Dianne Hawker: The Sunday Independent
THE SHORTAGE of doctors is likely to seriously hamper the government's National Health Insurance (NHI) plan, with medical experts saying the country needs to double the number of doctors it trains each year. While there are an estimated 27 641 doctors practicing in South Africa, approximately 23 407 South African-born doctors are believed to be practicing in Australia, Canada, the US and New Zealand. These figures are contained in a presentation compiled by doctors Mark Sonderup and Phophi Ramathuba for the SA Medical Association's (Sama) 2011 Conference. Many of the figures were taken from a detailed research report compiled by the Colleges of Medicine of SA (CMSA) published in the South African Medical Journal last month. Between 1998 and 2006, South Africa trained 14 145 doctors and specialists - almost 10 000 fewer than those believed to be overseas.
Sonderup said that with the NHI debate heating up, the shortage of doctors was a major concern in the medical community. He said that even the private sector was collapsed, SA was probably still going to be short of doctors - actually extra doctors were needed. He said the two most critical aspects of the NHI were how it was going to be funded and how it was going to be staffed. Compounding the problem was the fact that of the 27 000 doctors registered in South Africa, authorities had no way of knowing how many practised locally. Sonderup said the Health Professionals Council of SA (HPCSA) sent out a renewal form every year, but no question was asked about whether one was actually resident in South Africa. He said there was a second group of people who continued to pay the registration fee, but did not actually practice. Others remain registered but were retired. As an urgent solution to the problem, Sonderup and Ramathuba say the country needs to "train and retain". An estimated 46 000 more nurses and 12 500 doctors were needed urgently to staff hospitals, they told the Sama gathering.
The staff shortages are playing into a vicious cycle which sees the remaining doctors, particularly those in the public health sector, burning out and leaving the country for greener pastures. Sonderup said the tide of people who were still leaving needed to be turned and SA had to and try to actively recruit those who had left. He said that if just one-tenth returned, it would be the equivalent of a year's worth of graduates. Critical to solving the problem was the establishment of new medical schools and ensuring vacancies at the existing schools were filled. The CMSA report raises concerns that specialists who are being trained at the country's eight medical schools are not being absorbed into the public health sector. South Africa compares unfavourably with other middle-income countries in terms of medical and dental professionals per 1000 of the population. The UK has 120 000 doctors for a population of 60 million: South Africa, with a population of 48 million, has 27 000 doctors, according to the CMSA report. It also noted a major shortage in the field of dentistry, with only 4 153 dentists on the books nationally. Sonderup said that in order to produce doctors and specialists, a functional academic sector was needed. He said the capacity that to train doctors has been under enormous pressure and was limited. He said that despite HIV/AIDS, the population was growing and there had been an increase in the number of immigrants. SA had not kept up with that, he said. In May, Health Minister Dr Aaron Motsoaledi told parliament he had asked the deans of medical faculties to think of innovative ways to increase intake.
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