Medical practitioners outraged by 13% council fee hike

Cape Town - Additional financial constraints on medical practitioners is pushing the healthcare system to its knees following the rise in the professional fee rate.

This comes after the Health Professions Council of SA (HPCSA) announced that the annual registration fees for medical practitioners will be raised by 13% this year, and as a result, the South African Medical Association (Sama) warned that if the registration fee continues to inflate, there will be an increase in litigations due to the shortage of doctors in operating rooms.

With more than 25 000 signatures on a petition underlining the challenges that medical practitioners face, medical staff believe that the increase is unreasonable considering that they were front-line workers in the face of Covid-19 and still had to succumb to financial setbacks brought on by the pandemic.

A doctor, who wished to remain anonymous, mentioned that the increase sparked significant unhappiness, as state doctors were poorly supported during the pandemic and the steep increase seemed to be piling on to their already significant woes.

“I started the petition to try and see how many other doctors felt abused by this system, and I saw very quickly that I was not alone in my frustration. This increase was announced suddenly, and there was no consultation with us, the doctors working on the ground. The HPCSA reported that they had an ’extensive consultation with medical and dental boards’; however, as is often, there was no engagement with the medical community, and no opportunity was given for doctors to voice their concerns."

“My experience with the HPCSA, and the experience of countless doctors has been that of a dysfunctional organisation that frustrates and disregards those who are members of it. Doctors who are trying to register, or who need to obtain crucial paperwork for their employment, often struggle for weeks and months at a time to get hold of the HPCSA. They are literally unable to make contact with the organisation. Some doctors have had to resort to physically travelling to their offices in Pretoria to try to get anything processed."

“One of the reasons why the increase is being questioned is the fact that the registration process for the vast majority of practitioners is online. The online system updates your status once payment is received and a QR code is generated with the updated registration details. This is not a costly process. Furthermore, the system whereby doctors need to comply with CPD points (continuous professional development) has also been automated, which must surely decrease their running costs further.”

“The final aspect is that this increase is not a small amount of money. There is only one payment option, and that is via EFT, or if working in a state, having it deducted from your salary. It can only be paid as one amount, there are no payment options outside that. In 2020, fees for general practitioners were R2 500 for the year. Last year it jumped to R2 890 and this year it's shot up to R3 266. For specialists, the fees are significantly higher. The HPCSA has not provided satisfactory reasons for these increases."

“The fact that doctors don't riot in the streets and go on strike does not mean that we should be treated with impunity by the powers that are meant to protect our profession,” said the source.

Amahle Booi, a graduate physiotherapist, said she wishes a concrete plan could be implemented since she is in a position where she is unable to pay, and continual rise in the fee makes matters worse.

“Being unemployed, I don’t see why they are constantly increasing, whereas they don’t do anything tangible for us as health workers. Having worked on the front during a global pandemic, the least they could have done for us is halting the fees for this year or the next instead of increasing them every year. It’s not like your salaries are increasing as well,” said Booi.

The SA Medical Association (Sama) spokesperson, Mvuyisi Mzukwa, said that the association was deeply saddened by this ill-conceived idea of raising registration fees regardless of the current circumstances.

“Sama is of the view that this decision was insensitive and inconsiderate, especially for raising fees by almost 30% in two years during an economically devastating pandemic.”

“Some doctors are unemployed, some are without salaries. Those that are employed by the state get a 1.5% increment, and in private practice some have closed shop, while some are drowning financially due to loss of revenue caused by the loss of jobs in the economy.”

“If the increase continues, we’ll find ourselves in a space where we have doctors and healthcare workers leaving the country, changing careers or retiring early.”

“This unfortunately will have a rippling effect on the healthcare system because there would be less experienced doctors and healthcare workers training medical students or supervising difficult operations in operating rooms.”

“If the fees continue and this trajectory, they’ll be longer queues in the hospitals, and we’ll see a dramatic increase in litigations because if you have few doctors in the hospital, they’ll be more likely to make mistakes because of the pressure and the number of patient they have to see a day.”

“The best solution is to unbundle the HPCSA, leading to a separate medical and dental council. In the meantime, the minister should intervene and stop this scourge of dysfunctionality. Health-care workers are being punished by the HPCSA instead of being commended for being on the front line during a deadly pandemic,” said Mzukwa.

The president of the HPCSA, Professor Simon Nemutandani, said the council was aware of the concerns raised by practitioners and they were looking into it.

“We remain committed to continued stakeholder engagement with all relevant and affected parties on this matter. The council is further committed to the Medical and Dental Professions Board and its practitioners and will continue to focus on strategies that will improve service delivery, improve efficiencies and reduce costs."

“Going forward, the council is currently engaging all relevant stakeholders to ensure a common understanding of the process which was followed and the main contributors to the determination of the annual fee increase,” said Nemutandani.