Sunday Independent Sept : Doctor shortage to hit NHI

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 Associations (Sama) 2011 Conference. Sonderup is a specialist at UCT  Medical School and Ramathuba chairs the (Sama) Committee for Public Sector Doctors.   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.   Speaking to The Sunday Independent, Sonderup said with the NHI debate heating up, the shortage  of doctors was a major concern in the medical community.   “One point I must make is that even if you collapse the private sector, we are probably still going to  be short (of doctors). We actually need extra doctors. The two most critical aspects of the NHI are  how are we going to fund it and how are we going to staff it,” he said.
Compounding the problem is the fact that of the 27 000 doctors registered in South Africa,  authorities have no way of knowing how many practice locally, he said.   “The HPCSA (Health Professionals Council of SA) sends out a renewal form every year, but no  question is asked about whether you are actually resident in South Africa. There is a second group of  people who continue to pay the registration fee, but don’t actually practice. Others remain  registered but are retired,” Sonderup said.
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 are 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.
“We have got to turn the tide of people who are still leaving. And we have got to go back and try to actively recruit those who have left. If we got just one-tenth back, we would have the equivalent of a  year’s worth of graduates,” Sonderup said.
Critical to solving the problem is the establishments of new medical schools and ensuring vacancies  at the existing schools are 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 unfavorably with other middle-income countries in terms of medical and  dental professionals per 1 000 (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.” the CMSA report says.  It also noted a major shortage in the field of dentistry, with only 4 153 dentists on the books  nationally. “To produce doctors and specialists, you need a functional academic sector. The capacity  that we’ve had to train doctors has been under enormous pressure. The capacity to train doctors has  been limited. What we need is more medical schools. Despite HIV/Aids, our populations are growing.
There is an increase in the number of immigrants. We have not kept up with that,” Sonderup 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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