Tag: medical careers

Categories : Healthcare Politics and RegulationsTags :

Gauteng State Doctors Gear up for a Fight with Health Department over Proposed Changes to Overtime Payments

On By ModernMedia
Photo by Usman Yousaf on Unsplash

By Ufrieda Ho

Trade unions, medical associations and universities are raising the alarm that Gauteng budget cuts at the cost of doctors’ take-home pay will have dire consequences for public sector health. Meanwhile, the National Minister of Health has convened a committee to review the future of overtime for state doctors. 

Dysfunction in the Gauteng Department of Health hit home hard for many public sector doctors on 29 April when their overtime payments due for the month went unpaid.

The non-payment came without notice and affected medical staff in facilities across the province, according to the South African Medical Association (SAMA). Only by 6 May did some doctors start to see payments reflect in their bank accounts. More payments are expected soon given that, according to the Basic Conditions of Employment Act, the employer has seven days to settle, said SAMA.

But tensions are rising as this payment blunder follows a protracted row over the department’s unilateral decision to cut and change the terms of commuted overtime in the province. Proposals to cut down on commuted overtime come in the light of a very tight provincial health budget. As with most other provincial health departments, Gauteng’s health budget has been shrinking in real terms for several years.

The delayed payments and the ongoing review of cuts and changes to commuted overtime pay has led to threats of protests and legal action. SAMA says they will make civil claims for salaries owed, including for interest and legal costs. Registrars and medical officers at Dr George Mukhari Academic Hospital in Ga-Rankuwa collectively wrote to the hospital giving notice of withdrawal of overtime services until the non-payment issue is completely resolved. By 7 May, the head of anaesthesiology at Sefako Makgatho Health Sciences University wrote to the CEO of George Mukhari Hospital informing him that no anaesthesia services would take place at the hospital starting 8 May, given the decision by registrars and medical officers to down tools outside of regular work hours.

Those from the medical fraternity that Spotlight spoke to have set out a series of concerns. These include resignations; an exodus of doctors, especially specialists from the public sector; plummeting staff morale; negative impacts on the training of doctors as fewer consultants and seniors are available to supervise – which then puts universities’ training accreditations at risk. Ultimately, several sources point out, it is the services offered to the public that suffer.

Committee appointed

By the beginning of April, there appeared to be some walking back by the Gauteng health department of its unilateral cutback proposals after meeting with the South African Medical Association Trade Union (SAMATU). In the same week, a circular was issued announcing that the national health department was conducting a review of its own, instructing provinces to hold off on their plans. Health Minister Dr Aaron Motsoaledi then set up a committee of experts to review certain human resource policies in the public healthcare sector. This includes a review of community service, commuted overtime, remunerative work outside the public service for health professionals, and rural and related allowances.

Commuted overtime is a pre-determined amount of overtime that doctors employed by provincial health departments are allowed to work. The amount is historically decided by hospital management and is based on an employee’s role, seniority, the department they work in and the amount of overtime they are allowed to safely work. It’s a fixed rate of 1.3 times the applicable hourly tariff for a specific work grade.

There are five contract options. A is no overtime worked; B is overtime of between four and eight hours a week; C is overtime between 9 and 12 hours a week; D is overtime between 13 and 20 hours per week; and an option E is where, on approval, a doctor can be authorised to work more than 20 hours of overtime a week.

As a fixed amount, commuted overtime is predictable supplemental income and for many doctors, it amounts to about a third of their take-home pay.

The long rumblings to cut their overtime pay has seen doctors being required to motivate why they should remain on contracts that pay for more overtime hours and junior doctors say they are being pressured to sign option C contracts, which will pay for fewer overtime hours. There are also proposals to change some of the terms relating to overtime, including scrapping overtime payments for doctors who are on call but not physically present at a facility.

Many doctors already exceed the maximum hours of their contracts because of the emergency nature of their work, gross understaffing and backlogs at their hospitals.

Costly, but essential?

The commuted overtime pay model has been contentious for years because it adds up to a sizeable chunk of the healthcare budget. According to a spending review conducted in 2022 on behalf of National Treasury, the country’s health departments spent R6.9 billion on commuted overtime in 2021. This made up about 70% of the total R9.9 billion spent on all types of overtime.

In an editorial published in the South African Medical Journal in April 2025, health sciences academics, associations, and unions slammed the Gauteng health department’s handling of pay issues. They argue that the basic salaries of medical professionals in the public health sector are already much lower than what would be considered fair pay.

“COT [commuted overtime] has long served as a critical mechanism to ensure that doctors are available beyond the standard workday, safeguarding round-the-clock care in the public health system…The abrupt curtailment of this framework risks hollowing out the after-hours safety net, leaving emergency rooms, wards and clinics dangerously under-resourced,” they wrote.

A co-author of the editorial, SAMA CEO Dr Mzulungile Nodikida, told Spotlight: “Medical doctors in South Africa’s public sector are severely underpaid. A study by SAMA has shown that even the annual cost of living adjustments that have been made on the salaries have not matched inflation in the last 5 years. Commuted overtime has had the effect of masking a deficient salary.”

He said the Gauteng health department has shown itself to be an “unreliable employer”, adding that its relationship with doctors remains fractured as a loss of confidence in the department deepens.

“This breach of the most basic employment obligation: timely remuneration, has cascading effects. It jeopardises morale, compromises service delivery, and calls into question the department’s commitment to its workforce. Doctors now operate under a cloud of uncertainty, unsure whether they will receive their salaries at month-end. This anxiety permeates every aspect of the employment relationship, from retention efforts to the willingness to engage in additional responsibilities,” said Nodikida.

View from the wards

Two doctors who spoke to Spotlight independently, and from two different Gauteng hospitals, say the commuted overtime pay disaster is yet another symptom of weak human resources and poor management from the department of health. For them, proposals to cut commuted overtime is the department shirking from addressing the staffing crisis; the need to improve human resources systems; and rooting out corruption, maladministration and wasteful expenditure. Both doctors asked not to be named for fear of reprisals.

Dr A, who is based at Charlotte Maxeke Johannesburg Academic Hospital, said: “Instead of having a system in place to record how many hours each doctor is actually working and what overtime that person should be paid, the department pays everyone this commuted overtime fixed sum….[Y]ou could be a dermatologist or a psychologist and have very few overtime hours or be a surgeon who is doing a lot of overtime but you all get paid the same if you’re on the same contract option,” she said. “But right now, in my career I’m working way more overtime hours than my contract and I’m not being reimbursed for any of it.”

Dr A said the overtime pay cuts and proposed changes will impact her decision to stay in the public sector.

“It used to be the case that you were happy, once specialised, to stay because the overall lump sum of money from your salary and commuted overtime made up a decent pay – not comparable to what you could earn in private – but decent enough to stay,” she said.

She said she feels like doctors are now being under-valued and coming under attack by their own employer. “The message we are getting is that ‘if you’re not happy, there’s the door’ – but what the department doesn’t understand is that you can’t just replace someone with 10 years’ experience or someone who has 30 years’ experience, it has a huge impact,” she said.

“Our patients are suffering; and every day it’s like a game of Survivor. We run multiple clinics in one clinic space at Charlotte Maxeke, but you can’t offer a functioning service like that. It’s noisy, the computers don’t work, and the intercom is going off the whole time.

“The other day, I had a 90-year-old patient have a panic attack in the waiting room. He had been waiting for a while and left his wife, who is blind, in the car. He had to park far from the hospital building because the parking lot from the hospital fire [in April 2021] is still not properly repaired and he was overcome with worry,” she said.

Dr B works at Chris Hani Baragwanath Hospital and he said the debacle over doctors’ overtime pay has pushed him to the edge. He said doctors are already overworked and disheartened from working within a failing system. He sent photos to Spotlight of theatres and wards in darkness as power went off at the Soweto hospital for days at the end of April.

Chris Hani Baragwanath Hospital plunged in darkness after days-long power outage in late April. (Supplied)

He said staff bring in their own toilet paper because they’re told there’s none. Most alarming, he said “doctors are not getting the training and supervision they need” and regularly perform surgeries and procedures without adequate experience and with no supervision.

“They are overwhelmed, overworked and doing way too many overtime hours that they’re not being paid for. Then they go home overtired, eat a pizza and crash, sleep a few hours then do it all over again the next day, and the next day,” he said.

“We, doctors, are literally the ones putting patients’ lives at risk,” he said, adding that he is “surviving on anti-depressants” and has sometimes shut himself away in hospital storerooms crying tears of sheer frustration, exhaustion and exasperation.

Dr B does still count the wins though. It’s days when he clears an impossibly long patient list of children who need procedures done. It’s when he and his colleagues decide to push through to make sure no child’s procedure gets cancelled.

“Those are the good days – they’re just few and far between. And now the department is coming for us by cutting our overtime pay and forcing us to sign contracts to downgrade our overtime pay,” he said.

Resignations and impact on training

Professor Shabir Madhi is dean of the faculty of Health Sciences at the University of Witwatersrand. He said the proposed cuts and freezing of posts and changes to commuted overtime pay has already resulted in resignations of some senior staff at state hospitals.

“If we don’t have the proper consultant staff complement in these hospitals who can provide supervision throughout the day, it compromises our training of specialists as well as of undergraduate students.

“If the Health Professions Council of South Africa were to do an audit and find that there isn’t adequate consultant cover and supervision, they could remove the accreditation of the training programmes offered by the universities.

“The medical schools are completely dependent on the Gauteng Department of Health to retain consultants and other categories of staff, and to ensure that staff are allocated time for supervision and training of future medical doctors, including specialist, as well as other academic activities.

“It means decision-making around cuts to overtime pay need to be cognisant of the overall impact that it would have, and not only in how it would assess budget constraints. This situation needs meaningful and informed decision-making,” he said.

Dr Phuti Ratshabedi, Gauteng chairperson of SAMATU, said the non-payment of commuted overtime pay in April was a slap in the face from the provincial health department as the union had a meeting with the department that month and left with the department agreeing to uphold their contractual agreements to leave contracts terms for commuted overtime pay unchanged at least till the end of March 2026 – the end of the financial year.

“What we saw is that the department will promise one thing and do another. But we will be holding them to what they stated in their own circular or we will look to legal action.

“What we want to see in this review period is that they go after departments [where overtime is not being performed, but being paid for] but leave other departments alone – they cannot put everyone under the same blanket.

“If the government is able to bail out over and over things like Eskom and Transnet, how can they not prioritise healthcare – this sets our country way back and we doctors will no longer be silent about this,” said Ratshabedi.

Spotlight sent questions to the Gauteng health department, including on how the payment delay happened; the number of people affected; how the department is addressing the wide-spread knock-on effects of their proposed commuted overtime cuts; and what amendments they hope will come out of the national review. Despite several reminders, the department did not respond to our questions.

Republished from Spotlight under a Creative Commons licence.

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Categories : Expert Opinion Medical IndustryTags :

Opinion Piece: U.S. Funding Halted, Futures at Stake

On By ModernMedia

Finding a path forward for South Africa’s healthcare workers

Donald McMillan

By Donald McMillan, Managing Director at Allmed Healthcare Professionals

06 May 2025

South Africa’s healthcare system is under serious pressure. The sudden suspension of critical US funding has resulted in the loss of around 15 000 healthcare jobs – many of them linked to HIV/AIDS programmes that served as lifelines for vulnerable communities. Combined with broader public sector budget cuts and a national hiring freeze, the situation threatens to undo decades of progress in healthcare delivery. As public hospitals struggle with fewer staff and shrinking resources, the country is at risk of losing not only jobs, but skills, infrastructure, and hope. But in the face of these challenges, there are still ways to keep services running and people employed. One of them is through Temporary Employment Services (TES), which provides a flexible staffing approach that can help stabilise the system while longer-term solutions are explored.

A healthcare system under pressure

The US aid cut has had an immediate and devastating impact. Programmes focused on HIV, tuberculosis, and reproductive health, many of which were propped up by international donor funding, have been forced to scale back or shut down entirely. Thousands of community healthcare workers, nurses, counsellors, and administrators have found themselves jobless, while patients are left facing longer wait times and reduced access to care.

At the same time, cost-cutting across the public sector has put a freeze on new hires, even in essential departments like health and the impact is already being felt. With public hospitals and clinics stretched thin, they’re unable to take on newly trained doctors and nurses. And while the private sector plays a role, it simply cannot absorb the overflow. This isn’t just a staffing issue, it’s a setback for the entire healthcare system, affecting everything from medical training to frontline care.

Young professionals left in limbo

Every year, South Africa produces thousands of highly trained doctors and healthcare workers, many of whom move into the public health system after completing their compulsory community service. These roles used to be a given but with hiring freezes and shrinking budgets, many young professionals are now finishing their training with nowhere to go. Despite their skills and frontline experience, these workers are left in limbo. This is a double blow as South Africa loses out on the return from its investment in their education, while the risk of a growing skills drain looms large. With countries like the UK, Australia, and Canada actively recruiting healthcare workers, there’s a real chance they may leave and not come back.

A flexible solution in Temporary Employment Services

In response to this crisis, temporary employment solutions have become a practical and effective solution. TES providers offer qualified healthcare professionals short- to medium-term flexible contracts, enabling them to continue working in their field while delivering essential support to overburdened healthcare facilities.

This approach offers a lifeline not just for displaced workers, but for clinics and hospitals struggling with limited resources. TES employees can be rapidly deployed where they are needed most, whether to cover staff shortages, serve remote communities, or support seasonal fluctuations in demand. Unlike permanent hires, they don’t carry long-term costs such as medical aid or pension contributions, making them a more budget-conscious option in uncertain times.

The benefits of the TES model have already been proven. During the COVID-19 pandemic, temporary staff played a key role in scaling up testing, vaccination, and treatment efforts across the sector. That same adaptability is needed now to respond to the healthcare funding crisis.

Rethinking the future of healthcare work

While temporary employment solutions cannot not solve the problem alone, it can provide an important stopgap and potentially a new way of thinking about workforce planning in the healthcare sector. Rather than relying solely on permanent positions, South Africa may need to adopt a more fluid, demand-based deployment model that allows professionals to move between roles, regions, and areas of urgent need.

Shifting to this model calls for a change in mindset. Permanent posts have traditionally been seen as the gold standard in healthcare, valued for their stability and benefits. But in a time of uncertainty, contract and locum roles – especially when managed by trusted TES providers – can offer a practical alternative, combining income, ongoing experience, and flexibility.

Retaining talent, restoring hope

Avoiding long-term damage to South Africa’s healthcare system will require urgent, coordinated action. Government departments must urgently reprioritise spending toward essential services like health and education. At the same time, private healthcare providers and staffing agencies must step up and work together to ensure that skilled professionals are not lost to the system or the country.

Despite the current turbulence, South Africa’s healthcare workers remain among the best trained and most resilient in the world and with the right support structures, including flexible employment options like TES, we can preserve our healthcare capacity and continue to serve those who need it most.

Categories : Healthcare Politics and RegulationsTags :

Government Announces 1200 New Doctor Positions – But Nursing Loses out

On By ModernMedia

In a move that will come as a relief for the hundreds of unemployed doctors currently seeking positions within public healthcare, the Department of Health has announced the creation of 1650 new positions for healthcare professionals. The move includes 1200 new positions for doctors – but only 200 for nurses.

Health Minister Dr Aaron Motsoaledi made the announcement at a media briefing on Thursday 10 April.

“We believe we’re in a position to announce today that the council has approved the advertisement of 1200 jobs for doctors, 200 for nurses and 250 for other healthcare professionals,” Motsoaledi stated. This would come with a cost of R1.78 billion – out of a healthcare budget that has not risen in line with inflation.

Jobless doctors picketed earlier this year as more than 1800 were left in limbo without positions – the true number is likely higher. The South African Medical Association (SAMA) had sent an urgent letter to President Cyril Ramaphosa, warning that if the problem was not addressed, doctors would leave for the private sector or emigrate, leading to the collapse of the public healthcare sector.

The road to specialisation had also been made more challenging by the shortage of positions, with junior doctors have been taking unpaid roles. Such unpaid work does not count toward the registrar component of specialisation and largely only serves to bump up the doctor’s CV by, for example, enabling them to apply for diplomas. Hiring freezes also saw GPs unable to move into government positions, and the limited number of registrar positions has also by some accounts become a bottleneck, with no additional registrar positions added for the past 10–15 years.

Regarding the loss of US funding for HIV programmes, he said that there was a buffer of stock for ARVS, and that “no person needing ARVs would lack” those drugs.

But the small number of new nurse positions was not well received. The Democratic Nursing Organisation of South Africa (DENOSA) was particularly unimpressed given the pressure on overburdened nurses.

DENOSA spokesperson Sonia Mabunda-Kaziboni said, “In the face of a nationwide crisis of nurse shortages, this announcement is not only shockingly inadequate but downright insulting to the nursing fraternity.”

Calling it a “slap in the face”, she continued: “The shortage of nurses in South Africa is nothing short of a devastating crisis. The Free State alone faces a 28% vacancy rate, and similar figures are reflected in other provinces such as the Eastern Cape. National projections estimate that South Africa could be short by over 100 000 nurses by 2030 if urgent interventions are not made.”

DENOSA plans to “name and shame” institutions that have become “dangerous to communities” as a result of unresolved poor conditions.

Categories : General Interest Medical Research & TechnologyTags :

Healthcare Trends to Watch in 2025

On By ModernMedia
AI image made with Gencraft using Quicknews’ prompts.

Quicknews takes a look at some of the big events and concerns that defined healthcare 2024, and looks into its crystal ball identify to new trends and emerging opportunities from various news and opinion pieces. There’s a lot going on right now: the battle to make universal healthcare a reality for South Africans, growing noncommunicable diseases and new technologies and treatments – plus some hope in the fight against HIV and certain other diseases.

1. The uncertainty over NHI will continue

For South Africa, the biggest event in healthcare was the signing into law of the National Health Insurance (NHI) by President Ramaphosa in May 2024, right before the elections. This occurred in the face of stiff opposition from many healthcare associations. It has since been bogged down in legal battles, with a section governing the Certificate of Need to practice recently struck down by the High Court as it infringed on at least six constitutional rights.

Much uncertainty around the NHI has been expressed by various organisation such as the Health Funders Association (HFA). Potential pitfalls and also benefits and opportunities have been highlighted. But the biggest obstacle of all is the sheer cost of the project, estimated at some R1.3 trillion. This would need massive tax increases to fund it – an unworkable solution which would see an extra R37 000 in payroll tax. Modest economic growth of around 1.5% is expected for South Africa in 2025, but is nowhere near creating enough surplus wealth to match the national healthcare of a country like Japan. And yet, amidst all the uncertainty, the healthcare sector is expected to do well in 2025.

Whether the Government of National Unity (GNU) will be able to hammer out a workable path forward for NHI remains an open question, with various parties at loggerheads over its implementation. Public–private partnerships are preferred by the DA and groups such as Solidarity, but whether the fragile GNU will last long enough for a compromise remains anybody’s guess.

It is reported that latest NHI proposal from the ANC includes forcing medical aid schemes to lower their prices by competing with government – although Health Minister Aaron Motsoaledi has dismissed these reports. In any case, medical aid schemes are already increasing their rates as healthcare costs continue to rise in what is an inexorable global trend – fuelled in large part by ageing populations and increases in noncommunicable diseases.

2. New obesity treatments will be developed

Non-communicable diseases account for 56% of deaths in South Africa, and obesity is a major risk factor, along with hypertension and hyperglycaemia, which are often comorbid. GLP-1 agonists were all over the news in 2023 and 2024 as they became approved in certain countries for the treatment of obesity. But in South Africa, they are only approved for use in obesity with a diabetes diagnosis, after diet and exercise have failed to make a difference, with one exception. Doctors also caution against using them as a ‘silver bullet’. Some are calling for cost reductions as they can be quite expensive; a generic for liraglutide in SA is expected in the next few years.

Further on the horizon, there are a host of experimental drugs undergoing testing for obesity treatment, according to a review published in Nature. While GLP-1 remains a target for many new drugs, others focus on gut hormones involved in appetite: GIP-1, glucagon, PYY and amylin. There are 5 new drugs in Phase 3 trials, expected variously to finish between 2025 and 2027, 10 drugs in Phase 2 clinical trials and 18 in Phase 1. Some are also finding applications beside obesity. The GLP-1 agonist survodutide, for example have received FDA approval not for obesity but for liver fibrosis.

With steadily increasing rates of overweight/obesity and disorders associated with them, this will continue to be a prominent research area. In the US, where the health costs of poor diet match what consumers spend on groceries, ‘food as medicine’ has become a major buzzword as companies strive to deliver healthy nutritional solutions. Retailers are providing much of the push, and South Africa is no exception. Medical aid scheme benefits are giving way to initiatives such as Pick n Pay’s Live Well Club, which simply offers triple Smart Shopper points to members who sign up.

Another promising approach to the obesity fight is precision medicine, which factors in many data about the patient to identify the best interventions. This could include detailed study of energy balance regulation, helping to select the right antiobesity medication based on actionable behavioural and phsyiologic traits. Genotyping, multi-omics, and big data analysis are growing fields that might also uncover additional signatures or phenotypes better responsive to certain interventions.

3. AI tools become the norm

Wearable health monitoring technology has gone from the lab to commonly available consumer products. Continued innovation in this field will lead to cheaper, more accurate devices with greater functionality. Smart rings, microneedle patches and even health monitoring using Bluetooth earphones such as Apple’s Airpods show how these devices are becoming smaller and more discrete. But health insurance schemes remain unconvinced as to their benefits.

After making a huge splash in 2024 as it rapidly evolved, AI technology is now maturing and entering a consolidation phase. Already, its use has become commonplace in many areas: the image at the top of the article is AI-generated, although it took a few attempts with the doctors exhibiting polydactyly and AI choosing to write “20215” instead of “2025”. An emerging area is to use AI in patient phenotyping (classifying patients based on biological, behavioural, or genetic attributes) and digital twins (virtual simulations of individual patients), enabling precision medicine. Digital twins for example, can serve as a “placebo” in a trial of a new treatment, as is being investigated in ALS research.

Rather than replacing human doctors, it is likely that AI’s key application is reducing lowering workforce costs, a major component of healthcare costs. Chatbots, for example, could engage with patients and help them navigate the healthcare system. Other AI application include tools to speed up and improve diagnosis, eg in radiology, and aiding communication within the healthcare system by helping come up with and structure notes.

4. Emerging solutions to labour shortages

Given the long lead times to recruit and train healthcare workers, 2025 will not likely see any change to the massive shortages of all positions from nurses to specialists.

At the same time, public healthcare has seen freezes on hiring resulting in the paradoxical situation of unemployed junior doctors in a country desperately in need of more doctors – 800 at the start of 2024 were without posts. The DA has tabled a Bill to amend the Health Professions Act at would allow private healthcare to recruit interns and those doing community service. Critics have pointed out that it would exacerbate the existing public–private healthcare gap.

But there are some welcome developments: thanks to a five-year plan from the Department of Health, family physicians in SA are finally going to get their chance to shine and address many problems in healthcare delivery. These ‘super generalists’ are equipped with a four-year specialisation and are set to take up roles as clinical managers, leading multi-disciplinary district hospital teams.

Less obvious is where the country will be able to secure enough nurses to meet its needs. The main challenge is that nurses, especially specialist nurses, are ageing – and it’s not clear where their replacements are coming from. In the next 15 years, some 48% of the country’s nurses are set to retire. Coupled with that is the general consensus that the new nursing training curriculum is a flop: the old one, from 1987 to 2020, produced nurses with well-rounded skills, says Simon Hlungwani, president of the Democratic Nursing Organisation of South Africa (Denosa). There’s also a skills bottleneck: institutions like Baragwanath used to cater for 300 students at a time, now they are only approved to handle 80. The drive for recruitment will also have to be accompanied by some serious educational reform to get back on track.

5. Progress against many diseases

Sub-Saharan Africa continues to drive declines in new HIV infections.  Lifetime odds of getting HIV have fallen by 60% since the 1995 peak. It also saw the largest decrease in population without a suppressed level of HIV (PUV), from 19.7 million people in 2003 to 11.3 million people in 2021. While there is a slowing in the increase of population living with HIV, it is predicted to peak by 2039 at 44.4 million people globally. But the UNAIDS HIV targets for 2030 are unlikely to be met.

As human papillomavirus (HPV) vaccination programmes continue, cervical cancer deaths in young women are plummeting, a trend which is certain to continue.

A ‘new’ respiratory virus currently circulating in China will fortunately not be the next COVID. Unlike SARS-CoV-2, human metapneumovirus (HMPV) has been around for decades, and only causes a few days of mild illness, with bed rest and fluids as the primary treatment. The virus has limited pandemic potential, according to experts.

Categories : CancerTags :

Radiation Therapy Graduates Unplaced for Six Months by Health Department

On By ModernMedia
Photo by National Cancer Institute on Unsplash

A number of radiation therapy graduates, who must by law complete the Department of Health’s Internship and Community Service Programme in order to practise medicine, say they have been waiting for nearly six months to be placed in hospitals.

They have finished their four-year studies and now need to complete a year-long internship, referred to as Comserve, in order to register and practice as medical professionals. Their primary role is to administer radiation treatment to patients with cancer.

The community service programme is administered by the National Department of Health.

“We are left in limbo, not sure when we will receive a post,” a graduate from the Western Cape, who wished to be anonymous, told GroundUp. He said that they’ve been told since the beginning of the year by Comserve officials that they are engaging with provinces to secure them placements.

He shared correspondence that said he was not yet allocated a position “due to the unavailability of funded posts”.

He said that it was “frustrating” that they are required by law to do Comserve yet the department cannot find them posts.

“We are all stressed out … We still have bills to pay from university. We are squatting with our parents. We were promised we were going to have a job after studying and now we can’t apply for other jobs. Our hands are cut off. We can’t do anything,” he said.

He said he knew of about nine other radiation therapists also waiting for placements.

Another graduate, from KwaZulu-Natal, said the lack of placement risked creating a backlog when next year’s graduates need to do Comserve.

“At the end of the day, our cancer patients are going to suffer … They need us and we have trained specifically to help them,” she said.

The failure to place graduates is happening despite staff shortages in radiation oncology departments in Gauteng.

On 30 April activists from SECTION27, Cancer Alliance and the Treatment Action Campaign (TAC) as well as cancer patients marched to the offices of the Gauteng department of health demanding that millions of rands set aside for radiation treatment be used.

In an open letter addressed to health MEC Nomantu Nkomo-Ralehoko, the organisations provided a backlog list of about 3000 patients awaiting radiation oncology treatment.

Salomé Meyer of the Cancer Alliance says there are radiation oncology staff shortages in Charlotte Maxeke Johannesburg Academic Hospital and Steve Biko Academic Hospital.

Both graduates GroundUp spoke to had applied to Charlotte Maxeke for their Comserve year.

In December 2023, the national department stated that nearly 10 400 Comserve applications were received. Of these just shy of 9400 applicants “were successfully placed, and this includes medical doctors, nurses, pharmacists and other health professionals at health facilities throughout the country”.

National Department of Health spokesperson Foster Mohale sent GroundUp an incoherent and incomplete WhatsApp response. “We only know those who were placed. We can’t tell those who were not placed because we are not sure of their career plans,” he wrote.

Asked about staff shortages, Mohale wrote that the department “prioritises all critical posts using limited budget”.

The Gauteng Department of Health did not respond to our questions about radiology therapist Comserve placements and staff shortages in its hospitals, despite committing to do so and repeated follow-ups.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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Categories : HospitalsTags :

Opinion piece: Specialist TES Providers Optimising Healthcare Operations – a Prescription for Patient Care Success

On By ModernMedia

By Sandra Sampson, Director at Allmed

Sandra Sampson

The healthcare sector in South Africa is beset with numerous challenges, ranging from high turnover rates to skilled staffing shortages and complex regulations in addition to stressful working environments, and communication barriers.

Despite these formidable obstacles, patients have the right to expect top-tier care from their medical facilities. Here, specialised Temporary Employment Services (TES) providers can become indispensable partners, adeptly assisting medical facilities to navigate these challenges in their quest to ensure a seamless continuum of care.

Streamlining healthcare staffing to counter shortages

Specialist TES providers offer a multifaceted remedy to the relentless staffing challenges in healthcare. Capable of promptly supplying temporary staff to bridge immediate gaps, TES providers ensure that all resources have already been rigorously screened, recruiting qualified professionals to function as a buffer against high turnover and staffing scarcities. Through tailored training, specialist providers ensure that their temporary staff placements align seamlessly with organisational expectations to consistently uphold care standards. Furthermore, specialist TES providers alleviate the burden of complex healthcare regulations on management and staff by taking on the responsibility of handling the entire employment relationship, from end to end, including managing human resources and labour relations components, as well as payroll. This provides significant relief for healthcare facilities giving them the staffing resources that they need, without the additional administrative complexities involved with recruiting, on-boarding and managing such resources.

Addressing skills gaps to raise the bar on healthcare resources

Maintaining consistent levels of patient care without compromising quality is challenging in the face of staffing shortages and high turnover rates. With so many specialised healthcare staff, including ICU personnel, leaving for better opportunities abroad due to financial considerations, such an exodus necessitates urgent strategies to retain and fill gaps within healthcare facilities. Specialist TES providers are already playing a critical role in addressing these concerns by focusing on nurse competencies and facilitating targeted courses to upskill their resources. These courses address critical gaps in patient safety and empower nurses to provide better care. Through the development of these essential courses, such as ECG interpretation and cannulation, TES providers are taking significant steps to ensure nurses possess the necessary skills and knowledge. This proactive approach not only enhances patient care at a facility level, but also contributes to nurse competence and job satisfaction, ultimately benefiting the healthcare ecosystem.

The strategic advantages of enhancing workforce dynamics

In addition to operational bolstering and sector-specific upskilling, specialist healthcare TES providers present strategic benefits for healthcare facilities. Access to a diverse, extensive talent pool makes it simpler for medical organisations to find the ideal fit for each role, effectively mitigating the risk of hiring mismatches usually associated with permanent placements. Medical facilities also benefit from the cost-effectiveness of the TES operating model, which aligns with the dynamic nature of healthcare to optimise resource allocation. This is particularly important in hospitals where patient occupancy levels fluctuate daily. Many healthcare organisations now operate with a 50/50 ratio of permanent placements and temporary resources, which gives them the flexibility to accommodate the ever-shifting demands of patient care staffing, while safeguarding the delivery of quality care. By efficiently managing both permanent and agency staff, TES providers optimise recruitment efforts and ensure that the right candidates are placed in suitable roles, benefiting the healthcare organisation’s operations and patient care. TES providers uphold patient confidentiality and provide comprehensive training, ensuring staff are cognisant of privacy protocols and handle sensitive information appropriately.

Boosting patient care excellence: the vital role of specialist TES providers

In an era where healthcare value is intricately tied to workforce excellence, TES providers play a pivotal role in elevating the sector by helping medical facilities conquer their industry-specific challenges, enabling the fundamental mission of enhancing patient well-being. Ultimately, Specialist TES providers represent a crucial element in the healthcare sector’s quest for excellence, as their strategic approach to staffing not only addresses immediate needs but also upholds patient care standards, while easing administrative burdens, and enhancing workforce competencies. As such, collaboration with specialist TES providers is a progressive strategy that medical organisations should prioritise to effectively navigate the intricate challenges of the healthcare landscape today while significantly enhancing patient care outcomes.

Categories : Expert Opinion HospitalsTags :

Our Nurses, Our future: Addressing the Critical Issue of Sustainability in SA’s Healthcare Sector

On By ModernMedia
Photo by Hush Naidoo on Unsplash

With only 22 090 nurses to serve the country’s public health sector of more than 50 million citizens1, urgent intervention is required to bolster their numbers and protect the wellbeing of our nation. After all, without their tireless dedication, who will be there to guide you through the corridors back to health? writes Bada Pharasi, CEO of the Innovative Pharmaceutical Association of South Africa (IPASA)

As the global healthcare industry commemorates International Nurses Day on 12 May, it is an opportune moment to reflect on the role of nurses as the heartbeat of healthcare systems globally. Amid turmoil and triumph, nurses stand as the unsung heroes and compassionate caretakers who embody empathy, endurance and expertise. 

In South Africa, where healthcare challenges often loom large and resources are stretched thin, nurses serve as the frontline warriors, bridging the gap between suffering and healing. Yet, despite the invaluable role they play, a concerning trend looms.

Minister of Health, Joe Phaahla, recently revealed a pressing concern – the anticipation of a staggering 30% of South African nurses retiring within the next decade, and 38% retiring the decade thereafter. Compounding the issue, 5060 vacancies remain unfilled on the back of crippling budget constraints1. 

Representing over 90% of global healthcare workers2, nurses are indispensable in the healthcare ecosystem, and addressing this impending crisis of their reducing numbers demands comprehensive and multifaceted solutions that approach the challenge from every angle.

The nurse shortage crisis in South Africa stems from multiple factors. Firstly, the escalating healthcare needs of a growing population, compounded by the burden of infectious diseases such as HIV/AIDS, have strained the healthcare system to breaking point.

Another factor is the restricted capacity of the private sector to train nurses comprehensively due to existing regulations. Moreover, poor working conditions, particularly in the public sector, and comparatively low salaries have led to high turnover rates, prompting nurses to explore alternative career paths or seek employment opportunities abroad3. 

While there are many challenges to defusing the proverbial ticking time bomb which is the declining number of qualified nurses in South Africa, increased investment across the board is critical to strengthening their ranks. 

Despite financial investment being central in realising this, addressing the problem demands a focus on improving the working conditions of nurses. Healthcare facilities must prioritise nurses’ well-being by offering competitive salaries, manageable workloads, and opportunities for career growth. By creating a supportive work environment, South Africa can retain more nurses and deter them from seeking opportunities abroad3.

Furthermore, granting private hospitals full participation in nurse training programmes is crucial. Private sector entities, such as Netcare, have the capacity to train as many as 3,500 nurses annually. However, limited accreditation from the government hampers their potential contribution to resolving the nurse shortage. Expanding private sector involvement in nurse training could substantially increase the number of trained nurses in the country3.

In addition to these measures, collaborative efforts between the government, healthcare institutions, and nursing organisations are essential. Such partnerships can identify and implement strategies to alleviate the shortage, including targeted recruitment drives, mentorship programmes, and initiatives to improve nurses’ job satisfaction and work-life balance3.

Innovative approaches to addressing the nurse shortage in South Africa extend beyond traditional solutions. Telemedicine platforms are emerging as a promising tool, allowing nurses to deliver care remotely and reach patients in underserved areas. 

Additionally, community health worker programmes are being expanded to complement nursing services and extend healthcare access to marginalised communities. Furthermore, initiatives to empower and support nurse entrepreneurs are gaining traction, encouraging the development of innovative care models and healthcare solutions. 

These diverse approaches reflect a multifaceted response to the nurse shortage crisis, leveraging technology, community engagement, and entrepreneurship to strengthen the healthcare workforce and improve access to care for all South Africans.

References:

1. Only 22 000 nurses for 50 million South Africans [Internet]. Democratic Alliance. [cited 2024 May 2]. Available from: https://www.da.org.za/2023/06/only-22-000-nurses-for-50-million-south-africans

2. Experiences of nurses and midwives in policy development in low- and middle-income countries: Qualitative systematic review. International Journal of Nursing Studies Advances. 2023 Dec 1;5:100116.

3. [Opinion] Nurse shortage crisis in South Africa [Internet]. Centre for Risk Analysis. 2023 [cited 2024 May 2]. Available from: https://cra-sa.com/media/opinion-nurse-shortage-crisis-in-south-africa

Categories : Healthcare Politics and RegulationsTags :

Unemployed Doctors March to Union Buildings

On By ModernMedia

They are calling for the president to intervene and make sure medical professionals are employed

By Silver Sibiya for GroundUp

Scores of unemployed doctors, nurses and other health workers marched to the Union Buildings in Pretoria on Monday, calling for the Presidency to intervene in the ongoing financial problems facing the health sector.

One of their main demands is for the health budget to be increased to absorb about 800 medical professionals.

Joining the march, Mandla Matshabe, said he never imagined being unemployed when he completed his community service at Sefako Makgatho University in December last year after studying in Cuba.

“Now I’m sitting at home with a medical qualification when there is a dire need. It’s appalling to think there are medical professionals at home,” he said.

Matshabe, who lives in Hazyview in Mpumalanga, said many unemployed health workers were becoming depressed at home. He said hiring qualified doctors could help alleviate some of the burnout among doctors in the public sector.

“Doctors in communities are overburdened because we don’t have enough medical professionals, including physiotherapists and dieticians or everyone in the hospital,” he said.

University of Cape Town graduate Lerato Jaca said it was discouraging to be an unemployed doctor. “I come from KwaNzimakwe in Port Shepstone where there were literally no doctors when I was growing up.”

Jaca was raised by an unemployed single mother who relied on the money she made during Jaca’s three-year community service employment at Ermelo Hospital.

She said they now rely on her brother’s disability grant and his children’s child support grants to buy food.

Deputy President of the South African Medical Association, Dr Nkateko Minisi, said: “Other health professionals in the allied sectors, including pharmacy, are here with us to hand over a memorandum to build up the health system. But to do so, we feel that human capital must be optimised by hiring all these unemployed professionals. Not tomorrow, not next week but now!” she said.

Mnisi said more than 80% of the population depends on public health services. “Healthcare is not a privilege that should be enjoyed by some; it is a basic human right that every single person deserves.”

Communications Manager at The Presidency, Phil Mahlangu accepted the group’s memorandum.

He said that the presidency was “immensely worried as the presidency about the negative issues affecting the medical industry”. He promised the protestors a response within a week.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Categories : HospitalsTags :

South Korean Trainee Doctors Walk Out en Masse

On By ModernMedia
Photo by Hush Naidoo on Unsplash

Physicians argue that trying to combat dwindling numbers with increased medical school places ignores the real problem: gruelling hours and low pay

At several major South Korean hospitals, thousands of doctors walked out on Tuesday, causing widespread disruption in a protest at the government’s plan to increase the numbers of medical school students, The New York Times reports.

On Monday, over 6000 doctors had submitted resignations at Seoul’s five hospitals and left at 6am on Tuesday, the Health Department reported. One of the hospitals had up a sign saying that its emergency department was only handling cardiac arrest cases; the other four were on “red alert”.

Government sources state that 7813 doctors had walked off the job, Reuters reports.

South Korea may have one of the most advanced healthcare systems in the world, but it is plagued by a critical shortage of doctors. The protestors, interns and residents, say that this shortage is confined to certain areas such as emergency medicine, which are poorly compensated by the government and insurance providers. Cosmetic medicine on the other hand, is highly profitable.

One survey found that doctors in training regularly work shifts longer than 24 hours and many work for more than 80 hours a week. (In South Africa, a 2012 study found that interns regularly put in 150–200 hours of overtime per month, working out to 80–90 hours a week.)

Other factors such as an ageing population are putting more and more strain on doctors.

Early this month, the government announced a plan to increase South Korea’s medical school admissions quota from 3000 to 5000. The Ministry of Health and Welfare regulates the licences to practice medicine. Doctors were immediately critical of the plan, protesting with placards saying things like “end of health care.”

Categories : Mental HealthTags :

New Tool Predicts Burnout Risk

On By ModernMedia
Photo by Mulyadi on Unsplash

It is not uncommon for people to “hit the wall” at work and experience burnout for short or long periods of time.

“We have found that approximately 13 per cent of Norwegian employees are at high risk of burnout,” says Leon De Beer, Associate Professor of Work and Organizational Psychology at the Norwegian University of Science and Technology (NTNU) Department of Psychology.

De Beer has contributed to a new study on burnout published in the Scandinavian Journal of Psychology with colleagues from the Healthy Workplaces research group.

They are working on a new tool that can identify people at risk of burnout. 

Signs that you might be at risk of burnout

If you are facing demands and stress at work that seem to be intractable, and you have frequently experienced the following symptoms in recent weeks, it might be a sign that you are on the verge of burning out:

  1. You feel mentally exhausted at work.
  2. You struggle to feel enthusiastic about your job.
  3. You have trouble concentrating when working.
  4. You sometimes overreact at work without meaning to.

Early intervention is key

It is important to identify the early signs of burnout in order to mitigate the harmful effects. The warning signs are often present before things have gone too far, as long as we manage to identify them.

“Not addressing the risk of employee burnout in time can have long-term consequences,” says De Beer.

The physical and psychological effects of burnout include cardiovascular disease, pain related to musculoskeletal injuries, sleeping problems, and depression. Organisations can also lose talented employees and experience an increase in sickness absence and lost productivity.

A new tool may become standard

De Beer’s research group has trialled a new measurement tool to identify the early warning signs of burnout. In the past, it has not always been that easy.

“Previously, we have not had a detailed enough measurement tool for use in both the field of practice and research that identifies workers who are at risk of burnout,” says De Beer.

There is currently no international standard for assessing burnout.

The new tool is called the Burnout Assessment Tool, or BAT among researchers who have a penchant for amusing abbreviations. The BAT consortium, of which the researchers are a part, is now testing the instrument in more than 30 countries.

https://burnoutassessmenttool.be/start_eng/

Start ENG

“Our studies show that BAT is a good tool for identifying the risk of burnout,” says De Beer.

Burnout is the body’s response to stress

BAT measures four main groups of risk factors: exhaustion, mental distancing, cognitive impairment and emotional impairment.

Burnout is not really an illness, but a feeling of being mentally or physically exhausted — the body’s response to a lasting, demanding situation.

Burnout is normally defined as a work-related syndrome, but there is evidence that work-life balance also plays a role. Stress and burnout don’t necessarily stop when you go home at the end of the day, as these effects often extend into other areas of life and vice versa.

Some may experience years of burnout

For some people, burnout can be stopped in its tracks and solutions found to improve their situation. For others, however, burnout can last for years if the problem isn’t addressed.

“We can deal with burnout through individual treatment, but it is of little use if people return to a workplace where the demands are too high and there are few resources. It is then highly likely that the employee will become ill again. Therefore, it is important to create good working conditions and structures that safeguard the health of employees,” says Professor Marit Christensen at NTNU’s Department of Psychology.

Culturally independent

The researchers studied a representative sample of 500 Norwegian workers. Norway is roughly on par with the EU average when it comes to mental health, but somewhat better when it comes to work-related matters.

A lower percentage of the Norwegian population struggles with exhaustion in connection with work. Somewhat fewer people than the EU average report health hazards at work, and we experience a better work-life balance.

“Using a recognised method, we found that around 13 per cent of the 500 surveyed workers were at high risk of burnout,” says Professor Christensen.

The tool can help identify who requires the most urgent follow up so that the risk of burnout can be reduced.

We do not yet know whether the prevalence of burnout in Norway is high in an international context. The Norwegian study is among several BAT studies that are currently taking place, so these answers will be available at a later date.

The tool is intended to be culturally independent, and it certainly works well in Norway. The researchers also found that the tool works regardless of gender.

“For entertainment and educational purposes, interested parties can use our online tool to test if they are at risk of burnout,” says Professor Christensen.

“Please note that the tool only gives an indication of risk and does not provide any type of formal diagnosis or medical advice. If you are concerned about your levels of work-related stress, we encourage you to visit a health care provider to discuss the matter,” says Professor Christensen.

Source: Norwegian University of Science and Technology