Doctors in South Africa are grappling with high unemployment rates post-community service, leading to severe implications for the healthcare system and patient care.
Last week, unemployed doctors protested in Mpumalanga and the Eastern Cape, demanding to be employed. Unemployed doctors also protested in KwaZulu-Natal last year. In one instance, unemployed doctors staged a sit-in at the Natalia building at the department’s offices in Pietermaritzburg.
Distressed and overwhelmed, many of these medical professionals are sounding the alarm, highlighting a crisis that extends far beyond their personal circumstances and into the broader health system.
South African Medical Association Trade Union (Samatu) general secretary, Dr Cedric Sihlangu, said the major challenge currently faced by doctors in the healthcare sector is the persisting high number of unemployed doctors who have completed their community service.
Sihlangu stated that as of January 21, 2025, the union has a record of 634 qualified doctors who are post-community service and are sitting at home unemployed.
“The ripple effect of this issue is that not only does it affect the unemployed doctors, it affects the employed doctors because they end up being overworked due to understaffing.
“Communities suffer because they have to wait in long queues to get basic healthcare services, the quality of healthcare provided diminishes, and the bill for medical negligence claims ends up skyrocketing because patients are seen by doctors who are fatigued,” he said.
Sihlangu added that this issue of unemployed doctors affects all of us in one way or another.
“The World Health Organization recommends a ratio of approximately 2.3 doctors per 1 000 patients, yet in South Africa, you get a ratio of approximately 0.9 doctors per 1 000 patients.”
Sihlangu said this indicates a challenge in meeting the healthcare needs of the population in terms of staffing in public healthcare facilities.
Challenges in commuted overtime and staffing
“The other issue is the commuted overtime. Some provincial departments of health have been issuing circulars intending to reduce the commuted overtime for doctors, which essentially means that the salaries for doctors will be reduced while they are required to work long hours,” Sihlangu said.
In addition, he mentioned that while the Department of Health is in the process of rolling out the implementation of the National Health Insurance(NHI), which is a significant step towards resolving the inequalities that exist in the current two-tier healthcare system, the current understaffing issue in public healthcare makes it impossible to implement the NHI efficiently.
“This issue has been persisting for far too long. Samatu has engaged the Department of Health during the previous years and highlighted the need for a strategy to be formed in terms of the absorption of doctors post-community service, but the department has failed,” said Sihlangu.
He noted that Health Minister Aaron Motsoaledi’s response to this issue is that these doctors should seek employment in the private sector or abroad.
“We find the minister’s response quite concerning because how do we allow doctors to leave the public sector or go practice abroad when we still have people in remote areas queuing for basic healthcare services from 5am only to be seen by a doctor at 10am?”
He emphasised that doctors should not be encouraged to go into private practice when private practice serves a relatively small percentage of South Africa’s population.
“We should be doing everything possible to retain as many doctors as possible in the public healthcare system, where there is a need,” he added.
Unsafe working conditions
Claude Naiker, who is the acting deputy general manager of members’ affairs at the Public Servants Association (PSA), said doctors are working in unsafe environments with aging infrastructure and constant abuse by patients.
Naiker stated that doctors are facing an unbearable work overload owing to chronic understaffing at most hospitals as the government claims that there is no money to hire more employees.
“There is a lack of support in terms of mental health and wellbeing. They experience emotional distress due to the weight of the work they carry, yet they are not allowed to make mistakes because people’s lives are involved,” he said.
He added that while committed overtime has been reduced by the employer, doctors are still subjected to work more hours due to the shortage of staff.
In addition, he mentioned that specialised doctors are also unprocedurally reshuffled to cover other areas in other institutions that have a shortage of doctors.
Naiker also stated that there is a frequent shortage of medical supplies, especially in rural clinics, as well as a shortage of support staff in clinics and hospitals.
Personal account from the front-line
A doctor working at a government hospital in Mpumalanga, who requested not to be named for fear of victimisation, said doctors are under attack in terms of unemployment and commuted overtime.
“Medical officers are sitting at home after completing community service while there is a shortage of doctors in the hospitals,” she said.
She noted that the Mpumalanga government is trying to remove or reduce overtime for doctors while there is already a shortage, which is evident on the call rosters.
Regarding infrastructure, she mentioned that there is a lack of emergency resources, broken SATS monitors, malfunctioning vital signs machines, no blood gas machine cartridges, no fitting blood pressure cuffs for obese patients and babies, and a general scarcity of resources.
“We are expected to do miracles with few to no resources as doctors,” she said, adding that on-call rooms are not easily accessible for all on-call doctors.
According to the doctor, there are no booking systems at the hospital where she works, nor triage nurses or phlebotomists in the Outpatient Department.
She noted that there is a delay in getting emergency blood results and that there is no referral system from the clinics.
“The filing system has collapsed in terms of files being lost during every visit, making it difficult for follow-ups.”
She mentioned that doctors do not have Wi-Fi to access systems like the medical referral app Vula, lab track, and email for patients to have a smooth referral to other hospitals.
The doctor added that the hospital has a leaking roof, which poses a risk when it rains as the floors get wet, and there are not enough toilets for staff to use.
The struggles of newly qualified unemployed doctors
A 30-year-old doctor, who completed her community service last year, said she has been struggling to find a job.
The doctor, who is known but requested to remain anonymous, said she is originally from Limpopo and is currently residing in Gauteng.
She mentioned that she has applied for positions in Limpopo, Western Cape, Gauteng, and Mpumalanga but has not received feedback.
“Coming from a disadvantaged background, I worked hard to be a doctor and to take my family out of where they were, and I was the sole breadwinner at home, so that affects everyone in the family.
“Unfortunately, now my brother is going to university, and I cannot afford to take him, meaning that he won’t be able to study because there’s no one else to pay for his fees. I have a 10-month-old daughter. I need to provide for her. I don’t have a place to stay anymore because I can’t afford it. So it has affected my life significantly,” she said.
She expressed hope that the government would step in to assist because she does not have the funds to open a private practice or even to move abroad. “I would be okay with being placed in a rural area. I just need employment, and I need to provide for my family,” she said.
The doctor noted that in her hometown, people don’t get seen in Emergency Departments because there is only one doctor or they employ a doctor who already has a private practice, and being in the hospital is not a priority.
“Most of the people don’t get to see doctors, and then they die before they even get to see a doctor. That is also a challenge on its own, so I honestly don’t know what that means for the community and the future of South Africa,” she said.
She added that it was her dream to become a doctor and change things around for her community and her family.
RuDASA highlights acute human resource crisis in healthcare
The Rural Doctors Association of Southern Africa (RuDASA) said the human resource crisis is acute.
In November, the association said the committee overseeing appointments did not even sit this as there was no point due to a lack of money.
“When a clinician leaves, the posts are routinely frozen and it is impossible to appoint. There are district hospitals that are struggling to cover their on-call roster due to lack of doctors while there are rural hospitals with services that are about to collapse due to lack of health professionals,” said RuDASA.
The association emphasised a need to examine where people are working versus the workload.
With regard to the impact of this lack of resources in rural areas, the association using an example of cataract, which is a clouding of the lens in your eye, said there is an estimated surgery backlog of more than 10 000 in the Eastern Cape.
“In some provinces, eye services like cataract surgery have completely collapsed. It seems like cataract surgery gives a good example of a health system working or failing,” said RuDASA.
In addition, the association said it is not just the lack of doctors in rural areas, but also the lack of consultants in referral hospitals that has an impact on patients.
“We had a 32-year-old patient die this week after the general surgeons at the referral hospital wouldn’t accept him on Sunday as there was no neurosurgeon on call. The referral hospital had too few to cover the call roster,” said RuDASA, emphasising that CEOs and clinical managers need to be appointed especially at tertiary and regional hospitals to provide leadership and improve accountability.
Health Minister’s response to unemployment crisis among doctors
Motsoaledi said last week that resources are needed to hire doctors and that crippling budget cuts affect the government’s capacity to hire as well as perform a large number of functions.
The minister stated that while the department agrees with the grievances of doctors, jobs cannot be provided if there are no funds to pay salaries. He advised medical students who completed their internship and community service to seek employment elsewhere.
“If the state advertises posts, you can apply. If the post is in the private sector, you can apply. If you want to open a private practice, you can do so,” he said, emphasising that the government is only required to absorb students fresh from university doing internships and community service.
Motsoaledi concluded by stating that the government does not have to absorb unemployed doctors.
karen.singh@inl.co.za