Doctors protest against South Africa's registration system

BMJ 1998; 317 doi: (Published 29 August 1998) Cite this as: BMJ 1998;317:557
  1. Pat Sidley
  1. Johannesburg

    A group of foreign educated doctors, who are now naturalised South African citizens, are challenging regulations in South Africa that prohibit them from gaining full registration as medical practitioners unless they retake their final medical examinations.

    The doctors' limited registration restricts them to occupying posts in state hospitals and denies them the right to go into private practice. The doctors have brought their case against the health minister, Dr Nkosazana Zuma, in the Pretoria High Court, and they allege that the regulations are discriminatory and that they are being used to ensure that well trained doctors are restricted to working in the public healthcare sector.

    South Africa faces a critical shortage of doctors working in its public healthcare sector–a shortage partly relieved by a flow of doctors from Cuba on relatively short term contracts as part of a contract between the two governments.

    The doctors who have brought the action occupy some of the top posts in teaching hospitals–such as Martin Tupy, who is head of urology at the Helen Joseph Hospital. According to their lawyer, some of the doctors had qualifications superior or equal to local qualifications, but the law prohibits these doctors from entering private practice, even on a part time basis.

    In 1991 the government allowed returning exiles who had qualified abroad, often in Eastern Europe, to return to South Africa and work as doctors. They were required to work supervised in an approved state institution for only a year before full registration became automatic. The anomaly this has created is that many Eastern European doctors who were born and raised outside South Africa qualified at the same institutions as South African exiles but their qualifications are not recognised in the same way.

    The issue had previously been taken up by the Human Rights Commission, a constitutional body with powers to rule on human rights abuses. This body had rejected the complaint laid by the doctors, but one commission member–the well known human rights advocate Helen Suzman–has broken ranks and is testifying on behalf of the doctors in the trial. She said: “Although the claimants do not fall into the category of exiles, I contend they deserve special consideration. They have been practising and teaching medicine in state hospitals for many years. When their students graduate, they can practise without restriction after one year's internship, yet their teachers–the complainants–remain confined to state hospitals.”

    The Interim Medical and Dental Council, which registers doctors, claims that no doctors are forced into the public sector and that avenues exist for them to obtain full registration. The council's registrar, Nico Prinsloo, however, conceded that the country's healthcare sector was dependent on the services of the foreign doctors.

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