A number of junior doctors, who have completed their studies and community service in the Eastern Cape, have sent a petition to the SA Medical Association Trade Union about the allocation of jobs for junior doctors attempting to fulfil their scholarship obligations.
According to eNCA, the petition adds that those interns who finished their community service in 2021 still haven't been advised about future employment and they are pleading with the Health Department to provide jobs for them.
“There are hundreds of us,” they wrote. "This comes after years and years of going through the system … we should be employed here… If they are not going to give us jobs can they please release us from this bursary so we can find jobs in other provinces. Some people have found jobs in other provinces but have been blocked by this province because of this bursary system. We are willing to oblige by it but they are not giving us jobs.”
The delays in job placements for interns by the SA Health Department are notorious, and last year it was served with a letter of demand compelling it to provide community service jobs. The letter was issued on behalf of 465 doctors. Of those, 298 were qualified medical doctors; six of whom were foreign nationals, and 292, South African. The second group was made up of 167 community service doctors.
A report in MedicalBrief last year (21 November) quoted the Junior Doctors Association of SA (Judasa) as saying that foreign medical recruiters are actively recruiting South African doctors for Ireland, Canada and Australia, and the “reckless behaviour” of the national Health Department in failing to place trainee doctors is one of the attrition factors.
Judasa said numerous trainee doctors are in limbo each year because logistics and difficulties of distant placement are disregarded by the Health Department, a claim the latter denied.
Yet in July and August 2021, the department battled to allocate sufficient money for public sector internship and community service posts because competing healthcare demands – including COVID-19 – sought priority, Mail & Guardian reported. Finishing the three years of public service is a legal requirement before junior doctors can register and practice as fully-fledged medical officers. Judasa claimed in June that there were up to 1,000 unfunded intern and community service doctor posts in the public sector.
The department admitted that its personnel budget “continues to take strain” from the growing numbers of medical students qualifying from local universities, the Nelson Mandela/Fidel Castro Cuban Students Programme and self-funded students studying abroad.
Victor Khanyile, manager of the national Internship and Community Service Programme (ICSP), said 288 students had written and passed supplementary exams at different times at six campuses from June onwards last year, but many had not been able to begin their internship immediately, for various reasons.
The historical context of the mess is a major ramp-up of doctor training and output since 1996 by the Cuban training programme, which, after a boost in 2011, began pouring 800 more final year medical students into the existing local campus final year training cohort. This resulted in some 2,700 interns entering in-service training annually from 2011 onwards. This has strained the public health fiscus, creating a headache for the treasury on whom the Cuban training policy was foisted with little consultation.
A Judasa executive member, Dr Sazi Nzama, a medical officer in the Pietermaritzburg Hospital Complex, said the health department releasing placements only in the second half of November was “reckless behaviour”.
“Theyʼre deliberately not executing their mandatory duty of placement. We often have to organise furniture and find a place to stay. Itʼs an unrealistic expectation to place on any human being. Itʼs becoming an attrition factor. Iʼd rather go where Iʼm appreciated and treated with respect, not as a pawn tossed around. There are foreign recruiters out there actively seeking doctors for Ireland, Canada and Australia,” he asserted.
Official data indicate serious attrition of community service officers. In 2016 there were 2,700 interns, increasing to 4,800 currently, yet community service numbers increased from just 1,300 in 2016 to 1,800 in 2021. Possible answers include data transfer dysfunction between provinces and national health departments and a failure to capture community service sign-ons.
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