Trade unions, medical associations and universities are raising the alarm that Gauteng funds cuts at the value of doctors’ take-home pay will have dire consequences for public sector health. Meanwhile, the National Minister of Health has convened a committee to evaluate the way forward for extra time for state doctors.
Dysfunction within the Gauteng Department of Health hit home hard for many public sector doctors on 29 April when their extra time payments due for the month went unpaid.
The non-payment came with out scrutinize and affected medical staff in facilities across the province, according to the South African Medical Association (SAMA). Most efficient by 6 May did some doctors start to contemplate payments replicate in their bank accounts. Extra payments are anticipated quickly given that, according to the Basic Situations of Employment Act, the employer has seven days to settle, said SAMA.
But tensions are rising as this payment blunder follows a protracted row over the department’s unilateral determination to cleave back and change the phrases of commuted extra time within the province. Proposals to cleave back down on commuted extra time near within the sunshine of a very tight provincial health funds. As with most varied provincial health departments, Gauteng’s health funds has been afraid in real phrases for several years.
The delayed payments and the ongoing evaluate of cuts and changes to commuted extra time pay has led to threats of protests and legal action. SAMA says they’ll make civil claims for salaries owed, together with for passion and legal charges. Registrars and medical officers at Dr George Mukhari Academic Hospital in Ga-Rankuwa collectively wrote to the hospital giving scrutinize of withdrawal of extra time companies until the non-payment situation is fully resolved. By 7 May, the head of anaesthesiology at Sefako Makgatho Health Sciences University wrote to the CEO of George Mukhari Hospital informing him that no anaesthesia companies would take place at the hospital starting 8 May, given the determination by registrars and medical officers to down tools originate air of regular work hours.
Those from the medical fraternity that Spotlight spoke to have set aside out a sequence of considerations. These encompass resignations; an exodus of doctors, especially specialists from the public sector; plummeting staff morale; negative impacts on the training of doctors as fewer consultants and seniors are available to supervise – which then places universities’ training accreditations at chance. Ultimately, several sources indicate, it’s miles the companies supplied to the public that suffer.
Committee appointed
By the start of April, there appeared to be some walking back by the Gauteng health department of its unilateral cutback proposals after meeting with the South African Medical Association Trade Union (SAMATU). In the same week, a circular was issued announcing that the national health department was conducting a evaluate of its maintain, instructing provinces to maintain off on their plans. Health Minister Dr Aaron Motsoaledi then arrange a committee of consultants to evaluate certain human resource policies within the public healthcare sector. This consists of a evaluate of community provider, commuted extra time, remunerative work originate air the public provider for health professionals, and rural and related allowances.
Commuted extra time is a pre-determined amount of extra time that doctors employed by provincial health departments are allowed to work. The amount is historically made up our minds by hospital management and is based on an worker’s role, seniority, the department they work in and the amount of extra time they are allowed to safely work. Or now not it’s a mounted rate of 1.3 instances the applicable hourly tariff for a explicit work grade.
There are five contract alternate choices. A is now not any extra time labored; B is extra time of between four and eight hours a week; C is extra time between 9 and 12 hours a week; D is extra time between 13 and 20 hours per week; and an choice E is the place, on approval, a doctor can be authorised to work more than 20 hours of extra time a week.
As a mounted amount, commuted extra time is predictable supplemental profits and for many doctors, it amounts to about a third of their take-home pay.
The prolonged rumblings to cleave back their extra time pay has considered doctors being required to motivate why they ought to remain on contracts that pay for more extra time hours and junior doctors say they are being forced to signal choice C contracts, which is able to pay for fewer extra time hours. There are also proposals to change one of the vital most phrases relating to extra time, together with scrapping extra time payments for doctors who are on call but now not physically demonstrate at a facility.
Many doctors already exceed the maximum hours of their contracts because of the emergency nature of their work, immoral understaffing and backlogs at their hospitals.
Costly, but essential?
The commuted extra time pay mannequin has been contentious for years because it adds up to a sizeable chunk of the healthcare funds. According to a spending evaluate performed in 2022 on behalf of National Treasury, the country’s health departments spent R6.9 billion on commuted extra time in 2021. This made up about 70% of the total R9.9 billion spent on all varieties of extra time.
In an editorial published within the South African Medical Journal in April 2025, health sciences academics, associations, and unions slammed the Gauteng health department’s handling of pay points. They argue that the basic salaries of medical professionals within the public health sector are already worthy lower than what would be regarded as fair pay.
“COT [commuted overtime] has long served as a critical mechanism to ensure that doctors are available beyond the standard workday, safeguarding round-the-clock care in the public health system…The abrupt curtailment of this framework risks hollowing out the after-hours safety net, leaving emergency rooms, wards and clinics dangerously under-resourced,” they wrote.
A co-author of the editorial, SAMA CEO Dr Mzulungile Nodikida, told Spotlight: “Medical doctors in South Africa’s public sector are severely underpaid. A study by SAMA has shown that even the annual cost of living adjustments that have been made on the salaries have not matched inflation in the last 5 years. Commuted overtime has had the effect of masking a deficient salary.”
He said the Gauteng health department has confirmed itself to be an “unreliable employer”, adding that its relationship with doctors remains fractured as a lack of self perception within the department deepens.
“This breach of the most basic employment obligation: timely remuneration, has cascading effects. It jeopardises morale, compromises service delivery, and calls into question the department’s commitment to its workforce. Doctors now operate under a cloud of uncertainty, unsure whether they will receive their salaries at month-end. This anxiety permeates every aspect of the employment relationship, from retention efforts to the willingness to engage in additional responsibilities,” said Nodikida.
Examine from the wards
Two doctors who spoke to Spotlight independently, and from two varied Gauteng hospitals, say the commuted extra time pay disaster is but another symptom of weak human resources and unfortunate management from the department of health. For them, proposals to cleave back commuted extra time is the department shirking from addressing the staffing disaster; the need to beef up human resources programs; and rooting out corruption, maladministration and wasteful expenditure. Both doctors asked now not to be named for fear of reprisals.
Dr A, who is based at Charlotte Maxeke Johannesburg Academic Hospital, said: “Instead of having a system in place to record how many hours each doctor is actually working and what overtime that person should be paid, the department pays everyone this commuted overtime fixed sum….[Y]ou could be a dermatologist or a psychologist and have very few overtime hours or be a surgeon who is doing a lot of overtime but you all get paid the same if you’re on the same contract option,” she said. “But right now, in my career I’m working way more overtime hours than my contract and I’m not being reimbursed for any of it.”
Dr A said the extra time pay cuts and proposed changes will impact her determination to stay within the public sector.
“It used to be the case that you were happy, once specialised, to stay because the overall lump sum of money from your salary and commuted overtime made up a decent pay – not comparable to what you could earn in private – but decent enough to stay,” she said.
She said she feels care for doctors are now being below-valued and coming below attack by their maintain employer. “The message we are getting is that ‘if you’re not happy, there’s the door’ – but what the department doesn’t understand is that you can’t just replace someone with 10 years’ experience or someone who has 30 years’ experience, it has a huge impact,” she said.
“Our patients are struggling; and each day it be care for a game of Survivor. We hasten a couple of clinics in a single medical institution space at Charlotte Maxeke, but you can’t offer a functioning provider care for that. Or now not it’s noisy, the computer programs don’t work, and the intercom goes off your entire time.
“The other day, I had a 90-year-old patient have a panic attack in the waiting room. He had been waiting for a while and left his wife, who is blind, in the car. He had to park far from the hospital building because the parking lot from the hospital fire [in April 2021] is still not properly repaired and he was overcome with worry,” she said.
Dr B works at Chris Hani Baragwanath Hospital and he said the debacle over doctors’ extra time pay has pushed him to the brink. He said doctors are already overworked and disheartened from working interior a failing contrivance. He despatched photos to Spotlight of theatres and wards in darkness as energy went off at the Soweto hospital for days at the top of April.
He said staff carry in their maintain toilet paper because they’re told there’s none. Most alarming, he said “doctors are not getting the training and supervision they need” and regularly perform surgical procedures and procedures with out adequate skills and without a supervision.
“They are overwhelmed, overworked and doing way too many overtime hours that they’re not being paid for. Then they go home overtired, eat a pizza and crash, sleep a few hours then do it all over again the next day, and the next day,” he said.
“We, doctors, are literally the ones putting patients’ lives at risk,” he said, adding that he is “surviving on anti-depressants” and has generally shut himself away in hospital storerooms crying tears of sheer frustration, exhaustion and exasperation.
Dr B does detached count the wins though. Or now not it’s days when he clears an impossibly prolonged patient list of teenagers who want procedures performed. Or now not it’s when he and his colleagues contemplate to push thru to make clear no kid’s arrangement gets cancelled.
“Those are the good days – they’re just few and far between. And now the department is coming for us by cutting our overtime pay and forcing us to sign contracts to downgrade our overtime pay,” he said.
Resignations and impact on training
Professor Shabir Madhi is dean of the faculty of Health Sciences at the University of Witwatersrand. He said the proposed cuts and freezing of posts and changes to commuted extra time pay has already resulted in resignations of some senior staff at state hospitals.
“If we do now not have the apt consultant staff complement in these hospitals who can present supervision for the duration of the day, it compromises our training of specialists as smartly as of undergraduate students.
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“If the Health Professions Council of South Africa were to achieve an audit and acquire that there’s never adequate consultant duvet and supervision, they may eliminate the accreditation of the training programmes supplied by the colleges.
“The medical faculties are fully dependent on the Gauteng Department of Health to retain consultants and varied categories of staff, and to be certain that that staff are allocated time for supervision and training of future medical doctors, together with specialist, as smartly as varied academic activities.
“It means decision-making around cuts to overtime pay need to be cognisant of the overall impact that it would have, and not only in how it would assess budget constraints. This situation needs meaningful and informed decision-making,” he said.
FAMILY PHYSICIANS TO THE RESCUE? The health department has near up with a blueprint with a renewed point of interest on family physicians. These doctors are known to beef up the quality of primary and district hospital care.
In finding out more: https://t.co/c0D0ZwSRri pic.twitter.com/tlpmF0FJhk
— Spotlight (@SpotlightNSP) October 25, 2024
Dr Phuti Ratshabedi, Gauteng chairperson of SAMATU, said the non-payment of commuted extra time pay in April was a slap within the face from the provincial health department as the union had a meeting with the department that month and left with the department agreeing to uphold their contractual agreements to leave contracts phrases for commuted extra time pay unchanged at least until the top of March 2026 – the top of the financial year.
“What we saw is that the department will promise one factor and achieve another. But we will seemingly be able to be maintaining them to what they stated in their maintain circular or we will seemingly be able to stare to legal action.
“What we want to contemplate on this evaluate duration is that they scramble after departments [where overtime is not being performed, but being paid for] but leave varied departments alone – they cannot put all individuals below the same blanket.
“If the government is able to bail out over and over things like Eskom and Transnet, how can they not prioritise healthcare – this sets our country way back and we doctors will no longer be silent about this,” said Ratshabedi.
Spotlight despatched questions to the Gauteng health department, together with on how the payment delay happened; the alternative of individuals affected; how the department is addressing the large-spread knock-on effects of their proposed commuted extra time cuts; and what amendments they hope will near out of the national evaluate. Despite several reminders, the department did now not acknowledge to our questions.
