Doctors and nurses are leaving South Africa – and it means you’ll pay more, medical aid warns

 ·21 Jul 2022

Part of South Africa’s national woes includes the significant shortage of skilled workers in critical industries, says Craig Comrie, chief executive officer of the medical scheme, Profmed.

Nowhere is this more apparent than in our nation’s healthcare sector, he said.

“Not only is there a major shortage of doctors, but there is a critical need for more nurses as well. This has a cascading effect on the rest of the healthcare sector right down the value chain through to the citizen’s pockets.”

And according to Comrie, this narrowing skills base is driving the price of healthcare up. “This is not about the available facilities but the skills and management of this scarce resource. We are simply not creating an attractive value proposition to retain existing doctors and nurses in our system and to create more supply of skills for people to access.”

He said that the skills shown locally in the medical industry have been aggressively targeted by developed countries as Covid-19 placed pressure on even the best-resourced territories.

The shortage of highly skilled and experienced healthcare workers is a global problem that places a huge strain on health systems, and often, the immediate reaction from developed markets is to poach highly skilled medical practitioners and specialists in South Africa.

“We have seen quite a large exit over the last three to five years, leaving us with a dearth of fundamental skills,” said Comrie. “The sad reality is that South Africa’s abilities to produce quality medical specialists has also deteriorated over time as a result of emigration, leaving fewer opportunities for specialised training.”

According to Comrie, South Africa has 28,000 registered doctors – not all practising – and produces around 2,500 doctors annually. These registered doctors include retired doctors who work well into their 70s because the demand for health skills is so great.

Please don’t go

Comrie called for a stronger value proposition to keep healthcare professionals in the country.

“Instead of increasing the supply of doctors, we need to retain the skilled doctors we already have by creating and maintaining favourable and secure working conditions with market-related remuneration, cultivating interest and opportunities for more medical graduates in the public and private healthcare space.”

Comrie said the country has a significant shortage of doctors who venture into fields of specialisation in terms of training and furthering their academic studies.

“This space will suffer initially because ‘super specialists’ such as pediatric oncologists and electro physiologists – specialists in cardiology devices such as pacemakers etc – are so few and far between. The public and private sectors will have to partner with many of these services just so that patients have access to them. This places our country’s social conditions and political instability under much-deserved scrutiny.”

With more doctors exiting the country, Comrie said the basic economic sum of supply and demand means that there are fewer doctors who do not charge traditional medical scheme rates as they have sufficient patients who pay cash upfront for their services.

“This leaves a funding gap for private patients, whether they belong to a medical scheme or are paying from their own pockets for services from reduced pool doctors that remain in South Africa. Many of these self-same specialists have their appointment books full for more than six months unless you have an emergency.”

In the ongoing NHI reforms, the medical expert said that little has been done to retain specialists where the bulk of their remuneration is funded by medical schemes or private payers.

In the run-up to the NHI, Comrie said many doctors have and will continue to exit the country as they feel insecure about the sustainability of their lifestyles if the bulk of their remuneration is planned to come from NHI.

Approximately half of Profmed’s membership comprises skilled healthcare professionals, doctors, and medical specialists. “A large percentage of members leaving Profmed are emigrating. This is something they share with us when they resign their membership, so we know where those skills are going to, and it’s a huge concern.”

To bridge the gap between public and private healthcare skills, Comrie said there needs to be an environment of collaboration in the health space where medical practitioners offer their services to both private and public facilities. There is, however, room for improvement in partnership and there is far too little of this going on at the moment.”

Comrie added that the country could reach a point where patients are comfortable accessing the services of a nurse instead of a doctor when it comes to facilitating basic healthcare needs. And for the more intricate and complex health conditions, he said a doctor can be brought in, and then eventually, if required, a specialist is contacted.

“Producing highly efficient nurses and filling current vacancy rates estimated to be just over 20,000 roles in the public sector would be a crucial start to improving the resource base. In a country like ours where unemployment is such a huge problem, we need to look at larger portions of the healthcare budget being allocated to these previous unfunded vacancies.

“For now, our skills base across both public and private healthcare remain on life support,” he said.

Read: South African Medical Association sends warning to government over doctors and other professionals

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