One in three specialists on the government's payroll also work in the private sector and abuse of the system is leaving state patients suffering, junior doctors unsupervised and medical students inadequately trained.
Katharine Childs writes in a Sunday Times report that Dr Chris Archer, CEO of specialist doctors group the South African Private Practitioners Forum, said a health department policy implemented in 1993 – called Remunerative Work Outside Public Service (RWOPS) – allowing state specialists to do private work had been a temporary response to the poor salaries paid to hospital specialists at the time.
The idea of private overtime was a compromise to retain specialised staff in public hospitals – and doctors have threatened to leave the public sector if the policy is revoked, said Archer. But, he is quoted in the report as saying, medical staff in the public sector are now well remunerated, so "RWOPS needs to stop".
Specialist physician Adri Kok said those who abused the system had created the negativity. Consultancy firm Healthman, which specialises in the management and administration of specialist and health-care networks, said in extreme cases it had seen specialists running five private practices while earning a full-time salary from the government. Consultant Dr Johann Serfontein said: "Some RWOPS doctors are among the top claimers from medical schemes – a clear indication of excess and lack of oversight."
However, South African Society of Anaesthetists CEO Natalie Zimmelman said the policy was often incorrectly blamed for shortages in the health system. The dean of the Wits Medical School, Martin Veller, said RWOPS had helped keep specialist staff working in state hospitals and was well controlled in the Western Cape and KwaZulu-Natal.
Health spokesperson Popo Maja said the department was concerned about possible abuse of the RWOPS system and the government had given a mandate to hospital CEOs to manage or restrict the system.
[link url="https://www.timeslive.co.za/sunday-times/news/2019-10-27-state-doctors-accused-of-chasing-private-work-while-patients-suffer/"]Read the full Sunday Times report (subscription needed)[/link]