Accreditation chaos prompts trainee specialists to abandon Eastern Cape state hospitals

5 Dec 2023

Doctors training as specialists are leaving state hospitals after Walter Sisulu University failed to get their Master of Medicine degree accredited in time.

Doctors who were training to become specialist physicians, anaesthetists, ear nose and throat (ENT) specialists and ophthalmologists are abandoning state hospitals in the Eastern Cape after Walter Sisulu University failed to get their Master of Medicine (MMed) degree accredited in time.

Caroline Corbett from the South African Health Professionals Collaboration, representing nine national associations and representative bodies, said that in March 2022 it was announced that several speciality disciplines were not accredited for the MMed degree at the Walter Sisulu University, which has affected registrars (doctors in training).

“Because of the negative press coverage, somehow obstetrics was suddenly accredited by the Council on Higher Education (CHE). Since then, anaesthetics, internal medicine, ophthalmology and ENT have been waiting for the CHE to sit and re-accredit them.

“Unfortunately, the CHE has postponed the meeting many times. In September they ran out of time and could not address the issue. They said early November. This has not happened yet,” said Corbett.

“Essentially, registrars have been appointed but have not been able to register with the university. Should the university close now in December and accreditation has not taken place, our registrars will have lost a year and even two years of training time.

“We have sent letters to the Minister of Higher Education, Blade Nzimande, the Council on Higher Education and the Dean of Walter Sisulu University, with no positive outcome.

“All our registrars are now looking elsewhere. We are also not certain which other university departments may be affected as not all are transparent in their accreditation until challenged,” she said.

The registrars write the same examination as their counterparts elsewhere in the country.

Corbett said that in Gqeberha and East London, four ophthalmology registrars are affected and two posts have not been filled.

In East London, three registrars in Frere Hospital’s ear, nose and throat department have been unable to register with the Health Professions Council of SA because of the lapse in accreditation and two will not be able to continue their studies.

Corbett said that in the Department of Internal Medicine at Livingstone Hospital, 16 doctors are affected. The positions of scores of anaesthetic registrars are also at risk.

Read more in Daily Maverick: Nelson Mandela Bay state hospitals face collapse – doctors resign on ‘unprecedented’ scale

Lives ‘hanging in the balance’

In correspondence sent to the university, doctors and registrars alike complain about a lack of transparency and a shocking lack of urgency that is causing a “sense of frustration and despair”.

In a letter addressed to Nzimande, desperate registrars asked him to step in:

“We write to you today with great concern regarding the prolonged delays in obtaining accreditation by the Council on Higher Education for the MMed degree specialisations in Anaesthesia, ENT, Internal Medicine and Ophthalmology at Walter Sisulu University.

“These delays are not only affecting the future of dedicated registrars in these fields but also exacerbating the challenges faced by the already overburdened healthcare system in the Eastern Cape.

“To our understanding, the lapse in accreditation and the process of re-accreditation has been ongoing for at least a year, with no visible results, numerous postponements, non-adherence to set timelines, and no communication regarding potential resolution points shared with us,” said the letter to Nzimande.

“The impact of these accreditation delays cannot be understated. Registrars who have invested years of their lives, hard work, and dedication to training in these critical medical specialities now find their futures hanging in the balance.

“The uncertainty surrounding their ability to register as specialists once they complete their contractual registrar time is deeply distressing. This uncertainty not only affects their career prospects but also has psychological and financial repercussions for them and their families.

“Furthermore, the ongoing accreditation delays have a profound influence on the delivery of healthcare services in the Eastern Cape. Many public sector healthcare posts remain frozen as the healthcare system waits for the accreditation process to be completed.

“This freeze on crucial medical positions exacerbates the strain on an already stretched public healthcare system, resulting in longer waiting times for patients, decreased access to specialised care, and compromised patient outcomes, thus impacting the well-being of the South African public.

“The individuals who are most profoundly affected by the accreditation delays are the patients served by these departments. They are often the most vulnerable and marginalised groups of our population, including those who are economically disadvantaged, frail, and elderly,” the letter says.

“We implore the relevant authorities and stakeholders to take urgent action and expedite the accreditation process for these Mmed specialisations. This is not just an issue of bureaucracy; it is a matter of public health, patient care and the future of healthcare professionals who are committed to serving their communities.”

They received no answer from Nzimande.

Budget cuts

This latest crisis to hit the Eastern Cape’s state hospitals offering specialist services comes in the wake of a dire warning by Premier Oscar Mabuyane that the Eastern Cape Department of Health will be hard hit by austerity measures implemented by the National Treasury.

In a response to the Eastern Cape legislature, Mabuyane conceded that state patients will have reduced access to healthcare.

“Patients may have to wait longer for appointments and procedures, and some services may be reduced or eliminated altogether,” he said.

But while services are likely to be reduced, the freezing of posts will at the same time lead to an increased workload for healthcare workers. Mabuyane said this would mean longer hours and an increase in healthcare workers’ patient loads.

“This could lead to burnout and decreased quality of care,” he warned.

“The freezing of posts could make it difficult to attract and retain healthcare workers, which could further exacerbate the shortage. Patients may have to pay more for out-of-pocket healthcare costs such as prescription drugs and co-pays.”

Posts are also likely to be frozen as the province has a shortfall of billions of rands, despite an adjustment in contributions by the national government to cover the wage agreement for civil servants.

Knock-on effect

The devastating impact on further medical training is now extending to fourth-year medical students, as the overburdened departments have indicated they will be unable to do any student training due to not having registrars to assist.

Medical specialists have predicted this will have a considerable impact on training programmes in the Eastern Cape.

“Unfortunately, this is going to have an enormous impact on service delivery as people will leave in droves. I do not think that the CHE has any idea of the impact that this is going to have,” a senior doctor said.

“Already, a number of our ‘registrars’ have applied elsewhere and once again the Eastern Cape will suffer. We will not have the capacity to accept any students either as the registrars play an important role in teaching.”

Other doctors indicated that training programmes that have been built up over more than a decade against enormous odds are now in danger of collapsing.

Read more in Daily Maverick: The Eastern Cape health system has collapsed — and the poor and working class are paying with their lives

Further email correspondence shows that registrars are leaving for Cape Town and Johannesburg to complete their training.

“Registrars are the primary clinician-teachers of undergraduate MBChB students for a variety of practical and academic reasons. So, without a full complement of registrars, we should never be allowed to take on MBChB students,” one doctor said, explaining why this would have a devastating impact on undergraduate medical training as well.

Eastern Cape Health Department spokesperson, Sizwe Kupelo, said they were in “constant communication” with the university about the issue.

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Dr Whitfield Green from the CHE said in response to questions that the “Council on Higher Education accredits programmes to be offered by legitimate higher education institutions, including the universities. The multi-step accreditation process involves evaluation by peer evaluators, consideration of recommendations by an accreditation committee and a final accreditation outcome provided by the higher education quality committee.

“In highly specialised areas, such as the Master of Medicine (MMed), a significant challenge lies in securing the services of proficient peer evaluators. The MMed programmes submitted by Walter Sisulu University are at various stages of the accreditation process.

“The institution will soon receive accreditation outcome letters for three programmes, and the balance of the MMed programme applications are planned to serve at the accreditation committee meeting taking place in February 2024,” Green said.

Spokesperson for Walter Sisulu University Yonela Tukwayo said their MMed programmes were accredited (presumably referring to obstetrics, gynaecology and paediatrics).

“The university has requested further MMed specialisations which the Council on Higher Education is currently reviewing. We are awaiting outcomes and the University will comment further when the results of the CHE evaluation process have been concluded and released,” she said.

She confirmed that no new registrars would be registered at Walter Sisulu University until the accreditation issue had been resolved. DM

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South Africa

Lives ‘hanging in the balance’

Budget cuts

Knock-on effect