Large-scale dissatisfaction persists for state doctors
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.