Health Minister Aaron Motsoaledi’s proposal to review remunerative work outside the public service (RWOPS) could bring both benefits and challenges to the sector, says an expert, who suggests new measures, for instance enhanced oversight to ensure doctors don’t neglect their public sector duties, could be introduced.
On the down side, she warned that it could be a catalyst for an exodus of healthcare professionals to greener pastures.
Motsoaledi recently blamed the absence and lateness of healthcare workers – particularly doctors – to misuse of RWOPS, but has dismissed concerns that changes would force doctors out of the government sector. He said they are fairly compensated under the occupation-specific dispensation (OSD).
Although medical staff in the public sector can apply for RWOPS to work in private clinics or hospitals when they are off duty, they need written permission from their department’s executive authority, reports The Citizen.
Former South African Medical Association (SAMA) board chairperson Dr Angelique Coetzee said that reviewing the RWOPS programme could have some significant implications for public healthcare.
One major benefit could be an increase in the availability of doctors in state-owned hospitals and other healthcare facilities.
“If there’s a stricter RWOPS policy, it could mean fewer doctors spending time in private practice and more focus on public healthcare, which should improve waiting times in patient care in state hospitals,” she told The Citizen.
A revised system could also lead to better service delivery, particularly in reducing surgical backlogs at public hospitals.
“There could be more equitable healthcare, which might help bridge the gap between private and public healthcare, ensuring more equitable treatment.”
She said some doctors prioritise private patients over public ones, so a stricter RWOPS policy could help address this issue by ensuring doctors fulfil their public sector responsibilities before engaging in private practice.
Downsides
However, she cautioned that changing the status quo could trigger a loss of skilled professionals, as many specialists depend on the programme for additional income.
“A restrictive review could push them to leave the public sector entirely, leading to the brain drain problem as doctors seek better-paying opportunities abroad or in full-time private practice.
“If it’s removed or heavily restricted, some doctors might resign, worsening the shortages in state hospitals, leading to an increased patient load per doctor, again, negatively affecting patient care.”
Another potential downside is the impact on medical training.
“There might be a reduction in training and mentorship, which could affect the training of junior doctors, interns and registrars,” Coetzee said.
Additionally, if RWOPS were significantly restricted, fewer doctors would be available in the private sector, leading to increased costs and longer waiting times for private healthcare services.
“It’s a very difficult situation,” she admitted.
Possible adjustments to RWOPS
Coetzee suggested a system with enhanced oversight to ensure doctors do not neglect their public sector duties.
“They need to adhere to the working hours for which they are signed up. You cannot double-dip – getting paid by the public sector hospital but running a private practice during office hours,” she pointed out.
One solution could be mandatory reporting of private practice hours to ensure transparency. Additionally, doctors could be limited to a certain number of private practice hours per week to keep their primary focus on public healthcare.
“Government might also allow RWOPS only for certain specialisations where public services are not effective.
“For instance, allowing part-time private work only in fields with an adequate number of public sector doctors, if possible. We know we have a shortage of specialised doctors in all sectors in the public sector,” she noted.
Another approach could involve salary adjustments to make the public health sector more attractive, reducing doctors’ need for additional private-sector income.
Financial incentives like student loan forgiveness, promotion opportunities, or housing allowances, could also be introduced to encourage doctors to commit fully to public service.
“Doctors who misuse RWOPS to the detriment of the public hospitals… may face stricter consequences including fines, suspensions or terminations.
“They need to be held accountable if they’re not at work when they’re supposed to be there.”
Challenges with the OSD
On OSD, which was introduced in 2007 to address remuneration disparities and retain professionals in the public sector, Coetzee highlighted the perception of unfairness around this, leading to demoralisation and strained relationships between management and nursing staff.
Issues like incomplete and inaccurate information systems, insufficient planning, and poor communication have all weakened the policy’s effectiveness, she said.
The OSD had resulted in significant salary increases for some categories of state-employed doctors, including interns, registrars, and senior specialists, but its effectiveness varies in adequately compensating higher-level specialists.
Working conditions, career development opportunities, and resource availability also play a crucial role in specialist retention, she added.
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