Don-Wauchope, Andrew C

South African Medical Journal (SAMJ)

August 2005, Vol. 95, No. 8  SAMJBRIEWEEmployment contracts for SouthAfrican doctorsTo the Editor: There has been concern about the loss of healthcare professionals from South Africa, and while there aremultiple factors contributing to this, one of them, in myopinion, is that health care professionals work under pooremployment terms and conditions.My brief experience with South African employment after aperiod of time in the UK led to an unfair dismissal(Commission for Conciliation, Mediation and Arbitration(CCMA) case reference WE3402-04) because I refused to sign acontract that among other issues, included a clause in breach ofSouth African labour law (notice period in violation of thebasic Conditions of Employment Act).  To illustrate thescenario, a selection of my points of objection follow.A set of clauses covered hours of service. These were notconsistent between the employment contract and theconditions of employment document. Further, a separate clausedealing with out-of-hours work was not specific and did notrefer to the clause on total hours of service. I wanted thecontract to be consistent and clear about what was expected ofmy time.  Another clause indicated that any submission forpublication must be made through the librarian of theorganisation. I can see the benefit in having all publicationscentrally recorded but do not see why the submission shouldbe made through a central service. The contract as a whole hadthe appearance of a document that had been compiled from anumber of other contracts without proper thought ororganisation. It had clearly not been reviewed by any personwith knowledge of the basic Conditions of Employment Act.While I was in the UK contracts between doctors and theNational Health Service were extensively debated andnegotiated between the British Medical Association andemployers. Accepted understanding of a contract between anemployer and an employee is that it clarifies the conditions ofservice of the employer and helps define the individual’sposition. The contents of the contract should be discussed andnegotiated. In South African health care, contracts arepresented to employees and are not negotiable. South Africandoctors sign these contracts and implicitly consent to poorlabour practice.Apart from employment contracts for doctors, South Africanhealth care has many other issues to deal with.  However,when health care professionals with access to internationalpositions look at South Africa and find non-negotiablecontracts that are poor in quality and incorrect in content theymay choose to seek employment elsewhere. In my case I wasforced to look for work outside the country as my onlypotential employer dismissed me.There is a solution if the South African Medical Associationtakes up the issue of employment contracts and negotiatesthese properly with the different employers. Alternatively,SAMA could challenge the contracts that breach South Africanlabour law in labour court. I would encourage South Africandoctors to stand up against poor labour practice and challengetheir employers. My case took many months to be heard at theCCMA and eventually they found that I had been unfairlydismissed. The CCMA will not allow another case like mine towait so long before it gets heard. The chances are that doctorswill win and employers will have to concede to contractnegotiation.South African doctors are a precious resource to the country.I would urge you to stop allowing poor labour practice tocontinue unabated in the health care sector.Andrew C Don-WauchopeDepartment of Clinical MedicineTrinity CollegeUniversity of DublinMedical negligence – what isSAMA’s position?To the Editor: One sincerely hopes that comments from SAMAchairman Kgosi Letlape quoted in the Sunday Times on 5 June2005 do not represent SAMA’s consensus view on medical riskand the rise in number of professional conduct enquiriesconducted by the Health Professions Council of South Africa(HPCSA).In the report entitled ‘Dodgy docs need insurance’, DrLetlape commented on the apparent inability of certain doctorsto pay fines when found guilty of professional misconduct.  Inwhat appeared to be direct quotes, he blamed the ‘unbecomingbehaviour of doctors on the appalling conditions in whichsome of them worked’, slow payment or non-payment bymedical aid companies, and ‘refusal of hospital administratorseager to blame doctors for errors, to assume responsibility’. Even if we accept that medical practice is compromised tovariable degrees by the issues highlighted by Dr Letlape, Iquestion whether such factors adequately explain the widerange of misconduct allegations reported to the HPCSA.   I ammore concerned that the tendency to blame medico-legaldisputes primarily on extrinsic factors ignores both theprinciples and the challenges of safe, ethical practice.  In turn,such dismissal denies medical practitioners any opportunity toconstructively address the fundamental issues underlyingmedical error, lawsuits and HPCSA enquiries.Modern risk-management philosophy rejects both the JustWorld Hypothesis (‘bad things happen to bad people’) and theknee-jerk tendency to shame and blame either ourselves orothers when mistakes happen.1 The Bristol Inquiry whichshook the British medical establishment, arose from aninvestigation into the deaths of paediatric cardiac surgery542539-544 pgs tib  7/27/05  11:58 AM  Page 542

Employment contracts for South African doctors

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Employment contracts for South African doctors

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South African Medical Journal (SAMJ)