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Looming crisis for SA healthcare as specialists face 30% pay cut

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A new overtime policy introduced by the national Department of Health could see some doctors in the public sector facing a pay cut as high as 30% in January.

Several KwaZulu-Natal doctors speaking to News24 on condition of anonymity have warned of a mass exodus of specialists from the public sector to the private sector if the policy is implemented.

The doctors, most of whom are specialists, raised concerns after the South African Medical Association (Sama) released a statement on Wednesday saying it intended lodging a formal dispute with the National Bargaining Council after the department’s decision.

The new overtime policy for public healthcare personnel was signed and released by Health Minister Aaron Motsoaledi recently.

The policy, which essentially prevents doctors from claiming overtime, could cripple the already overburdened public healthcare sector, doctors said.

A paediatric specialist working in KwaZulu-Natal told New24 that she first heard of the draft policy in June. She later found out that the draft had escalated to implementation stage.

Doctors’ rights

“Doctors provide overtime cover far in excess of what is contracted or paid for.

“Reducing salaries for the overtime cover, particularly for offsite means that there will be less emergency cover and night cover. The specialist cover is provided constantly to junior doctors by a way of expertise and advice given throughout the day or night, whether the specialist is onsite or not.

“The new policy calls for this cover not to be recognised or paid for. There are not facilities for specialists to sleep onsite, they are not given days off, even when they have covered a 24-hour stretch. The overtime policy now seeks to reduce this emergency cover and continuous cover that specialists have been providing despite the fact that the government does not pay for the majority of that cover.”

She said the decision was infringing on the rights of doctors.

Overtime, she said, was not a policy but “meant to be a mutual agreement between the employer and employee because we are providing a scarce skill”.

She warned that the public health sector stood to lose a vast amount of expertise to the private sector.

“This will add a burden onto existing cases and there will be a high rate of fatalities if there is a mass exodus.”

‘Systematic sabotage’

She said the government’s proposal had reduced the overtime rate to almost 0% for services provided offsite.

“We are responsible for providing training for future doctors and specialists at the University of KwaZulu-Natal, we don’t even get paid for it. If specialists leave then it will impact on the quality of training that these doctors receive and the training itself might not exist in the future because of a lack of resources.”

She blamed the department for “systematically sabotaging the public healthcare sector to reduce costs by freezing doctor posts, reducing the number of nursing overtime and now reducing the specialists in the medical workforce”.

“The occupational specialist dispensation which we fought so hard for has not even been implemented in KZN and I believe that this is an attempt to recoup that money.”

She said politicians were also government employees but their salaries had never been cut and “yet the government was prepared to challenge an already challenged public healthcare sector by attacking the very people that were trying to make it work on the ground”.

She added that public sector doctors and specialists were doctors who have always put their patients first.

“They have a choice to move to the private sector but have chosen not to. Many in the state sector have served for over 10 to 15 years and this will penalise and force them out of the public sector.”

Specialists most affected

She said there was a perception that doctors took home large pay cheques.

“People think that we get paid highly for doing minimal work but the reality is that we don’t get paid as much as our counterparts in the private sector and professionals with lesser qualifications.”

Another specialist said he could not understand government’s logic.

“Overtime has always been a part of doctors’ salary. If I look at my gross, I can see that life is not going to be easy because this will have a knock-on effect on my gross salary.”

He said specialists, who were the backbone of the sector, would be most affected by the policy.

“This is honestly going to cripple the healthcare sector and it will have a negative impact on the staff morale.”

‘Hospitals will be empty’

He said, for example, if specialists at Inkosi Albert Luthuli Central Hospital were to go on strike, there would be a complete shutdown of services in KZN.

“If we go on strike, hospitals will be empty.”

He believed that the government did not think about the implications the policy would have on doctors and their livelihoods.

“Looking at my own salary, overtime accounts about 30% of my total salary,” said the doctor.

A neurologist said there were only 10 neurologists in the state sector servicing the entire province as well as the Eastern Cape.

She said their current salaries were not compatible with other state employed professionals, such as lawyers.

Patient care ‘compromised’

“In addition to our overtime, our days are extremely busy dealing with clinics, ward rounds, teaching and lecturing.”

She said if the policy was implemented it would have dire repercussions for the public healthcare sector.

“There will be a loss of highly skilled professionals to the private sector and other countries. Patient care will be compromised and there will be no training for registrars.

“Specialist units will be reduced to primary healthcare sector,” she said.

News24 has seen a circular [number 82 of 2016] that was sent out by the department of health in KwaZulu-Natal on December 6 informing employees about the termination of their overtime allowance.

The circular states that the approval of a new commuted overtime policy by the National Department of Health would be implemented on January 1, 2017.

Consultative labour processes ‘overtaken’

All commuted overtime contracts in terms of the existing policy must end on December 31, 2016.

Human Resource offices must ensure that the commuted overtime allowance is terminated on December 31, 2016.

It further states that employees who will be participating in the commuted overtime system with effect from January 1, 2017 will be required to enter a new contract with effect from January 1, 2017.

Chairperson of Sama Dr Mzukisi Grootboom said the latest development had caused a great deal of anxiety within the medical fraternity “because it has overtaken the current consultative labour processes”.

Grootboom said at the time of the release of the final draft the medical profession was still waiting for further consultation for ratification of the proposed amendments.

“The minister appears to have overlooked this important step in the process,” he said.

“We reject this attempt to force public sector doctors to abide by this policy. For this reason the industrial relations department of Sama is preparing to lodge a formal dispute with the National Bargaining Council,” Grootboom said.

Department ‘committed’ to working with stakeholders

KwaZulu-Natal department of health spokesperson Agiza Hlongwane referred all queries to the national department.

Motsoaledi’s spokesperson Joe Maila claimed that in late 2014 the department responded to calls for a single national commuted overtime policy for doctors to replace individual provincial policies.

He said the aim of the national policy was to provide a uniform approach to commuted overtime in the public health service based on existing provincial department policies.

“In 2015 an extensive consultation process was initiated, which included provincial departments, various professional associations as well as interest groups. An initial draft policy was presented to various representatives, including the South African Medical Association [Sama] for comment.”

He said inputs received on the initial draft were dully considered and this resulted in a further draft which was presented to the national human resource committee for final review.

“The National Health Council as well as its technical advisory committee provided further opportunities for representatives to provide direct inputs to these national decision-making structures. Pursuant to this, the National Health Council adopted the commuted overtime policy on 9 September 2016.”

Maila said to support the implementation of the new policy, the department had proposed to establish work teams with representatives of the profession and provinces.

“While consensus may not be reached on all matters, the department remains committed to continue working with the relevant stakeholders on additional concerns that may be raised,” he said.

[Source: News24]
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