Medical Doctor Skills Shortage in South Africa
From the statistics available for analysis and bearing in mind the DoL’s definitions of scarcity, it is clear that there is a shortage of doctors in South Africa in both absolute and relative terms. Nowhere in the country do we find the doctors per population norms of even middle income countries internationally.
We might compare favourably with our African neighbours but they are the most undeserved countries in the world. In World Bank terms we are, overall, are only slightly better than countries defined as ‘low income’. Our shortage is particularly high in the public sector and in rural areas.
Figures on vacancy rates make this clear. In the public sector in general, nearly one third of the medical practitioner posts (a total of 5103) are vacant to bring the number of doctors in the public sector to the international norm for low income countries we would have to raise that vacancy figure to 6450.
The DoL’s database of vacancies advertised in the Business Times shows that in the three years 2004 to 2007, vacancies for health professionals formed nearly one third of all vacancies for professionals advertised. Of these more than one third (36 per cent) were for medical practitioners. The HSRC survey found a fill rate of 57 per cent for health professionals in general and 54 per cent for medical practitioners. In international terms this is a clear indication of shortage (the New Zealand DoL regards fill rates of less than 80 per cent as signs of shortage.)
In some rural provinces such as the Eastern Cape we have hardly more doctors per population than some of our poorest neighbouring countries. The fact that we have been relying on foreign doctors and community service doctors to prop up the rural services confirms this. At the same time, our commitment to the governments of other African countries that we will not encourage their doctors to come to South Africa, means we are sending back or turning away doctors who would be more than willing to serve in these areas.
In generalising the policy to all foreign doctors, including those from developed nations, we are also barring many who come from countries that have more than enough doctors to serve their needs and who wish to work in this country either for various, often altruistic, reasons.
The Department of Health is pinning its hopes on government- to- 95 government agreements but so far these have failed to secure more than a few hundred doctors, mainly Cubans, and their numbers are dwindling.
The DoH’s HRH Plan has set a target of doubling the number of medical graduates by 2014. Research shows this is unrealistic, given existing growth rates and the fact that the plan presents no concomitant plans to expand the existing medical schools or start new schools or, most important of all, to increase numbers of academic staff.
There has been very little growth in the numbers of enrollments recently (4 per cent increase between 1999 and 2005) although our numbers of graduates increased by 51 per cent, largely due to very high percentage increases at UKZN and WSU.
Whether these increases are due to catch up (from earlier increases in enrolments) or a decline in standards for graduating needs to be investigated. Our research also indicates two worrying points of attrition: those graduates who do not enter community service straight after completing their internship and the slow rate of increase in the numbers of female registrations (at current rates it will take 21 years for women doctors to reach a 50:50 ratio with male doctors even though they already outnumber males at university where the ratio is 56:44 women to men).