SAPPF Chair, Dr Philip Matley

South Africa could face another exodus of specialists in the coming months, not because of the devastating impact the Covid-19 pandemic had on private practices, but because of growing disillusionment and disappointment about the negative developments in the healthcare sector and the country.  

Many specialists started leaving soon after the relaxation of lockdown regulations in countries such as the UK and Australia while emigration has replaced Covid as the main topic of discussion among clinicians, particularly in the under 55 age group.

This was confirmed by surgeon and SAPPF chairperson, Dr Philip Matley (above), who cited issues such as the corruption in the Department of Health, government’s continuous insistence on introducing National Health Insurance (NHI) and a Certificate of Need, and the recent looting and violence as some of the main reasons why specialists are packing their bags.

“Everyone supports better access to universal healthcare, but factors such as government policy issues and the dysfunctionality of the HPCSA are creating tremendous uncertainty because of their potential threat to the already diminished viability of private practice,” noted Matley in an interview with MedBrief Africa.

“Specialists are fed-up and are not prepared to run the risk of remaining in a country where the government is apparently hell-bent on making private practice increasingly difficult,” says Matley.

In some instances, specialists are emigrating without having obtained the required specialist registration to work in countries like the UK with some of them prepared to take any job they can get in anticipation that they will get full registration in the foreseeable future.

Hopes of recovery not realising yet

For those who have decided to remain in the country, there is some hope of recovery in the immediate future with hospitals having opened to full capacity for elective procedures and non- Covid-related medical admissions. However, the numbers are still far from the pre-Covid levels as patients remain hesitant to seek care if it is not urgent with the yo-yo trend of healthcare utilisation increasing and decreasing set to continue as subsequent waves hit the country.

Routine visits and screenings, check-ups and follow-up care are still not happening, raising concerns about a significant rise in morbidity and mortality in the coming months as well as costs relating to more complex and expensive treatments.

“There is no doubt that we will see the knock-on effects of delayed diagnoses and care, particularly for chronic and other conditions such as breast and colon cancer in the next year or so,” says Dr Matley.

The concern is that the anticipated increase in healthcare utilisation could be too late to aid the recovery of many practices.  Some practices have already closed because of financial distress while many doctors in the 60 and over age range opted for earlier than planned retirement rather than continue in the uncertain climate.

In April and May last year, the turnover of the worst hit specialties such as ENT and ophthalmology reduced by more than 25% while surgical practices doing mostly elective surgery were running at about 30-40% of normal capacity. The numbers picked up after the first wave, but dwindled again during the second and third wave, leading to an unsustainable financial situation that forced practices to restructure and cut staff salaries and bonuses.

But says Dr Matley, although the situation remains depressing and threatening, most practices remain resilient as measures are put in place to adapt to the new normal and specialists learn to cope with it. Many have made use of the financial aid offered to doctors last year or took out loans to keep them afloat through the first months of the pandemic.

Referring to the impact on his own practice, Dr Matley calls it “destructive”’. The managing partner of Dr Matley and Partners, a 13-man surgical practice in Cape Town, he himself contracted Covid-19, preventing him from working for a prolonged period while several staff members decided to leave as the practice battled to keep its doors open.

“It was just an awful time to be in private practice. We had to restructure and reduce staff salaries for a while and we are still suffering the consequences which could remain with us for months to come depending on the impact of further waves,” Dr Matley says.

Booster shots for HCWs urgently needed

A huge concern at the moment is evidence that the effectiveness of the J&J vaccine is waning and no concrete plans from government as yet to offer healthcare workers booster shots before the impending 4th wave hits in the next two or three months.

“The recent examples of colleagues passing away of Covid-19 despite vaccination, have raised fears that the possible decline in the vaccine’s efficacy could again increase frontline workers’ risk of infection in the expected next wave because they were the first to be vaccinated,” Dr Matley explained.

“It is a great frustration that we don’t have any clear plan from government to offer booster shots as something needs to be done to address it urgently,” Dr Matley warned, adding that SAPPF and SAMA will meet next week to discuss how they could work together to ensure that booster shots are offered.

In the meantime, he is advising specialists to use the current lull in Covid infections to catch up on postponed procedures and treatments and doing everything in their power to convince their patients and staff to get vaccinated.

“The vaccination of staff and patients and supporting booster jabs are key to returning our practices to viability. If we don’t focus on that, the chances of practices recovering in the foreseeable future are very slim,” Dr Matley concluded.