Thread by @Jonathan_Witt

This doctor placement issue is a great example of the law of unintended consequences. Several years ago the Department of Health pushed for an increase in the number of graduates from medical schools, in part due to significant public pressure from advocacy groups. 🧵

The advocacy groups don’t generally have a good understanding of the system, and the politicians who control things are more inclined to make decisions which reflect well on them in the short term as opposed to whether these are good ideas in the long term.

As a result all medical schools were instructed to increase their output. Several cited concerns, including a potential drop in training standards given increased demand on the same resources. Government largely dismissed these claims, promising increases in funding.

Ultimately the medical schools acquiesced and increased the number of doctors they were churning out by between 20 and 40% annually. This is human capital, so ramping up production is a gargantuan task unlike almost anything else, which the universities mostly did well.

However the system is structured in such a way that once you complete your medical undergraduate training you are then required to perform 2 years of internship training followed by a year of community service time. In total 3 years of employment paid for by Health Departments.

At the end of the day these are jobs, and there aren’t an endless number available. The total number of available posts was never increased enough to match the increase in graduates. This is also a problem for specialist training whereby the same scarcity of posts exists.

Even in a good economy Government jobs for doctors can’t be unlimited because this is a massive burden on taxpayers (cost to company for an intern/community service doctor is between R500k and R800k per annum). We do not have a good economy and haven’t for well over a decade.

Thus it is easy for activists to demand more doctors. It is straightforward for a Minister to exert pressure on medical schools to increase output. However if employment opportunities don’t exist then the effort is wasted and highly qualified individuals are left at a loose end.

The bottom line is that the number of doctors qualifying annually can’t and should not exceed the number of employment posts available in internship and community service. This is simple mathematics. If we want more doctors we need a better economy which is a separate discussion.