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Doctors win South African registration battle

BMJ 1998; 317 doi: (Published 17 October 1998) Cite this as: BMJ 1998;317:1036
  1. Pat Sidley
  1. Johannesburg

    A group of doctors born and trained outside South Africa have won their High Court case against the South African Medical and Dental Council to have limitations on their registration as doctors scrapped so that they may go into private practice.

    The case arose out of the fact that foreign born and trained doctors from several countries (excluding the British Isles and Belgium) do not have their qualifications recognised automatically by the council (29 August, p 557). These doctors can work only in state hospitals and cannot work in private practice. Many of these doctors, however, are naturalised South Africans, have worked in state hospitals for many years, supervise the training of doctors born in South Africa in those hospitals, and in many cases are the only doctors working in these hospitals.

    In 1991, South African doctors who were in exile and had qualified outside South Africa were given a special dispensation by the council to have their qualifications recognised and go into private practice. But this “window” for exiles was not extended to the foreign born doctors, some of whom had trained in the same facilities as their South African counterparts. The High Court has now ordered the medical and dental council to register these doctors immediately.

    The minister of health, Dr Nkosazana Zuma, supported the council's stand in the case. Although the council consistently maintains that it is an independent qualifications body, many of its decisions follow government policy.

    The issue is not going to go away. The council has already announced its intention to appeal, and at the same time a larger group of foreign born and qualified doctors have, with legal help, instructed the council to register them for private practice.

    Shortly after the court case, it emerged that the Ministry of Health had ordered the Department of Home Affairs not to renew the work permits of many of the foreign born, non-naturalised doctors propping up the state hospital system. The government has also entered into agreements with Cuba and Germany to supply doctors to the state hospitals on fixed contracts.

    It is likely that continuing legal action will determine whether doctors born and trained outside the country will be able to practise–and how they will practise in South Africa. But government policy has become murky owing to local doctors' continued refusal to work in the public sector because of lower salaries and the difficulties of working either in rural areas or in black townships.

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