There are some good reasons why South African-trained medical doctors should be asked to serve the community for two years...
A MEDICAL doctor of my acquaintance was frothing at the mouth and falling all over recently when this idea was first broached. "Why not," he asked "insist that lawyers and accountants do the same thing?"
Simple, another of us replied. The community does not need lawyers and accountants. There was much drunken laughter and the conversation quickly degenerated into variations on every lawyer joke any of us had heard.
But back to doctors. Are they really being shafted by recommendations that they "contribute" two years of community service before being allowed to move out into private practice?
About one week ago, I revisited Baragwanath Hospital just outside Soweto. The place is more a city than a hospital. One needs a road map to be able to find 24 Casualty Crescent which is just off Maternity Road around the corner from Hospital Street.
Bara is the largest hospital in the southern hemisphere with over 3000 beds, all of which are occupied at any given time.
Bara is a training hospital. Medical students are seconded to Bara from universities. As a learning experience, Bara is probably unrivalled in the medical world.
If you can think of a disease, chances are that Bara has seen it. They haven't had the flesh-dissolving Ebola virus which resurfaced in Zaire not so long ago, but there is no shortage of rare blood disorders, strange skin afflictions, and any number of cancers.
With our extremely high rate of crime-related injuries, road accidents, and workplace disasters, Bara has no shortage of trauma cases. Orthopaedic surgeons in particular have the opportunity to experiment with every documented method of bone repair, and design new ones.
So a doctor who qualifies after having worked at Bara is streets ahead of the doctor who trains in a specialised private hospital in a wealthy country.
For many specialists, Bara is the only place where they may study real cases that are otherwise found only in textbooks.
Bara is only the largest and most dramatic of our hospitals. Durban's King Edward VIII hospital is a marvel in its own right and is also a training ground for our doctors.
It costs a medical student just R9 800 per year in tuition fees to provide her with a level of medical experience that allows her to hold her own anywhere in the world.
As most of our medical students enter medical school immediately after high school, the cost of a seven year medical degree is less than R70 000 or US $15 000.
Now contrast this with the USA where would-be doctors complete a four year basic undergraduate degree before going on to seven years of medical school.
Typical tuition cost per year at top medical schools in the United States is currently about $25 000. Multiply that by 11 years and one ends up with a rather tidy sum of about R1 237 500.
That's right. One million, two hundred and thirty seven thousand, five hundred rand per doctor.
But what's important to remember is that training doctors costs just as much in this country. Except the money does not come from the students. It comes in the form of funding of public teaching hospitals. We pay for that as taxpayers, you and I.
So, I see nothing wrong with asking our doctors to pay back some of that money by working in the public health service for a few years. Do you?
Lawyers and accountants do not need this massive public-funded infrastructure to learn their craft. Neither do journalists.
About half of our doctors skip this country to more profitable places around the world, including the USA. I see no reason why you and I as taxpayers should be subsidising the health care systems of those countries.
Doctors need to pay back some of that money. The way in which they should do that is by working it off for the benefit of the people who paid in the first place, you and I.
Alternatively, they can pay first world prices for a better education than they could acquire in the first world, and consider themselves free agents.
We can certainly use the money to provide bursaries for those who do wish to work for the public service, but cannot afford R9 800 per year.