It's criminal

One of the largest academic hospitals is facing a meltdown as specialists threaten to resign en masse because overtime pay is being cut and private work stopped.

Several doctors have told The Times the Charlotte Maxeke Hospital in Johannesburg could lose its accreditation as an academic hospital if there are too few specialists left to train registrars.

Already, seven specialists have officially resigned within just three weeks. Many more are threatening to follow suit in the coming weeks.

The consequences: a severe shortage of specialists, increasing waiting times for patients to be diagnosed and surgery at the hospital coming to a near standstill.

At the centre of the unhappiness is a substantial cut in overtime pay, which has left junior specialists earning just 5% more than registrars, whom they outrank by five years.

Gauteng health spokesman Simon Zwane confirmed yesterday that specialists were no longer allowed to work also in the private sector after completing 40 hours in a government hospital.

This has outraged specialists, who say a significant portion of their income is from the supplementary work because the government "pays too little".

The cut in overtime pay has led to:

• The department of 26 anaesthetists is expected to halve in size by the end of May;
• Two anaesthetists have resigned officially, with a further six to give a month's notice at the beginning of May. Another six are "seriously considering it". This means some surgery in all departments will be cancelled;

Several gynaecologists resigned on April 15 when overtime worked was not included in their pay;

• Heads of department are no longer being paid overtime. They want an explanation why they were not warned of this;
• Senior doctors have expressed fears that not enough registrars will be trained, leaving the country short of specialists in the future; and
• There are four plastic surgeons at the hospital. One has resigned. Another is going to do so in May.

The only doctors expected to stay at the hospital are the "old-timers with a few years to retirement". They say they have nowhere else to go.

Doctors said: "We get lie upon lie from management when explanations are asked" and that if they did resign, a senior official said: 'Good, they are criminals, I rejoice. Our country does not need them'.''

A doctor explained how the recent cancellation of the Remunerative for Work Outside the Public Sector agreement had significantly reduced specialists' pay.

"Because the government cannot afford to pay specialists well, there was a 'gentleman's agreement' that government specialists would work 40 hours-plus overtime a week [at government hospitals] if they could supplement their income with private work.

This kept them in the public sector and allowed them to train registrars to become specialists," he said.

Doctors say the end of the agreement has not been discussed with them but has been imposed "unilaterally".

The Gauteng health department said it had discussed the changes with the dean of the faculty of health science at Wits University, Ahmed Wadee, who oversees the training of registrars by specialists.

Doctors admit some of them have abused the system: ''There are doctors, however, who are never in the hospital and that is why it is so difficult - some are abusing the situation and that is also unacceptable."

Another spokesman for the health department, Chris Maxon, said anaesthetists and radiologists were taking one day off a week to work in the private sector, meaning they were working only 32 hours a week at a government hospital. He said this was not acceptable.

"They expect the department to turn a blind eye to something they know is wrong and illegal."

The specialists say they make up the eight hours in the evenings and at weekends.

Maxon said only three specialists at Charlotte Maxeke had resigned.

A doctor who sent an anonymous letter to DA health spokesman Jack Bloom said: ''The hospital management do not have any appreciation for the type of work these specialists perform, and appear more concerned about budget goals and political agendas."

Acting head of the Gauteng department of health Ndoda Biyela last night said he would discuss resignations with senior management of the hospital this morning.