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Battle for jobs: Motsoaledi takes swipe at 'picky' doctors

Cape Town - Health Minister Aaron Motsoaledi sought to set the record straight on claims that there are no jobs in public service for hundreds of trainee doctors and pharmacists.

"I wish to state that quite often the conflicting information and numbers of doctors not placed in posts stem from the fact that available posts may not necessarily be in facilities which a doctor prefer. However, we select these facilities accordingly (sic) to the needs of the population," said Motsoaledi in a prepared speech on Thursday.

The Junior Doctors Association of SA (Judasa), an affiliate of SA Medical Association (Sama), and the National Healthcare Professions Association (NHPA) compiled separate dossiers of unemployed doctors and pharmacists.

This apparent job crisis was attributed to the government's alleged failure to place them into posts, and to a shortage of posts.

Motsoaledi said both the Judasa and NHPA lists were not only constantly changing, but at times did not align with the department's records.

The minister said according to the Judasa list, 135 interns and community service doctors are unemployed. It also states that there are 126 newly qualified medical officers - doctors who have completed both internships and community service - who are also unemployed.

Motsoaledi explained the various categories of doctors in the public service by making a distinction between internships from community service and post-community service medical officers.

Interns

Interns are doctors who have just passed from medical schools.

"The internship years they have to do is part of their training done under strict supervision. Internship is done for a period of two (2) years."

He said an internship cannot be done in just any hospital in the country. "For a hospital to take interns, it must first be accredited for a specific number of interns by the Health Professions Council of South Africa (HPCSA). The hospital may not take more than what it is accredited for."

Motsoaledi said internship training is statutory, but there is a problem in the country.

"An overwhelming number of newly qualified doctors prefer to do internships in mostly four cities: Cape Town, Durban, Johannesburg and Pretoria. A few may opt for Port Elizabeth, East London and Kimberley."

To deal with this, the department introduced a system called the Internship Community Service Placement Programme (ICSP), whereby interns apply centrally and are placed in various institutions from the National Department of Health.  

Motsoaledi said using ICSP, all the South African applicants received were made offers, with 45 internship positions still available. These are the Bloemfontein Complex and Mohumahadi Manapo Mopedi hospital in the Free State as well as Nelson Mandela Academic hospital in Mthatha.

He said 22 South African interns placed in jobs declined to accept them. Reasons range from marriage, family responsibility, medical conditions and religion to owning expensive property in a particular geographic location.

Despite strenuous attempts, Motsoaledi said his department is not always in a position to accommodate everyone.

"However, we still have 89 foreign nationals who also applied and still need to be placed," he said. "The reason that we did not place the 89 foreign students was that we needed to place all South Africans first, because this is statutory."

Motsoaledi said of the 89 foreign nationals who have completed their medical studies in South Africa, most are from the Southern African Development Community.

"We have checked the lists brought by a representative of Judasa whereby doctors who are said to be unemployed append their names against our ICSP online system. We found that 13 doctors who are on that list are duplicates, 12 are part of the 22 who declined placement and 9 did not apply as required."

He said the remainder are the foreign nationals who have not yet been placed.

Community service

"The main objective of community service is to ensure improved provision of health services to the rural and underserved areas of our country."
 
Motsoaledi said in the process this also provides young health professionals with an opportunity to develop their skills and acquire knowledge, behavioural patterns and critical thinking that will help them in their professional development. He said offers were made to all the South African applicants.

"Unfortunately because of the very rural nature of facilities selected for community service, they are not preferred by most doctors." 

He said 75 of the 88 foreign nationals who completed their internship in South Africa and wanted to continue with community service have been placed.  

"The remaining 13 foreign nationals will still be placed as from today [Thursday] because there are places available for them since we have now completed placement of all South Africans who need to be placed."

Post-community service medical officers

Motsoaledi said this category has caused much confusion in the media and among members of the public.

"There is (a) misconception that the state has got a statutory obligation for them like internships and community service."

He said after completion of community service most doctors have various options: 

- They may go back to university to specialise as registrars/specialist in training;
- They may go into private practice as general practitioners; 
- They may enter the private health industry and work for a medical aid scheme, pharmaceuticals firm or company;
- Some may join NGOs like Gift of the Givers;  
- Unfortunately, others may opt to leave the country or leave the profession altogether.

"When they do all these, they have no obligation to inform the Department of Health, so we have no way of knowing them or their numbers. However, if they wish to remain in the public sector, we have at least 147 posts available for them," said Motsoaledi.

"So the 135 doctors quoted in the media who are said to be without jobs may contact us because we don't know them. We can advise them of the available posts. It is up to them to choose from among these, but they can't claim to be unemployed."

For pharmacists, the confusion has been about community service. Some have been arguing that it be scrapped altogether, alleging that posts are not always available for this type of service. Objectives for community service for pharmacists are the same as those for doctors.
 
"I can confirm that 795 pharmacists applied for community service," Motsoaledi said.

"Of these, 716 are South Africans and have all been offered positions. However, 3 declined to take them. Seventy-nine are foreign nationals. We have identified 108 positions in which all of them can perform their community service."

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