Clock is ticking for new doctors

MORE than 200 newly-qualified doctors and health professionals are still awaiting placement for their compulsory community service at public medical facilities, which begins on January 1.

On completion of their degree, a year of internship is required followed up by a year of community service – a process that begins many months before, when candidates send through an application to the Internship and Community Service Programme (ICSP) facilitated by the Department of Health.

Candidates can choose five preferential locations for community service, as most have families and commitments that might restrict their ability to relocate.

Frustrated doctors told POST this week that the application process was not “smooth or transparent”.

Speaking anonymously, one candidate revealed that the ICSP had assured them that an SMS would be sent out notifying them of their respective placements, followed by an official email before the beginning of December.

“I had applied to hospitals in particular areas on my first application as I’m married and would prefer to stay in the province,” she said.

“We had been receiving drips of questionable information from people on WhatsApp and Facebook about delays in the process and promises that notifications would be sent out. But they seem to be scams. There has been no official communication from the ICSP or the Department of Health at all, which is incredibly worrying.”

Doctors without placements formed a WhatsApp group to keep each other informed and updated throughout the protracted notice period.

Another doctor said his family and children were under strain due to the incompetent manner in which the ICSP had planned and distributed doctors throughout the country.

“I have my wife and three children to consider at a very short notice,” he said.

“I have not even been placed in my own province. I know of other doctors that were married during their internship and have been placed in the same hospital that they have been serving their internship. They don’t even have to change their routine.”

Dr Yetish Ramsarrup, of Verulam, is currently serving his community service at the Dora Nginza Hospital in the Eastern Cape.

He said he had been placed far away from his preferred zone, despite applying for special consideration for his commitment to be closer to his partner, known as ‘social compact’ applications.

“While the community service programme does broaden your horizons and help you hone your skills as a doctor, the delays and mishandling of allocation applications are appalling,” said Ramsarrup.

A female doctor from Durban North, who did not want to be named, said she was due to begin her community service in 2024.

She spoke about her exhausting ordeal in obtaining a placement.

“Right from the get-go, the application process was flawed,” she said.

“The ICSP website was down for applications and as a result, the process was conducted informally over Google Docs, exposing sensitive personal data of several doctors,” she claimed.

She added that an already stressful job was made worse by the inept procedures in place.

While serving her internship at a noted government hospital in Durban, she found the state of the facilities to be “squalid”, and “without the proper equipment” to treat patients.

“During load shedding, only parts of the casualty ward are dimly lit, and we have to use our cellphone torches just to see patients. We don’t even have proper strapping for inserting intravenous lines, so we use tape,” she said.

According to the Department of Health, the administration of the allocation of doctors is complicated due to the number of graduates needing to be placed each year; the needs and capabilities of different facilities in different areas; and budgets from the National Treasury.

The South African Medical Association chairperson, Dr Mvuyisi Mzukwa, said graduate numbers had increased by over 100% during and after the Covid19 pandemic.

Universities feed the ICSP graduate numbers, which allows the Department of Health to estimate the number of doctors to be placed into community service. This is then matched against the different facilities and needs across the country.

This is then read against the National Treasury’s budget allocation and then reorganised, where late shifts in priorities and changes occur, causing confusion and chaos.

Another doctor, who has not yet received a placement, said she would be in a “grave situation” if she did not receive notification soon.

“I currently have my mother living with me and I am the sole breadwinner, and if I don’t get placed both my mother and I won’t have a place to live,” she said.

“It’s incredibly stressful, exhausting, and demotivating to know that as newly-qualified doctors, we get treated this way.”

The spokesperson for the Minister of Health, Doctor Tshwale, said he was unaware of any backlog of doctors awaiting placement, and claimed the ICSP was on track with fulfilling its obligations.

“Allocations were prioritised for doctors who can start work from January 1, 2024, and doctors who can start from March 1 will be informed of their allocation in January 2024.

“SMSes have been sent to all doctors informing them of their allocations, and those who can start from 1 March will receive SMSes informing them that their allocations will be concluded in January 2024 to avoid confusion.”

A meeting was held between the Department of Health and the Health Professions Council of South Africa yesterday, regarding the management and allocation of interns and community service for 2024 candidates.

In a statement, the department claimed the administration process following 10 386 applications could be considered a success, and that priority was given to South African citizens. It said all candidates allocated were accommodated as best as possible considering the needs of accredited public health facilities. The ICSP allows for a window of appeal where doctors can, once notified of their placement, consider swopping with another candidate for a post which better suits their position.

According to another doctor, this has led to a “black market” where the swops are made for “financial incentives”. This is prohibited by the ICSP guidelines and is punishable by prosecution.

“I won’t consider swopping my post in exchange for cash, that goes against my personal values,” said the doctor.

Doctors allocated to outlying areas are given a rural pay bonus on top of their original salary.

However, doctors in these areas claim that this does not compensate for the poor working and living conditions.

“Some of the doctors quarters don’t even have water, and as a woman, I don’t feel particularly safe,” said one doctor.

“The fact that this system is not software-based or handled by statisticians who can better utilise the data to accommodate all doctors efficiently, is representative of the pathetic manner in which our government handles such important decisions.”

If doctors are not placed for community service, the HPCSA guidelines don’t permit them to practise.

The HPCSA had stepped in on Monday to allow unplaced candidates to re-upload their applications through its website, together with a fee of nearly R5 000.

This includes a 15-day waiting period for doctors to receive their practice numbers before January 1. This means that candidates had until today (December 6) to send in their documents.

A doctor from Durban, who aced his studies, said he was despondent.

“I feel really angry but also sad that we get treated this way. We are overlooked as a scarce skill and after working such difficult hours, we now have to sit at home – what is the point of staying in South Africa?”