Junior doctors ‘fed up’ with delay in preliminary placements

A group of junior doctors is fed up with the national department of health for not paying urgent attention to grievances about their preliminary placements for 2022.

The group said in a joint statement they were left in limbo each year because little attention was paid to the logistics regarding their placements and filling gaps in the healthcare sector.

After completion of their studies, junior doctors are legally required to do community service to enable them to practise independently.

The group blamed the health department for what it says is poor planning of community service placements and failure to manage budgets.

A second-year intern, who asked not be named, told TimesLIVE the department of health did not plan sufficiently for the funding of community service posts every year.

“The [department] is barring us from working anywhere in SA while simultaneously failing to employ us all for the mandatory community service year. Community service is not a requirement in any other country and was initially put in place to ensure service delivery in poorly resourced and rural areas,” the young doctor said.

“But if they can’t guarantee us posts we have no other option but to go overseas, because we are legally not allowed to practise in SA in the public and private sectors.”

She said her biggest concern was if the department did not fill all the community service posts every year, many doctors would emigrate.

“I am very concerned that this is a brewing crisis in the public health sector that will result in decreased service delivery for patients.”

Another doctor, also an intern, said every year there was a shortage of funded posts due to a budget shortfall and poor planning.

“The issue with this is they [health department] know exactly how many people graduated in 2019, so that means in two years’ time you know exactly how many will need placement.

“Saying you have underestimated or that too many doctors are at the end of the graduate programme, or there are too many interns at internship placement, is absolute nonsense. That has been an excuse happening continuously.

“We don’t have funded posts, so some of us will be without a job next year. The reasoning for those posts being unfunded is just nonsense.”

The doctor said the second issue was that placements had not been released. She said they had received very little response on this.

“Mentally we prepare for delays because this is what happened over the past few years.”

A female doctor, who finished her second year of internship at Mitchells Plain District Hospital in May, said she was unemployed after declining a placement more than 1,700km away from home.

She applied for placement after taking maternity leave but delays resulted in her being unemployed while awaiting placement.

“When I did eventually receive notice that I had been placed for community service, I found I was placed at a facility more than 1,700km away from my home,” she said.

“I was forced to decline the post as it was simply not an option for me to abandon my newly purchased home and my support system, or to uproot my one-year-old son and husband, who has permanent, full-time employment in Cape Town.

“The [department] basically gave me an ultimatum to relocate 1,700km away from home, or if not to remain unemployed. I found it extremely difficult to come to terms with the fact that the [department] would rather have qualified doctors sit at home and unemployed during a global pandemic and during the Covid-19 infections.

“With less than a month to go before I’m supposed to commence with community service, I’ve become increasingly anxious while awaiting any form of communication regarding placements. I’m faced with so much uncertainty.”

A second-year intern at Tygerberg Hospital said the placement process had been “frustrating at best and scary at worst”.

“We all expected delays and disappointment in this process. Our seniors told us ‘it’s always late’. But what we are experiencing is the latest release of placements ever provided to community service doctors,” she said.

“The department of health knows better than anyone how many medical graduates and intern doctors there are and will be. They know this year's in advance. But despite their own hand in how many of us there are, they consistently fail to plan for our employment.”

She said every year they are met with radio silence and occasional false promises, and guaranteed delays.

“For community service doctors this is an entire year of mandatory government employment that stands between us and our financial freedom.

“It's an awful position to be in to know that without placement, we will be stuck in obligatory unemployment because we are legally barred from practising our hard-earned qualifications for at least six months, often longer.

“This is not a problem that hits us only as individuals, it also hurts our families. Many junior doctors financially support their grandparent, parents, siblings, spouses and children, as well as their own cost of living. Leaving us suddenly unemployed is devastating to whole communities.”

On Sunday the SA Medical Association (Sama) said it was “completely outraged” by the government’s failure to plan for junior doctor’s statutory placement. The association said the government should have planned better.

“Internship and community service are state-imposed requirements, as well as being part of medical training. A tremendous amount of time and finance has been invested in training these doctors. This cannot be utilised if they cannot practise and serve the nation,” it said.

“Ministers of both health and Treasury should have incorporated these placements into the budget adjustments tabled in parliament last month. This is a huge priority for our country.

“It’s completely unacceptable that this late in the year government is claiming there is not funding for interns and community service doctors. These young doctors cannot go and work for themselves due to the statutory requirements.”

The association urged the government to find money for placements or risk facing legal action.

“We intend to approach the courts on an urgent basis to force government to place all internship and community service doctors by latest December 16.”

The national department of health did not respond to questions sent last week. This article will be updated when it comments. 

TimesLIVE