Large-scale dis­sat­is­fac­tion per­sists for state doc­tors

Weekend Argus (Saturday Edition) - - COMMENT -

WHAT does the fi­nal OSD (oc­cu­pa­tion spe­cific dis­pen­sa­tion) of­fer for doc­tors mean? We, as a group of con­cerned doc­tors work­ing in a large aca­demic re­fer­ral cen­tre in Cape Town, would like to re­port that there is over­whelm­ing dis­sat­is­fac­tion among med­i­cal staff at pub­lic hos­pi­tals with the OSD process and the fi­nal of­fer.

Al­though there has been lit­tle in the press re­cently re­gard­ing state doc­tors’ salaries and the in­dus­trial action em­barked upon by doc­tors a few months ago, the process has been con­cluded de­spite an over­whelm­ing re­jec­tion by 91 per­cent of the doc­tors polled. The fact that the fi­nal of­fer has been signed off would seem to sug­gest to the pub­lic and to our em­ploy­ers that a sat­is­fac­tory con­clu­sion has been reached. This is not the case.

To take a step back, the aim of the OSD, as per clause 4.1 of PSCBC 1 of 2007, was to “ne­go­ti­ate and im­ple­ment salary struc­tures in or­der to at­tract and re­tain pro­fes­sion­als and spe­cial­ists in the pub­lic sec­tor”.

A sur­vey con­ducted by the South African Med­i­cal As­so­ci­a­tion (Sama) in re­sponse to this showed that pub­lic ser­vice doc­tors were re­mu­ner­ated at lev­els about 50 per­cent be­low other pro­fes­sion­als with sim­i­lar qual­i­fi­ca­tions in the pub­lic sec­tor.

In the sub­se­quent OSD of­fer that the Min­is­ter of Health re­layed to the press, even be­fore pre­sent­ing it to the bar­gain­ing cham­ber, he stated that a de­ci­sion had been made that three par­tic­u­lar cat­e­gories of med­i­cal staff would ben­e­fit max­i­mally from the OSD, with in­creases of up to 60 per­cent. Th­ese were:

In­terns (who were ex­cluded from the first of­fer) – in or­der to at­tract stu­dents to study medicine.

Reg­is­trars (spe­cial­ists in train­ing) – in or­der to at­tract doc­tors to spe­cialise.

Prin­ci­pal and chief spe­cial­ists – in or­der to pre­vent “the teach­ers” from be­ing at­tracted to jobs else­where.

Sub­se­quently, it tran­spired that the fig­ures orig­i­nally quoted were sig­nif­i­cantly and in­cor­rectly in­flated. The cat­e­gories quoted above would re­ceive in­creases of up to 43 per­cent, but the other classes of doc­tors – med­i­cal of­fi­cers, spe­cial­ists and se­nior spe­cial­ists, who make up the bulk of the ex­pe­ri­enced work­force, as well as phar­ma­cists – would re­ceive in­creases of be­tween 0.8 per­cent and 12 per­cent. In ad­di­tion, phar­ma­cists have been ap­pallingly dealt with.

In con­trast to the aim of the OSD process, this new salary struc­ture still of­fers no in­cen­tive for qual­i­fied doc­tors to re­main in the pub­lic sys­tem af­ter train­ing. The stark re­al­ity is that in­terns have to do in­tern­ships and reg­is­trars have to train at state aca­demic hos­pi­tals.

In prac­tice, prin­ci­pal and chief spe­cial­ist posts are very few. In aca­demic cen­tres, even many se­nior pro­fes­sors re­main in se­nior spe­cial­ist posts be­cause prin­ci­pal posts are far too few (a mat­ter of much un­hap­pi­ness). In ru­ral ar­eas, the higher-pay­ing prin­ci­pal and chief spe­cial­ist posts are fre­quently awarded to ju­nior doc­tors to at­tract them to ar­eas where no doc­tors oth­er­wise want to work.

The fact is that the pub­lic sys­tem of day, secondary and ter­tiary hos­pi­tals, and all the teach­ing pro­grammes, are pre­dom­i­nantly staffed and run by ded­i­cated med­i­cal of­fi­cers, and ju­nior and se­nior spe­cial­ists – the very groups that have been over­looked by the OSD, bar a vague spe­cial res­o­lu­tion promis­ing to re­view th­ese groups in the fu­ture.

What the in­dus­trial action aimed to bring to the pub­lic’s no­tice is that this is a crit­i­cal time for the pub­lic health ser­vice. Any fur­ther loss of ex­pe­ri­enced per­son­nel or fur­ther cut­backs in this sec­tor in the West­ern Cape will lead to cat­a­strophic de­te­ri­o­ra­tion of an al­ready ex­tremely stretched sys­tem. In sev­eral prov­inces, a col­lapse of the pub­lic health sys­tem has al­ready occurred. Ev­ery year we lose ex­cel­lent staff to the pri­vate sec­tor and over­seas.

And bear­ing in mind that all our un­der­grad­u­ate train­ing and reg­is­trar teach­ing is done in aca­demic hos­pi­tals, who will train and teach if we have no more ex­pe­ri­enced peo­ple in the sys­tem? A few years of this and what will the stan­dard be of our med­i­cal grad­u­ates and spe­cial­ists in pub­lic and pri­vate medicine in South Africa?

The OSD was sup­posed to ad­dress pay­ing pro­fes­sional doc­tors em­ployed by the state salaries in line with their qual­i­fi­ca­tions, ex­pe­ri­ence and re­spon­si­bil­i­ties. It is about main­tain­ing our health care ser­vices and teach­ing. What has been of­fered is an in­sult to the pro­fes­sional con­tri­bu­tion of med­i­cal of­fi­cers, spe­cial­ists and se­nior spe­cial­ists. It has been over­whelm­ingly re­jected by all in the state med­i­cal ser­vices. Im­ple­men­ta­tion of this of­fer is go­ing to neg­a­tively im­pact on the pub­lic health sys­tem of the fu­ture, and the pub­lic needs to be aware of this.

Part of the prob­lem with the process is that we, as state doc­tors, ac­tu­ally have very lit­tle bar­gain­ing power. Sama, as our union, has to bor­row seats in the bar­gain­ing cham­ber from larger sis­ter unions. A sim­ple ma­jor­ity in the cham­ber car­ries a de­ci­sion, as it did with this OSD of­fer. Clearly the time has ar­rived for doc­tors to be af­forded the op­por­tu­nity to bar­gain in­de­pen­dently with their em­ployer.

We there­fore strongly urge a re­con­sid­er­a­tion of the OSD process, looking at the salaries of state-em­ployed med­i­cal of­fi­cers, spe­cial­ists, se­nior spe­cial­ists and phar­ma­cists. We would be pleased to work con­struc­tively with the rel­e­vant au­thor­i­ties in this process in or­der to ad­dress the com­mon goal of pre­vent­ing fur­ther de­cay in the pub­lic health care sys­tem.

Try us small guys for size

JAUN­DICED EYE colum­nist William Saun­der­son-Meyer pro­vides food for thought re­gard­ing char­ity do­na­tions.

May we sug­gest that those con­cerned about the per­cent­age of their do­na­tions reach­ing the in­tended ben­e­fi­cia­ries, look to smaller char­i­ties where pro­por­tion­ately much less is used for over­heads and salaries.

A case in point is our an­i­mal char­ity, staffed by vol­un­teers for no fi­nan­cial re­ward. Ex­penses are only claimed when the bank bal­ance al­lows.

For the 2007 fi­nan­cial year our ex­penses were ap­prox­i­mately R56 000. In­come from do­na­tions and fund-rais­ing for the same pe­riod was R60 000.

An­other ad­van­tage of be­ing small is that we have more free­dom to do our work than large or­gan­i­sa­tions bound by red tape. How­ever, we ad­here strictly to our con­sti­tu­tion and sub­mit reg­u­lar re­ports to the reg­is­trar of non­profit or­gan­i­sa­tions. Our au­dited books are open to scru­tiny at all times.

We surely speak on be­half of all small wel­fare NGOs when we ask that peo­ple con­sider char­i­ties like ours.

Newspapers in English

Newspapers from South Africa

© PressReader. All rights reserved.