Pressure for private medical schools
The private sector is putting pressure on government to allow it to operate private medical schools.
While this has the potential to boost both the public and private sector, the SAHR cautions that mechanisms would have to be put in place to ensure that there wasn’t an exodus of skills from state-run medical schools to private institutions.
Private medical schools would not exclusively benefit the private sector as graduates would still be required to do a year’s internship and a year’s community service, says authors Haroon Wadee and Farzana Khan.
In addition when doctors specialize, the public sector gets at least seven years service from these graduates.
There are currently eight medical schools in the country that train around 1 600 doctors every year. Between 1996 and 2001 there was a 6,3% average annual growth in general practitioners and an annual 1,1% average annual growth rate in specialists.
However, despite the fact that both the public and private sectors were feeling the impact of shortages, the skewed distribution of human resources between the public and private sectors is massive.
Over 70% of doctors, 75% of medical specialists and 40% of nurses are working in the private sector. The situation is worse for pharmacists, where only around one in 10 of those registered with Health Professions Council of SA (HPCSA) are in the public sector.
Of the 34 324 doctors registered with the HPCSA, only 9 527 are working in the public sector. Interestingly, African doctors now outnumber white doctors in the public sector, with 4 103 African doctors to 3 542 white doctors.
It is unclear whether these private training facilities would receive public subsidies.
Wadee and Khan argue that there is also a need to carefully review the policy with respect to the employment of doctors in the private hospitals.
Currently private hospitals are unable to ‘employ’ doctors but instead offering incentives for them to establish their practices with the hospital premises and make use of the hospital infrastructure to treat patients.
Wadee and Khan said that changing this policy could see more newly graduated specialists attracted to this model given the high costs incurred in the setting up of private practice. They cautioned against specialists employed in the public sector being attracted to private hospitals.
Private hospitals are arguing that the lifting of these restrictions would allow hospitals to contain the spiraling costs of specialists as set user fees could be negotiated.
The SAHR highlighted the lack of data on the true public-private distribution of heath providers and conclusive information on how many nurses are being trained in the private sector
More than half of all registered nurses and midwives are over the age of 40.