I was shocked to read entry-level medical officers in public health earn R80-90,000 a month excluding overtime. This compared to R15-20,000 for other professionals like engineers, lawyers, accountants, etc.
This reveals how unrealistically high public sector salaries are. It's well-known these workers, in all disciplines, earn more than their private sector peers - 30% is often given - for typically a lower standard of service. The unsustainable and irrational public employee costs over the past 30 years is partly to blame for SA being driven to a fiscal cliff in recent years.
According to the internet the average annual salary for an (experienced, private) general practitioner doctor is about R540,000. This excludes benefits like medical aid, pension etc that public workers take for granted. Private doctors must fund their own. The starting salary is around R222,000, similar to other junior professionals. They too, like white-collar workers in the private sector, work or are expected to work long hours and overtime which are not reimbursed.
It's no wonder then medical graduates want to work for the government where they can earn four or five times private salaries plus benefits.
In 2019 there were 46,420 doctors in South Africa. Today there are around 1,800 unemployed doctors. The government will hire 800. So 1,000 out of around 46,000 (for this purpose omit those who left and entered the profession since 2019) are unemployed, a 2% unemployment rate - all young people who recently completed community service.
For Q4 2024 the overall graduate unemployment rate (ages up to 65) was 8.7% (Q3 9.8%). So doctors' unemployment is almost a fifth that. In labour economics 2% unemployment is very low, almost negligible - anything below 4% is labour market churn, ie a state of flux or temporary situation for individuals.
Put in context of the national unemployment rate of 31.9% - the real rate is 41.9% - the doctor unemployment rate is normal by healthy economic standards and not structural: they will find work sooner rather than later.
The media present the (low) doctor unemployment number - 1,000 - as a labour crisis and, by itself, a health crisis. It's neither. A year or two ago there was also around 800 unplaced young doctors. The unemployed numbers are not increasing so they do find work, as this year's cohort will in due course. Scarce skills like engineering, etc are not so lucky. There are few professions in South Africa, politician being another, as unemployment and recession-proof as medicine.
I agree with the health department official who said doctors' high salaries and overtime, a self-created problem, prevent them hiring more. It's more than simply numbers, though. The inefficiency, ineffectiveness and overall failure of public health exacerbate available resources and patient care. It's common cause it would be a lot better if not marred by mismanagement and corruption.
I disagree with health activists' demand all unemployed doctors should be hired. At almost a million a year each, that would add R1 billion to government employee cost. Budget 2025 is a crisis primarily because the original shocking 2% Vat proposal was meant to cover public workers' pay increase of 5.5%. Two years ago health and education budgets were cut to cover an unfunded pay increase. This is the reason for the budget crisis.
As a public health user where I don't get to see a doctor at clinic but "clinician", ie nursing sister, for diagnosis and chronic care, I experience these constraints. Even in well-resourced Western Cape it's not uncommon to wait up to six hours to renew a script and receive medication which ought not to take more than two hours at best, three at most per their guidelines. But poor to ineffective patient management and often the many staff not doing their jobs, rather than no money, mean long waits and short tempers. Complaints are ignored and problems persist.
Problems in the public health system are severe. As other departments, the causes are neglect, disastrous management and corruption which the ANC has no desire to eliminate. Inadequate budgets is a less significant problem, one that can be managed to extent by eliminating financial and managerial malfeasance.
But even if government hires all 1,800 unemployed doctors, it would be a drop in the ocean to remedying entrenched deficiencies in the system. In fact, because SA is at a fiscal cliff, the additional R1 billion a year needed would exacerbate the country's situation.
Like all tax and spend propositions, activists' and the left's starting point, the discussion about doctors who cannot find work in public health is incorrectly framed - it's not just about money. But by placing them in the macroeconomic realities of SA, one should see that only 1,000 is not a crisis; the crisis in health is described above. However, for them personally it is, but not beyond their individual circumstances when they can and should find work as locums or self-employed anywhere else.
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