Navigating the complex landscape of unemployed doctors

Professor Terrence Kommal

Professor Terrence Kommal

Published Feb 18, 2024


In the challenging terrain of South Africa’s medical landscape, the plight of unemployed doctors echoes a profound dissonance.

As a practising medical doctor and professor, and someone who also studies with government scholarships, I delve into the multifaceted dimensions surrounding the claims of young doctors, juxtaposing historical contexts, the correlation between unemployment and negligence claims, and the undeniable personal aspirations propelling these medical professionals.

Setting the stage: a historical overview

To comprehend the contemporary challenges confronted by young doctors in South Africa, it is imperative to cast our gaze back over five decades. The roots of the current predicament delve into a history where the control and allocation of training posts were already contentious issues.

More than 50 years ago, during the era of apartheid, the medical training landscape bore the scars of racial segregation. Access to quality education and training opportunities was systematically denied to aspiring doctors based on their racial backgrounds.

This discriminatory practice not only perpetuated social inequality but also left an enduring imprint on the distribution of medical professionals across the nation.

The vestiges of this historical injustice persist, shaping the contours of the present discourse on unemployment among young doctors. The control over training posts, historically concentrated in specific demographics, continues to influence the availability of positions for emerging medical professionals.

Understanding this historical context lays a foundation for unravelling the intricate complexities embedded in the contemporary health-care system. It sheds light on the long-standing current challenges that have permeated the medical profession, contributing to the current landscape where young doctors grapple with issues of unemployment and access to specialised training.

Unravelling the threads: correlation vs causation

Central to the ongoing debate is the correlation drawn between the alleged unemployment of these young doctors and the surge in medical negligence claims against the government. Yet, caution is imperative before accepting this correlation as a direct causation. The health-care landscape is a complex tapestry woven with factors extending beyond immediate employment concerns.

Insights from interviews: a glimpse into reality

Engaging in conversations with and reading about young medical professionals, like Dr Le Roux Viljoen and Dr Suhera Sukdeo, provides invaluable insights into the tangible challenges faced by young doctors seeking specialised posts.

Dr Viljoen’s narrative underscores the scarcity of state- funded positions, shedding light on the harsh reality that often involves working for free to accumulate vital experience. In Dr Viljoen’s case, the options seem limited—seeking locum positions in private practices or waiting for elusive government posts. The financial strain and uncertainty associated with these choices form a crucial part of the narrative, emphasising the personal sacrifices made by these doctors.

Financial realities: a crucial element in the discussion

A critical element of this discussion is the financial aspect that young doctors face in the initial years of their careers. Over the three years of internship and community service, these individuals typically amass a net income of approximately R1.5 million. While this figure might seem substantial, it becomes imperative to consider the financial landscape, especially when aspiring to set up a private practice.

Options beyond unemployment: private practice and specialist training

As we explore potential pathways for these young doctors, it becomes evident that avenues exist beyond unemployment. An often-overlooked option is the opportunity to work and learn from private specialists. While private practices may not align with the initial aspirations of many, it offers a practical route to gain valuable experience, contribute to patient care, and alleviate financial burdens.

Moreover, the potential to write the primary exams of the Colleges of Medicine of South Africa (CMSA) opens up new possibilities. Young doctors can focus on their areas of interest, showcasing their commitment to specific fields and potentially increasing their chances of securing registrar posts when advertised. This approach aligns with the idea of personal investment in professional development.

Low barriers to entry: affordable practice set up in certain regions

It’s noteworthy to recognise that while the general perception of setting up a practice may appear financially burdensome, there are regions, such as Langa in Cape Town or Phoenix in Durban, where the barriers are relatively low.

In these areas, the cost of rentals and initial set-up can be significantly more affordable compared to prime locations. This low barrier allows doctors with modest capital to venture into private practice, providing an alternative path for those facing challenges in securing government positions.

A proposed solution: a contractual model inspired by the military health service

In the face of ongoing debates, a proposed solution emerges - one rooted in fairness and equity. Young doctors aspiring to specialise in government-funded training positions might consider committing to an equal amount of service time in the public sector.

This contractual model, inspired by practices in the military health service, aims to harmonise personal aspirations with the societal imperative for expanded health-care services.

Government’s focus: service delivery amid challenges

Amidst these discussions, it is crucial to recognise that the government’s primary focus is on service delivery. Despite existing challenges, including corruption and systemic issues, the core objective remains the provision of healthcare to the public. This distinction is vital as it underscores the broader societal context within which the employment challenges faced by young doctors unfold.

Progression in professions: Dispelling entitlement notions

Dispelling notions of automatic entitlement, it’s crucial to acknowledge that the next stage of professional development is not a guaranteed progression.

Reflecting on other professions, such as engineering and accounting, it becomes evident that not every graduate secures a position directly related to their field of study. The aim is to emphasise that diversification in career paths is not unique to the medical profession and can contribute to reducing corruption and enhancing public services.

The engineer and accountant analogy: No entitlement in career progression

Drawing parallels with engineering and accounting professions, one must acknowledge that not every engineering graduate secures a position at Eskom or Prasa. Similarly, accountants do not automatically find employment within government auditing bodies. The absence of entitlement in these fields dispels the notion that graduating in a specific discipline guarantees immediate employment in a corresponding sector.

The progression in these professions is marked by a competitive job market, individual career choices, and the dynamic nature of the industries. A civil engineer may explore opportunities in private construction firms, and an accountant may opt for positions in private corporations. These alternative paths do not diminish the value of their qualifications but rather contribute to a diverse and resilient workforce.

In conclusion: A call for collaborative solutions

As the discourse surrounding unemployed doctors in South Africa evolves, it becomes evident that collaborative efforts are essential. The proposed contractual model seeks to align individual goals with societal needs, fostering a more sustainable and equitable healthcare system for the benefit of all stakeholders.

Navigating the complex landscape of unemployed doctors requires a nuanced understanding of historical legacies, systemic challenges, and the genuine aspirations driving young medical professionals. By engaging in open dialogue and exploring solutions that balance personal ambitions with societal demands, we can collectively strive towards a health-care system that serves both the professionals and the public.

Professor Terrence Kommal is a medical doctor, CEO of the Medical Expert Consulting Group, and Extraordinary Professor of Practice at North West University. Connect with Kommal on LinkedIn ( to explore his expertise and impactful contributions to the medical field.


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