By Zahid Badroodien, November 2016, bhekisisa.org.

More than 200 newly qualified doctors may be left with worthless degrees if provinces can’t raise funds for internship positions.

As South Africa struggles to address its shortage of doctors, newly graduated medical students may be left with worthless degrees as government coffers run dry. It is a crisis that may be years in the making.

As the academic year draws to a close, 1 628 final-year medical students have applied for medical internship positions with the department of health. Without these internships, these young doctors cannot complete the subsequent community service needed to practise professionally.

At the start of the second-round placements for 2017, 474 graduates were vying for just 167 vacancies. In short, it remains unclear where 258 newly graduated doctors will be placed for internship positions.

We are presented with the jaw-dropping reality that there may be a large number of unemployed medical interns who will not be incorporated into the already overburdened and under-resourced health system.

The department of health has admitted that funding shortfalls have led to the crisis. But the department says it remains confident the provinces will find the money for additional posts by the end of November and there are indications that this may already be happening.

This has been a long time coming.

Although there is much speculation about the factors that have caused this crisis, it is well documented that the government’s health expenditure has increased exponentially. Meanwhile, we have seen marginal increases in health budgets.

Slowing economic growth and irregular expenditure have also put pressure on government revenues, and this is being felt across all government spheres. So, too, is the impact of the #FeesMustFall movement. Although the founding principles of the movement are based in South African realities, students must not be mistaken in believing that their actions have had consequences. The effects of the movement have contributed to the uncertainty of final-year medical classes graduating, as well as the subsequent diversion of government funds from other departments to the higher education sector to subsidise underfunded students.

The national health system now faces a R9-billion deficit, according to the Western Cape health department head, Beth Engelbrecht.

As the Junior Doctors’ Association of South Africa, we are concerned about the causative factors and consequential effects on the expected reduced uptake of medical interns into the health system.

Between 2002 and 2012, South Africa made great progress in increasing the number of healthcare professionals working in government service. During this decade, there was an average 6.1% annual increase in the number of health workers employed by the government. This is commendable.

But the Rural Health Advocacy Project (RHAP) raises real doubts about the country’s continued ability to absorb the doctors it produces. The RHAP projects that, if the country hires about 500 new doctors each year — about 30% of those who graduate annually — this would cost the state about R859 000 a year per doctor, without adjusting for inflation.

This means the department would have to budget for an additional R430-million annually for doctors alone.

If this trend continues for the foreseeable future, it raises the question: Where will the newly qualified medical doctors be accommodated if provincial health systems are being instructed to downscale in light of budgetary constraints?

As of February, the RHAP says that all but two provinces were allegedly suspending the filling of vacant health posts.

The national health department now finds itself at a tenuous juncture: find the money to open posts for medical interns or risk leaving dozens of graduates essentially unemployable.

We are hopeful that, by continuously engaging with the department, a resolution will be found among the provinces.

We caution the department that leaving any health professional unemployed risks causing a decline in access to services and the quality of services being delivered.

This runs contrary to the right to have access to healthcare, enshrined in section 27 of the Constitution, and cannot be considered rational or proportional in terms of legislation.

Zahid Badroodien is the president of the Junior Doctors’ Association of South Africa