RP Dispensing with doctors? [Letter to the SAMJ 2003]

To the Editor: South Africans have been fortunate beyond belief in their access to doctors, widespread poverty notwithstanding. They are unaware of their good fortune, taking it for granted, but all good things must come to an end.

Other health care professionals cannot replace doctors at a lower cost. True, the work done by doctors can be divided up among several classes of professionals, but doing so increases the costs of care severalfold - the British and American experiences serve as proof of this.

The South African public does not think of a visit to a doctor as one for information or a diagnosis, but rather as one for treatment. This mistaken belief has meant that many attend doctors inappropriately, but it has also meant that the public has not paid for the true cost of care.

South Africans are about to discover that they cannot afford doctors, and their doctors are about to discover the same. Already highly sought after by developed economies, circumstances will force their flight, however regretfully. South Africa will find itself in the same situation as other sub-Saharan countries with regard to the numbers of doctors in relation to the population. The ratio will be woefully inadequate.

Less than 3% of any age cohort in this country is capable of studying medicine. This group must produce our accountants, lawyers, statisticians, actuaries and engineers, among others. It cannot do so completely, and of all the career options, medicine probably falls at the bottom of the scale. We already produce fewer doctors per year than we did in the past, and that number will only get smaller.

It now takes 22 years of study to produce a doctor in South Africa. Which intelligent person is going to make such a commitment in order to be paid as much as a secretary - and to have his or her place of work and residence decided on by the government? I thought the constitution outlawed slavery? And I thought that the USSR proved conclusively that a central command economy does not work? Even the Chinese

acknowledge this. 

The government is changing doctors' scope of practice while calling it something else. This can only end badly for all concerned if the government fails to listen to an important constituency, viz. doctors in South Africa. Pearl Harbour was not a bolt from the blue, nor was 9/11: in both cases those in authority failed to pay attention to the necessary information until it was too late.

Hegel may have been right that history teaches only that we learn nothing from the past.

E Hassen