Too few doctors, too little funding, says Phaahla

The government lacks enough doctors to meet the needs of patients who rely on public hospitals and clinics but cannot afford to hire more, health minister Joe Phaahla conceded on Monday.

About 1,000 doctors who completed community service in 2023 are unemployed, according to Akhtar Hussain, chair of the employed doctors’ forum of the SA Medical Association, SA’s biggest doctor organisation.

Much as the government would like to hire all doctors who recently completed community service, it lacks the resources to do so, Phaahla said, adding that he hopes they will seek jobs in the private sector rather than going overseas.

“We hope the majority will practise as GPs and give some hours to the public service.

“We just hope they don’t opt for offshore, but remain in the country,” he said.

“While we regret we can’t immediately guarantee every medical graduate a post after [community service] it is a worthwhile investment. They can use that training ... and establish their own practice or explore elsewhere,” he said.

Medical graduates are required to complete two years of internship and one year of community service before they can register with the Health Professions Council of SA and practise independently.

While in the past doctors who had completed community service readily found posts in the public sector, budget constraints on health departments are putting the brakes on new hires.

Provincial health departments are under pressure because they have to honour last year’s higher-than-anticipated wage deal, which was only partially funded by the Treasury. They were also hit by unexpected in-year cuts to their conditional grants, announced in the medium-term budget policy statement in November. The crunch has hit personnel-heavy departments such as education and health particularly hard.

Phaahla drew attention to the size of the wage bill in health, saying that the cost of employment is “extremely high — up to 65% of annual budgets in some instances”, adding that the annual package for a medical officer, including allowances, could be as high as R1.5m. A medical officer is the entry-level post for a doctor employed by the state.

A total of 564 medical officer posts have been filled since October, 239 are currently advertised and 375 more will be advertised in the next six months, the minister said.

“Provincial departments of health continue to actively engage their provincial treasuries to find ways of addressing the unemployment of health professionals, including medical doctors,” he said.

While the state has steadily increased the number of healthcare professionals it employs in

recent years, they are unable to meet the demand for services, the minister said.

“The trend over the past five years shows an annual increase of medical doctors ... [but] I would be the first to concede that these numbers are inadequate when considering the vast health needs,” he said.

Figures provided by the minister show the number of medical interns employed by the state rose from 1,472 in 2018 to 2,210 in 2024, but this year’s figure is down on last year’s 2,365. The number of community service doctors increased from 1,340 in 2020 to 2,101 in 2024.