Budget constraints leave hundreds of doctors jobless in deepening public health crisis

13 Mar 2025

SA’s budget can only afford to employ 800 of 1,800 unemployed doctors, despite vacancy rates for public sector facilities ranging between 5% and 22%.

When Theresa Brummer finished up her medical degree at Stellenbosch University, she had a clear vision for her future: to work in the public healthcare system in the Eastern Cape, where she was raised.

Brummer spent a year at Madzikane Ka Zulu Memorial Hospital in Mount Frere doing her government-required community service in a public hospital — in addition to two years of medical internship at state health facilities — before she was able to practise medicine in South Africa.

But today, instead of healing patients, Brummer sits at home in Gqeberha scanning job listings.

She is just one of between 1,500 and 1,800 unemployed post-community service doctors who can’t find public sector jobs.

On Wednesday, Finance Minister Enoch Godongwana budgeted to employ 800 doctors like Brummer; the remaining 1,000 unemployed doctors can’t be helped.

The irony cuts deep: we desperately need public sector doctors. In 2024, the health ministry reported that public health sector vacancy rates ranged from 5.48% in the Western Cape up to 22.4% in the Free State.

Join Daily Maverick’s webinar: The Budget Finally Lands: What you need to know

Overall, the health budget will grow from R277-billion in 2024/25 to R329-billion in 2027/28.

An additional R28.9-billion will go towards employing 800 post-community service doctors without jobs, as well as 9,300 healthcare workers.

“In the last year alone, our public sector health system lost close to 9,000 health workers,” Godongwana said. “We did not have the money to retain or replace them even after reprioritising funds budgeted for consumables and medicines.”

No provision in the budget was made to employ about 7,500 health workers working for nonprofits funded by the United States Agency for International Aid, USAid, who lost their jobs after the Trump administration cut their funding.

In the end, Godongwana said, South Africa’s high debt-service costs, which will come to R389.6-million in the 2024/5 financial year, prevent it from spending more on health.

“This (debt) translates to 22 cents of every rand we raise in revenue. It is more than we spend on health, the police and basic education.”

Godongwana said accruals — unpaid invoices in the public health sector from the previous financial year — also ballooned to nearly R22-billion.

“This means that the money allocated to departments ends up paying for previous services and goods rather than for the current needs, setting off a vicious cycle of budget shortfalls, unpaid invoices, and a crisis in cash flow and the planning and predictability of budgets,” Godongwana said.

“This is an untenable situation that we could not leave unresolved.”

Going overtime

But the health department also says part of why it can’t afford to fill all doctor positions in the state sector is because doctors’ salaries are too high — and that cutting the overtime of those already employed would open up budgets to employ others.

The department’s Percy Mahlathi, who oversees hospital services and human resources, told Health Beat in February that doctors in the public health system earn disproportionately higher salaries than other professionals.

“With the legal profession, many first-year workers would be earning R15,000 to R20,000 a month. But our health service doctors, with overtime, are earning about R80,000 to 90,000,” he said. When compared with doctors in Kenya and Nigeria, South African doctors earn in a month than their counterparts make in a year.

Mahlathi said redistribution would be a better approach: “If you use part of that overtime money to employ 10 more doctors, there will be less demand for overtime, and you’ll have more hands to look after patients.”

South African doctors routinely work 60-hour weeks. A normal work week, according to the government Employment Act, is 45 hours. Doctors, however, get paid for their overtime, even though many other employees who earn above the government’s earnings threshold of R261,748.45 (for 2025) don’t, because the law doesn’t require it.

Mahlathi said some provinces had already begun restricting overtime to eight hours weekly, potentially saving 50% of current overtime expenditures.

Salary structures

But the South African Medical Association’s vice chairperson Ames Dhai told Bhekisisa’s TV programme Health Beat that there was more than enough money to employ all doctors in the country; the problem lay with the way the health department managed its budget.

In February, Health Minister Aaron Motsoaledi told the health portfolio committee in Parliament that the health department would need R1.9-billion to employ 1,500 doctors.

“Between 2009 and 2013, close to R24-billion was lost due to corruption,” Dhai said. “So how can the state say it doesn't have enough money?”

Doctors’ salaries aren’t actually the fault of doctors — the current salary structure was implemented by the health department itself. In 2009, occupation-specific dispensation was created specifically to keep skilled professionals in government service.

Under this system, entry-level medical officers earn just over R900,000 annually, with salaries increasing to more than R1-million after five years. Grade 3 medical officers, doctors with at least 10 years of experience, earn between R1.2-million and R1.5-million annually. When overtime is added — virtually unavoidable in chronically understaffed facilities — compensation climbs higher still.

Graduates outpacing budgets

Medical students study for six years before their two-year internship and year of community service — both of which are paid for by the state facilities where they are required to work before they can practise independently.

According to Motsoaledi, South Africa produces 3,600 doctors per year — up from 1,200 in 2011. This is the result of a plan Motsoaledi and then minister of finance Pravin Gordhan came up with to triple the country’s annual output of physicians. Universities had to up admissions and South African students trained in Cuba — who return to finish their last 18 months in medical schools here — increased from 80 to 1,000 per group per year.

But that means that the health department also needs to provide each graduate with a community service post each year, and often struggles to do so. Once doctors had completed their community service year, Motsoaledi said, the government simply didn’t have enough money to employ them all.

Motsoaledi told Parliament in February that the health department had not “anticipated the subsequent economic difficulties, which had severely impacted its ability to absorb new graduates into the workforce”.

Dhai put it simply: “The problem is the state has fallen behind in its obligation to employ doctors to deliver healthcare to patients in need,” she told Health Beat. “It’s a huge indictment on the state.”

Holding out for a government job

In Gqeberha, Brummer has set April as her self-imposed deadline for securing government employment before considering private practice, or even opportunities abroad.

“I’m holding out that I’ll be able to work in the government because that’s really where I want to work,” Brummer said. “But you know, I can’t hold out forever.” DM

This article includes reporting from Bhekisisa’s Health Beat programme about unemployed doctors, which was broadcast on eNCA on February 24 2025.

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.

If you wish to comment on this issue, please send an email to [email protected]

Letters will be edited.

Categories:

Tags:

DM is much better if you are signed in...

Business Maverick

Going overtime

Salary structures

Graduates outpacing budgets

Holding out for a government job