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The cost of medical education

And why our doctors emigrate.

JOHANNESBURG – This is the second story in a two-part series on medical schools, in the first part entiled “The bunfight to get into med school”, the focus was on how difficult it is to get in, in this part we look at the cost of getting into medical schools and emigration.

Emigration
The writer’s own eminent physician said it breaks his heart that his 18-year-old daughter, who has outstanding academic grades, will never get into medical school. He blames, not the government but the large number of doctors who have emigrated – “fully half of my class of 20 years ago”. He believes this diminishes entry prospect for white candidates but the professors disagree.

According to University World News, in August 2009 parliament was told that SA was losing 17% of its practising doctors every year. Nearly 1 000 newly qualified doctors did not register to work in SA.

A paper by Mignon Breier and others of the Human Resource Research Council (HSRC) in 2006 found that 12 136 SA doctors were registered in OECD countries. The Department of Health reckons the number of doctors lost to First World countries at 8 921.That equates to more than a third of 33 220 practitioners registered in SA at the time. The department says the attrition rate is 25% of the supply of new doctors.

Some 5 534 doctors from sub-Saharan Africa were practising in the US. Of these 1 053 were from Wits, 655 from UCT and 132 from Pretoria.

SA has imported doctors from a number of countries, most notably Cuba. Foreign doctors practising in SA number some 3 000.

Professor Ahmed Wadee, Dean of the Wits Faculty of the Health Sciences,roughly estimates the cost of a medical education at R250 000 a year. Dr Ronel Retief at Stellenbosch puts the cost at R80 000 a year excluding subsidies and grants. The cost of tuition at Wits is R40 000, Pretoria R35 000 a year and Stellenbosch R43 149 pa, so every doctor that emigrates leaves a hole in the fiscus.

UCT estimates the cost at R1.3m for six years. That far exceeds the first year fee of R47 000.

Pretoria has converted the Thembisa and Mamelodi hospitals into academic hospitals to enable it to increase its total enrolment to 400 by 2016. The university loses R50 000 per student a year and has asked government to help bridge the losses. The cost to government is already more than R100 000 per student a year.

Conventional wisdom is that whites are more likely to emigrate but Prof Ralph Kitsch, former professor of medicine at UCT, told the Financial Mail in 2007: “(The idea that) changing the racial profile of students from white male to mostly black would make them less like to emigrate has turned out to be false. Poor students have been just as inclined to migrate, perhaps more, given the large debts they have to pay”.

So why do SA doctors emigrate? According to a survey by Bezuidenhout, Joubert and Hiemstra of the University of the Free State, financial reasons and better opportunities were at the top of the list. Third came concern about crime and violence.

The Department of Health lists low pay, poor working conditions, lack of resources, limited career opportunities and limited educational opportunities as its chief reasons. The Department’s human resources plan envisages lifting the number of new doctors from 1 300 a year to 2 400 a year.

Prof Wadee agrees that financial considerations predominate.

“Even those who come here with starry eyes end up chasing the money.”

SA remuneration has become a lot more competitive following big adjustments to public sector salaries. According to the DoH website, the lowest rate (for interns) rose 31%-51% to R314 000 pa. Medical officers are now paid R392 000 pa, registrars R529 000 pa, principal specialists R962 000 pa and professors and chief specialists R1,2m. Many public sector doctors also practice privately.

Of 1 300 new doctors last year only 35 chose to locate in rural areas. The Department of Health lists the lack of funding in the bundu, as well as historical deficiencies, inhospitable settings, concern about personal safety, the lack of schools and opportunities for spouses to work.

All the medical schools swear that they have not let their standards slip. They say their students are kept up to date with advancing knowledge and technology. They have adapted to new realities. The whole country needs medical services, no longer just an elite and the schools today are more aware of their social duty. The good news is that there are still thousands of all colours who meet the tough entry grades. Failure to gain admission might be heartbreaking but competition should do much to preserve the high standards to which we have become accustomed.

*This story is published posthumously

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