Up to now those who have shouted the loudest have been the specialists and doctors who believe that sticking to the letter of the law will lead to a mass exodus from the public sector.
Clearly, what has been missing from some of the recent debates and reporting on this contentious issue, are the voices of the many doctors who do agree that even though there is merit in RWOPS, the system has been grossly abused for far too long and desperate patients are paying the price.
What the debates fail to point out is that some doctors are earning good salaries and it is highly unlikely that many of them need to supplement their income by doing private work. There is also a case to be made that some specialists are still underpaid and that a well-managed and balanced RWOPS system offers benefits, but that it has been abused by a group of greedy specialists.
Recent moves by the Free State and Gauteng health departments to curtail RWOPS has led to an outcry from specialists presenting a number of reasons why it is the wrong step to take.
Both the Free State and Gauteng heads of department have restated that they intend to efficiently manage the overtime and compliance with the Public Service Act in granting permission for RWOPS. At Charlotte Maxeke Johannesburg Hospital RWOPS for anaethetists and radiologists was slashed, despite the fact that the surgeons stand accused of committing the greatest abuse.
In an article published in the South African Medical Journal (SAMJ) in December, it was revealed that working privately during their official state working hours, nearly one in four specialists forensically reviewed and employed by the Nelson Mandela Academic Complex and/or Walter Sisulu University in Mthatha earned between R 6 500 and R126 000 extra over six months in 2011.
Hennie Groenewald, acting cluster manager for human resources in the national health department explains that the policy of RWOPS as it is outlined in the public service act has been in existence in the public service for many years. Furthermore, a system of commuted overtime was introduced 13 years ago in an effort to recruit and retain clinical skills within the public health sector, especially among the more senior specialists who were at the time not earning good salaries.
However, that changed in 2009, when Government reviewed these salary packages.
The latest salary scales, updated in April, show that a newly qualified specialist will earn R747 674 per annum plus R200 000 per annum for 16 hours of commuted overtime each week. After five years the annual salary will be around R854 751 plus R200 000 overtime.
Head of a unit (former Principal Specialist) will earn R1 168 488 per annum plus overtime and the head of a clinical department (former Chief Specialist) R 1460 886 per annum excluding overtime.
It is important to note that not all specialists are earning these salaries as they are not employed in head of department posts, despite fulfilling this function. Specialists also argue that they are not compensated for being on call, which essentially means they cannot socialise, be far from the hospital and so on.
The SAMJ report also revealed that a 2004 Public Service Commission probe into RWOPS abuse in Gauteng found that more than half the specialists owned private practices.
The practice of RWOPS is more a rule, rather than the exception, and there are literally only a handful of doctors in the public sector who do not have private practices.
A list sent to Health-e claimed that several heads of deaprtment at Charlotte Maxeke Johannesburg Academic Hospital all run full-time private practices.
A number of senior specialists at this hospital were doing the same, according to the source.
At Chris Hani Baragwanath Hospital, several heads of department as well as a number of senior specialists were allegedly also running full-time practices, according to the list.
At Helen Joseph Hospital, where they are battling to cope with patient numbers, the several heads of department as well as a number of general surgeons were running private practices.
The list did not include specialities such as obstetrics and gynaecology, anaesthetics, paediatrics and orthopaedics. No specialists at Rahima Moosa run private practices.
Speaking on condition of anonymity, a senior specialist at a Johannesburg hospital said ‘RWOPS abuse is widespread and the department of health is simply not getting value for money in terms of doctors earning their salaries in the public sector’.
The angry doctor, who captured the sentiments of several doctors speaking to Health-e, said it boiled down to greed as the doctor salaries have been increased substantially. He said most of these doctors showed no commitment to public hospitals as waiting lists are still long and clinics are deserted by 2pm.
‘The system has been corrupted with the sole purpose of allowing RWOPS to thrive. Departments allow their senior staff days off a week to perform RWOPS. How can that we tolerated if the public sector is overwhelmed,’ he asked.
He added that two other factors contributed. Poor management who are too scared of ‘popular professors’ to hold them accountable, and private hospital groups who ‘unashamedly and actively’ recruit specialists who they know are employed in the public sector.
Groenewald says the Act is clear that if permission is granted to work in the private sector it may not be in conflict with the agreed working hours.
He confirmed that there were reports of public sector doctors spending time seeing private patients when they are supposed to be in the public hospital.
‘They are contractually bound to work for the State, but some even see their private patients during their normal hours,’ added Groenewald.
He said that a number of doctors also claimed their overtime, when they are supposed to be working and available to state patients, but they use this time to see private patients.
It is understood that RWOPS has been discussed a number of time at various executive levels within both the National Department of Health and provincial Departments of Health
‘We are simply starting to manage the existing RWOPS policy better, which applies to all public servants, and to restore discipline in the system,’ added Groenewald. A health department source confirmed that health minister Dr Aaron Motsoaledi has expressed his concerns regarding the abuse of RWOPS.
‘There is a feeling that we now need to demand that employees deliver what they are being paid for,’ the source added.
At the end of the day more and more South Africans are relying on the state sector for their healthcare. Human resources are precious and the state is within its rights to ensure that those are being paid to provide much-needed services, are doing so.
A selection of quotes from doctors in Gauteng:
‘ I do RWOPS. I do it properly ‘ I declare my RWOPS to the HR department and the head of department. I do it after all my Government and University related work is done. My first allegiance is to the hospital, they employed me.
‘However, there are departments and individuals that do not do it honestly. They are in their private practices during core hours. They do not declare their RWOPS, neither do they respect the concept of giving your time to the hospital that pays your full time salary. These people are truly ‘thieves of the state’. Specialist at Helen Joseph Hospital.
‘The current RWOPS system is grossly abused. Majority of those who undertake RWOPS do so with complete disregard of the public patient whom they are primarily employed to care for.’ Specialist in Johannesburg.
‘The State patients remain voiceless and disempowered and will inevitably be neglected, further widening the gap of healthcare provision.’ Helen Joseph specialist.
‘I am not against the principle of RWOPS per se, but I am against the abuse thereof.’ Senior specialist at a Johannesburg hospital.
‘I have long been perturbed by the rampant and flagrant abuse of RWOPS ‘privileges’ by some of my colleagues.’ Senior specialist at Helen Joseph.
‘I cannot fathom how junior staff members are to learn if their seniors and teachers are often not on premises to support and teach them.’ Specialist at a Johannesburg hospital.
The summarised guidelines on RWOPS includes some of the following:
– All provincial employees may apply to do remunerative work outside of the Public Service;
– Permission to perform RWOPS must be applied for in advance and RWOPS may be performed only once approval has been obtained;
– It has to be reviewed on an annual basis.
– Details of the kind of employment proposed must be included;
– RWOPS shall in no way interfere with an employee’s duties for the province in terms of either time or content;
– Permission to perform RWOPS will be considered only if the proposed employment takes place entirely outside an individual’s official hours of employment for the State;
– The proposed employment must in no way result in a conflict of interest;
– The core hours required for the occupational class of full-time medical practitioner including all ranks and specialties, are determined by the respective duty rosters as approved by the hospital management including stand-by (on call) and overtime arrangements where required, and should be at least cover 8 hours per day (40 hours per week);
– Should an individual who is employed by the province wish to perform RWOPS during the time that he/she has been contracted to work for the State, the following would apply ‘ Permission may be refused, or alternative employment arrangements may be agreed to in the process.