The entire process of placing doctors in community service is fraught with bureaucratic nightmares. The national health department claims it has to work with a variety of stakeholders on a national and provincial level, including the treasury and the Health Professions Council of South Africa. It is a system that exacerbates inefficiency and makes true transparency impossible. But, worst of all, the system leaves newly qualified doctors that are not placed unemployed, as they are not allowed to practise before completing their community service, yet they are dependent for that on an incompetent health department that often forgets they exist. The state doesn’t seem to care about that, or the chronic healthcare professional shortage. In 2021, the South African Medical Association (SAMA) had to threaten legal action against the National Department of Health to force them to actually do their job and place doctors in community service positions. This is yet another wasteful and harmful government practice in a vital sector of our society, where shortages and inefficiency take their toll on the actual survival of many of the country’s most vulnerable people who lack good medical care. – Sandra Laurence
Abolish community service for new doctors
By Nicholas Woode-Smith*
Doctors in South Africa have it rough. Places for medical students at universities are hotly contested and artificially restricted. And once a student makes it in, they have to study for a minimum of 6 years, then serve 2 years as an intern. In any normal job, this would be enough. But after these 8+ years, they are expected to do an additional year working for the state as a part of mandatory community service.
This community service sees them become pawns of a woefully underequipped and incompetent national health department, and often just becomes another stumbling block contributing towards our shortage of much needed doctors.
While allegedly a way for doctors to ‘give back’ to the community, and assign medical professionals to neglected areas, the way in which this project is enforced is forceful and tantamount to conscription. It should, like the conscription that went before it, be abolished.
Doctors have no genuine obligation to give back to any community. They have paid their ‘dues.’ First, by qualifying for a medical degree, and actually paying for it. Imagine if we required all professions to do mandatory community service because paying and earning their degree apparently wasn’t enough.
Doctors, like everyone else, should have the right to use their hard-earned degrees as they choose.
But even if we were to tolerate mandatory community service in South Africa, the system is fundamentally broken. Doctors who have completed their 6 years of study and 2 years of internship, and qualify fully in all meaningful ways to be a doctor, are left unable to practise because the government won’t place them in a community service role.
Without this mandatory community service, they aren’t allowed to practise. But the state doesn’t seem to care about that, or the chronic healthcare professional shortage.
In 2021, the South African Medical Association (SAMA) had to threaten legal action against the National Department of Health to force them to actually do their job and place doctors in community service positions.
An anonymous doctor, awaiting placement for community service for over 3 months, lamented how the delays in placement have disrupted his life: “I feel as if I am living in a state of never-ending uncertainty, unable to progress in a career that I so wholeheartedly dedicated my life to.”
The entire process is fundamentally inefficient, consistent with the state’s general performance when it comes to policing crime, keeping the lights on, delivering mail, and basically acting like a responsible institution.
The entire process of placing doctors in community service is fraught with bureaucratic nightmares. The national health department claims it has to work with a quagmire of stakeholders on a national and provincial level, including the treasury and the Health Professions Council of South Africa. It is a system that exacerbates inefficiency and makes true transparency impossible.
But, worst of all, the system leaves the doctors that are left behind unemployed as they are not allowed to practise before doing their community service, yet they are not allowed to do their community service without being dictated to by an incompetent health department that has forgotten they exist.
“The reality of unemployment is no longer merely a temporary inconvenience, but also evidenced by the accumulating mountain of bills and financial commitments, unhelped by the trove of unanswered emails and dismissive phone calls that I have been forced to put up with as part of the ‘system’,” added the anonymous doctor. He added that, while he is facing poverty as a trained professional, after only three months – he has colleagues who have been waiting to be placed for six.
When doctors are placed in community service, the trouble doesn’t end there. They are often forced to serve far from home, away from their families. This places a large cost on them, as they have to acquire new accommodation, and puts a huge strain on their dependents.
This forced movement of a profession is reminiscent of the migrant labour system, which continues to tear families apart so that a breadwinner can pay the bills.
What the mandatory community service system does, above all else, is leave doctors beholden to an incompetent government that doesn’t care about them. “Despite being a country with a chronic shortage of doctors, we are being forced to live in a never-ending state of limbo – paying taxes to a government that pays no heed to our concerns,” a doctor awaiting placement said.
Doctors have given enough already. They should not be required to give any more of their time. All that mandatory community service accomplishes is adding another hurdle to addressing our shortage of doctors.
Mandatory community service must be removed. Let qualifying doctors practice as they wish. Let them join the private or public sector, let them specialise, and let them use the degree that they earned as they wish.
If the purpose of community service is to redistribute doctors to neglected areas, then there are better ways to accomplish this. Deregulate the medical industry to make it easier to start up private healthcare facilities wherever they are needed. And, if doctors are still needed in rural areas, provide tax incentives for the private sector to create scholarships for students that requires said student to do community service in a rural area.
There are many creative and less heavy-handed, disastrous approaches we can adopt to solve South Africa’s problems. Forcing an entire profession to become beholden to an incompetent government is not a good solution. And by simply abolishing this terrible requirement, we will make tremendous strides in growing and retaining our medical practitioner population.
*The doctor quoted in this article wished to remain anonymous as he feared that decrying the health department would jeopardise his career.
- Nicholas Woode-Smith, an author, economic historian and political analyst, is a contributing author for the Free Market Foundation. The views expressed in the article are the author’s and not necessarily shared by the members of the Foundation.
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