In a major concession by government to the growing medical staff crisis, the revised Critical Skills List – gazetted on 2 August – includes five pages of medical posts, with at least a dozen specialist categories. None of the drafts or previous lists did.
The inclusion of medical posts comes amid a growing shortage of healthcare professionals, with the past year seeing an exodus of 35,000 from the country, particularly specialists, and predictions of more emigrations before the National Health Insurance comes into effect, notes MedicalBrief.
Home Affairs Minister Aaron Motsoaledi’s updated 10-page list of jobs and the qualifications which the applicant must have to apply for either a critical skills visa or permanent residence includes aircraft technicians, multimedia specialists and call centre agents to – finally, a host of medical specialists: doctors, dentists, neurosurgeons, nursing lecturers, ear, nose and throat specialists as well as gynaecologists and psychiatrists, among others.
Also included are pathologists (anatomical, clinical, chemical, virological, haemotological), radiation specialists (oncology), specialist nurse educators, cardiothoracic surgeons and specialists in plastic surgery.
The list provides for 140 skills considered in critically short supply, mainly due to the increasing emigration from South Africa.
Earlier this year, when the original 2022 list was released, there was an outcry from the medical profession and public alike. MedicalBrief reported Hospital Association of SA (HASA) CEO Dr Dumisani Bomela as saying the organisation was “perplexed” by the omission of medical skills, in particular nurses and doctors, from the list.
HASA, which represents the private hospital sector, had urged a government rethink, pointing to OECD statistics showing South Africa lags far behind a basket of comparative countries for nurse and doctor numbers per 1,000 inhabitants with ratios of 1.3 (Turkey 2.1; Russia 8.1; Norway 17.8) and 0.8 (Turkey 1.9; New Zealand 3.3; Austria 5.2) respectively. “In the category active medical schools per million inhabitants, South Africa’s ratio of 0.16 similarly lags behind countries like Libya (1.88), Brazil (1.50), and Colombia (1.15),” Bomela had said.
“Leaving out skills previously included on the Critical Skills List sends the message that we have overcome the problem we had – but that is simply not the case. It cannot be, as the nursing profession has long struggled to attract new recruits, which is exacerbated by the amendments to the nurse training curriculum, and the accreditation of training facilities that has stalled the numbers of new nurses being trained – at a time when a significant number of nurses in the profession are already over 50 and will be retiring soon.
“It is also difficult to reconcile the 2030 Human Resources for Health Strategy which, for instance, projects a shortage of 34,000 nurses by 2025 if nothing is done to attract and retain falling numbers of nursing aspirants, with this critical skills list,” Bomela had added.
Similarly, Jaundiced Eye columnist William Saunderson-Meyer, writing in PoliticsWeb, said, “This is the basis on which South Africa will condescend to allow the world’s brightest, most skilled and most talented people, to seek a new life on our shores”.
The list, he wrote, delivered by the Department of Home Affairs after “two painful years of intellectual constipation”, was “a sad waste of time”.
“To start with, the last thing in the world that this government wants is clever, capable people. Especially not foreigners who might show us up.
“Not only is the Skills List already long out of date but it was compiled by exactly the type of people who cause one to appreciate the need for imported talent. Remarkably, for a document produced under the ministerial oversight of Dr Aaron Motsoaledi, himself a medical doctor and the previous Minister of Health, it will permit the immigration of general practitioners but not medical specialists, of which there is a crippling shortage.
“Ann Bernstein, head of the Centre for Development Enterprise, told Business Day that such a restrictive approach will be of no benefit to the economy. ‘I don’t understand why a country with a massive skills shortage wastes money and time trying to work out what highly specific skills to let in,’ she said. ‘The modern economy does not work the way the compilers of the skills list assume it does.’
“One can find support for Bernstein’s cynicism about the government’s views of what makes for a vital economy by looking at whom it seeks to employ. Last week the public service’s job website listed 2,500 jobs to be filled. Almost a fifth were for top-level paper-pushers – assistant, deputy and chief directors – while barely 200 required real skills: 174 nurses, nine medical specialists and 20 accountants,” wrote Saunderson-Meyer.
This week’s revised and updated list shows that some thought, at least, has been put into the compilation, and clearly, consideration given to the thousands of medical professionals who have fled this country.
On the release of the new list, Saunderson-Meyer wrote in PoliticsWeb this week that “the flight from this country over fears of a failed state is not generally by the rich, who can afford to stay. Nor by the poor, who have no option but to stay. It’s by the squeezed middle”.
“Take the growing flight of medical professionals. This is the group whose erosion will most swiftly puncture the ‘positivity’ bubble and spur the exit of other groups who would otherwise hang in.
“It’s an existential issue. When you need a doctor, you want him or her to be as close as possible. It’s only the corporate creme-de-la-creme who can have their surgery done in London. Or ANC leaders fearing witchcraft, like Jacob Zuma, who can have the muthi spells of their jealous rivals negated in Moscow.
“According to statistics recently released in Parliament by Health Minister Dr Joe Phaahla, our doctor-patient ratios, already among the worst in the world, have worsened substantially in the past two years. In 2019, South Africa, then with a population of 58.6m, had a doctor-to-patient ratio of 1:1,266. Currently, with a population of 60.1m, that ratio is 1:3,198).
“That translates to a drop from approximately 46,294 doctors in practice in 2019, to only 19,772 in 2022. If Phaahla’s statistics are correct, that’s a terrifying drop in practitioner numbers in just three years.
“Further evidence of this trend comes from a survey last year of clients of the Professional Provident Society (PPS). A quarter of the 2,500 PPS clients who stopped using the company’s services cited emigration as the reason for doing so.
“PPS’s 2021 Graduate Professional Index also shows a sharp increase in medical professionals contemplating emigration. While financial services sector professionals had 80% confidence in the future, the dental and medical professionals were considerably more gloomy, with 58% and 56% confidence levels respectively.
“Earlier this year, in a presentation to Parliament, PPS said that 73% of its 30,000 members who are medical professionals felt that emigration would be the outcome if NHI were not implemented responsibly.
“As PPS said this week: ‘Emigration is always a realistic option for the qualified. Each healthcare worker not only represents a skilled worker, but many are also self-employed and pay taxes as individuals, as well as in their business capacity’.”
gazette critical skills
PoliticsWeb article – When the doctors go (Open access)
PoliticsWeb article – A critically ill Skills List (Open access)
BusinessTech article – These jobs have been added to South Africa’s critical skills list (Open access)
See more from MedicalBrief archives:
Medical interns from African countries struggle after removal from SA critical skills list
HASA chief: Medical omissions from Critical Skills List ‘incomprehensible’
Hospital Association ‘perplexed’ by omission of medical skills from Critical Skills List