A rash of resignations from public hospitals in Gauteng should have set off alarm bells within the Department of Health – but it denies services will be disrupted by this, while doctors say they are “simply not valued” and that their complaints have fallen on deaf ears.
The flight of specialist doctors will not only affect patients and staff but also have dire implications for those training to be specialists, reports Daily Maverick.
Recently, three cardiologists have resigned from Chris Hani Baragwanath Hospital, and apart from losing all of its cardiologists by the end of December, the hospital has also seen the exodus of three of the ear, nose and throat (ENT) specialists of the four in the department.
However, Gauteng Health insists the resignations will not disrupt service in cardiology or the ENT department, and that the positions are being filled.
“The hospital has already initiated a full recruitment and selection process to ensure the vacant specialist posts are filled by 2 January 2026,” it told Daily Maverick.
But a hospital insider is unconvinced that this will be the case come 2 January. He said: “Where is the evidence the posts were actually advertised? They’ve also talked about filling some of these posts on six-month contracts, but it’s unlikely this will materialise.”
The crisis of a shedding of specialists is ripping through departments and other hospitals in the province. Concerns remain that as posts become vacant they will not be filled timeously, or be funded.
There are also questions about the lack of a proper HR strategy and management for the long-term retention of specialists, who have a dual role of teaching and supervising registrars undergoing specialist training, at the academic hospital.
Without being able to offer trainees supervision and training, the accreditation status of medical schools is in jeopardy.
Accreditation requirements
Professor Shabir Madhi, Dean of the Faculty of Health Sciences at Wits University, said functioning specialist units at academic training hospitals should have a specialists staff complement that was compliant with HPCSA (Health Professions Council of South Africa) accreditation requirements.
“You need continuity of care that comes with full-time staff and integrated, efficient services to manage patients,” he said.
Madhi acknowledged that Wits’ training programme for specialists and undergraduate training would be affected by the resignations.
“The university will not be able to register new registrars or fellows for specialists training in disciplines that do not meet the HPCSA requirements for adequate supervisory capacity. For the training of specialists, the university requires one consultant for every four people who are in training,” he said.
Madhi added that the knock-on effects were that there wouldn’t be enough specialists coming into the healthcare system in the next few years.
The flood of resignations is being attributed to worsening working conditions in the public sector, and that the employer – the Gauteng Department of Health – is failing to address doctors’ dire concerns.
Key among the problems are rumblings of changes to commuted overtime pay for doctors, the fixed amount paid to them according to their contract agreements. It is a predicable supplemental income and can make up a third of a doctor’s take-home pay.
In April, doctors’ overtime pay was delayed. But even when the issue was resolved there remained ongoing threats of contracts being revised to introduce new caps, cuts and conditions, including doctors having to be physically present at hospitals, not just on call, during overtime hours.
This has added to growing frustration and dissatisfaction among doctors. There has also been talk of revising RWOPS (Remunerative Work Outside the Public Service). RWOPS is an agreement that allows doctors employed by the state to work a certain number of hours in private practice to bolster their state salaries.
There are also ongoing concerns over neglected infrastructure and lack of maintenance adding to worsening working conditions in public facilities, with doctors often working without functioning critical equipment and machinery, and a shortage of consumables and medical supplies.
A doctor at Charlotte Maxeke Johannesburg Academic Hospital told Daily Maverick there was a shortage of ICU beds, and that scheduled operations were routinely cancelled at the last minute because equipment in the theatre broke or something that was needed for a procedure suddenly became unavailable.
He said the relationship between doctors and management was marked by “confrontation, a lack of trust and frustration”. He said posts remained frozen and budgets for sessional consultants were not available.
“We don’t have enough consultants on call covering registrars – there’s just a blank on the roster. We are having entire teaching blocks cancelled because of no staff,” he said.
The Department of Health did not answer specific questions on the status of commuted overtime and RWOPS, nor the impact of resignations and unfilled posts on having enough consultants to ensure the training of the next generation of specialists at the province’s academic hospitals.
Crisis looming
Dr Phuti Ratshabedi, Gauteng chairperson of Samatu (the South African Medical Association Trade Union) who is based at the Obstetrics and Gynaecology Department at Chris Hani Baragwanath, said doctors had been warning that there was a crisis looming as more specialists left the public sector. But he said doctors were simply not valued by Gauteng Health.
“Doctors’ salaries are not being prioritised. The government is also not protecting specialists in whom they have invested years, and millions, to train, and it is not doing enough to keep them in the public sector, or even in the country,” said Ratshabedi.
He had personal experience this year of not being paid by the department for three months, he said.
He had worked at Bara for seven years and said being part of a teaching hospital and being involved in training had always been a personally rewarding and enriching part of his career.
However, he said he was now ready to walk away. He would be tendering his resignation in February next year.
“It makes me sad to do this, but it makes me sadder that the department is not taking doctors seriously. We are being abused in how we are treated. But no one can go every six months not getting paid for three of those months; doctors also need assurances that we will get paid, and that we can develop our careers in a properly functioning and supportive hospital,” he said.
See more from MedicalBrief archives:
Overtime non-payment for doctors sparks outrage in Gauteng
Gauteng plan to review doctors’ overtime pay policy a 'disaster'