagues redirecting referrals elsewhere.
Dr Gail Ashford, an SFP who works in both public and private sectors, said the problem starts in medical school.
“Students get only two weeks of Family Medicine in their final years – often taught by GPs. No wonder they don’t know the difference,” she said. “The environment we work in is disabling. We’re forced to function as GPs.”
Professor Tasleem Ras, head of Family, Community and Emergency Care at UCT, calls the funding model “perverse.”
“SFPs undergo four years of structured, accredited training across 10 disciplines,” he explained. “Their approach is evidence-based and holistic. It’s counter-intuitive that funders refuse to pay for this service – as if they prefer patients to be hospitalised.”
Countries such as Australia and Canada recruit South African SFPs without additional exams, fully recognising their advanced generalist skills. Data from abroad shows that facilities staffed by SFPs achieve better health outcomes and lower system costs.
“Our SFPs are world-class,” said Ras. “The tragedy is that South African funders haven’t grasped that.”
Retired Professor Bruce Sparks, founder of the Wits Department of Family Medicine, said the discipline’s philosophy – treating people, not diseases – is exactly what modern healthcare needs.
“Unfortunately, GP training is moving in the wrong direction,” he said. “SFPs internalise and practise holistic care. They’re the backbone of any sustainable health system.”
As the SFPs prepare to face the Goliath of the funding industry, their slingshot is simple: proof. Proof that their model saves money, proof that it improves lives, and proof that fair recognition isn’t just about doctors’ pay – it’s about justice for patients.
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