Abstract
BackgroundSouth African doctors work up to 60 h per week to ensure 24-h service delivery. Many doctors are physically and emotionally exhausted, neglecting families, self-care, patient empathy and innovative thinking about complex health issues. Exposure to clinical work hours demonstrated a dose effect with burnout, suggesting cause and effect, affecting up to 80% of doctors. To retain good doctors, their complex needs must be recognised and allowances made for flexible work options.Taking a riskGeorge Hospital, a large regional training hospital in a rural district, converted some full-time medical officer posts to part-time posts. This was in response to doctors’ requests for more flexible work options, often after returning from maternity leave or in response to burnout. Perceived risks revolved around institutional resource security and that part-time post vacancies would be difficult to fill.Reaping the benefitsEmploying doctors in part-time posts has created stability and continuity in the health team. The hospital had generated a cohort of young professionals who care with empathy and have emotional resilience to train others and plough their skills back into the healthcare service.ConclusionReducing working hours and creating flexible options were concrete ways of promoting resilience and retaining competent doctors. We recommend that training and work of doctors be structured towards more favourable options to encourage retention, which may lead to better patient care.
Highlights
South African doctors work up to 60 h per week to ensure 24-h service delivery
We support the previous calls of health leaders to structure the training and work environment of doctors towards more favourable options to encourage retention and reduce burnout, leading to better and safer patient care
The hope is that more of these innovations will be implemented in similar contexts in Africa
Summary
There is a shortage of doctors, which is accentuated in developing countries.[1] According to the World Health Organisation (WHO), South Africa (SA) had 9.1 medical doctors per 10 000 population in 2017, in comparison with the average global density of 15 per 10 000 people.[1,2] This is in contrast with other BRICS countries, for example Brazil with 21.5, China with 17.8, Russia with 40.1 and India with 7.8 doctors per 10 000 population.[1] In SA, this shortage is aggravated by the large private or public healthcare divide, with 30% of doctors caring for 85% of the population in the public sector.[3] The rural or urban divide contributes further to this shortage, where 46% of the country’s population living in rural areas are being cared for by 12% of doctors and 19% of nurses.[4] In the Garden Route district 3.3 doctors per 10 000 population care for the roughly 550 000 people in the public sector (Western Cape Department of Health Human Resources Department staff approved post list as at April 2020) Because of this shortage and the need to cover 24-h services, full-time doctors are contracted to work overtime, amounting to a 56-h work week.
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