Private work by state docs ‘needs to stop’
Chasing private cash can mean state patients suffer
● One in three specialists on the government’s payroll also work in the private sector, and abuse of the system is leaving state patients suffering, junior doctors unsupervised and medical students inadequately trained.
Dr Chris Archer, CEO of specialist doctors group the South African Private Practitioners Forum, said a health department policy implemented in 1993 allowing state specialist to do private work had been a temporary response to the poor salaries paid to hospital specialists at the time.
Now there are concerns that the policy — called Remunerative Work Outside Public Service (RWOPS) — is affecting the training of new specialists.
The system allows state doctors to work in private hospitals once they have completed their 40 hours a week and an additional 16 hours overtime in government facilities.
The idea of private overtime was a compromise to retain specialised staff in public hospitals — and doctors have threatened to leave the public sector if the policy is revoked, said Archer.
But, he said, medical staff in the public sector are now well remunerated, so “RWOPS needs to stop”.
A recent study by actuary Shivani Ranchod and her team found that 35% of state specialists also run private practices.
The team used anonymised data provided by Discovery Health and data from the National Treasury, which shows state doctor salaries. They also met with medical deans at universities and the department of health.
Ranchod said she cannot make a call on whether the 35% is high or not, but the fact that the figure was not known until now highlights that the system isn’t being well monitored, which by implication means it isn’t well managed.
Specialist physician Adri Kok said those who abused the system had created the negativity.
“There are unscrupulous doctors who do private work at the expense of their actual jobs. This has been more senior members of staff and then their teaching responsibilities are badly affected. Of course student and registrar teaching suffers.
“As a result, medical faculties have clamped down significantly on these activities.”
Consultancy firm Healthman, which specialises in the management and administration of specialist and health-care networks, said in extreme cases it had seen specialists running five private practices while earning a full-time salary from the government.
Consultant Dr Johann Serfontein said: “Some RWOPS doctors are among the top claimers from medical schemes — a clear indication of excess and lack of oversight.”
However, South African Society of Anaesthetists CEO Natalie Zimmelman said the policy was often incorrectly blamed for shortages in the health system.
“In our environment, if a surgeon cannot find an anaesthetist in the public sector to assist with operations, they blame RWOPS by default. They will never place the blame on the fact that institutions sometimes recruit more surgeons than anaesthetists in a specific year,” she said.
The dean of the Wits Medical School, Martin Veller, said RWOPS had helped keep specialist staff working in state hospitals and was well controlled in the Western Cape and KwaZulu-Natal.
“It has a [negative] effect on training, particularly in settings where it is not adequately controlled. On the other hand it has also resulted in the retention of some specialists in the public sector,” he said.
SA is lagging far behind the targets set in 2011 by the health department for the provision of specialists. In state hospitals, the latest figures are nine specialists for 100,000 patients, whereas the target was set at 42.46 for 100,000 patients.
In Chile there are 111 specialists per 100,000, and 124 per 100,000 in Turkey. These countries are used as benchmarks due to their economic proximity.
Ranchod said: “The shortages are extremely concerning. We are coming off a low base, and have a rising burden of disease. Planning, real efforts at retention, contracting across sectors and ways of improving productivity are desperately needed.”
Health spokesperson Popo Maja said the department was concerned about possible abuse of the RWOPS system as it could put quality care of patients at risk.
“Secondly, the abuse of the system is tantamount to fraud and corruption, which is unethical,” he said.
Last week a circular released by the department of health’s human resources department said the government had given a mandate to hospital CEOs to manage or restrict the system.