Patients' lives at risk as doctors refuse to work extra overtime without pay

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Last week patients at Oliver and Adelaide Tambo Hospital in Mbizana, in the Eastern Cape, were left in the lurch when, on Monday night, 21 January 2025, doctors refused to stay on-call overnight. According to doctors working at the hospital, nurses had to take care of the patients and those who needed urgent care were referred to other hospitals.

On Tuesday, a document which appears to be written on the provincial department’s letterhead and seems to be signed by hospital chief executive officer, Mziyanda Tshaka, did the rounds on social media.

Addressed to patients it read: "You are hereby informed that there will be days in a month where there will be no doctors on call starting from [Monday,] 20 January 2025 until further notice due to an acute shortage of doctors. However, all patients in the hospital will [have their] vital signs [taken] and nursing services and patients in need of medical consultation by doctors will be transferred to a nearby hospital for a doctor's consultation."

The  Eastern Cape health department released a statement on Wednesday calling the note “fake news”, saying that there are 16 doctors who work every day at the 100-bed hospital servicing a population of more than 280,000 people.  

To disprove comments that the note is fake, X user @ PhakathiSba shared what he says is the hospital’s call roster for January. Phakathi, who works at the hospital, explains that the roster shows that there would be no doctors on call from Monday to Thursday during the week in question. Additionally, it said there would be no doctors on call from Monday until Friday this week.

A doctor who works at Oliver and Adelaide Tambo Hospital said that a staff of 16 doctors is simply not enough, and no one was willing to work extra overtime without compensation.

"There were no doctors on call on Monday night because the department does not want to pay for extra overtime. All the doctors have already worked the prescribed 80 hours' [overtime]. Unfortunately, we could not go beyond that.”

Overtime a longstanding issue

Doctors’ overtime has been a contentious issue for, at least, the past two years with several provinces introducing changes that have sparked frustration among healthcare workers. 

For example, in May 2023  the Limpopo health department proposed adjustments to the working shift system which would significantly reduce the amount of overtime hours doctors worked. In the 2024/25 financial year, the Gauteng health department withdrew the hospital CEO's powers to approve commuted overtime. 

Last week doctors in Mpumalanga threatened to limit their working hours to 8am to 4pm, refusing to work beyond those hours due to the absence of proper compensation. 

The combination of budget constraints, staff shortages, and these new overtime policies has left patients in an increasingly vulnerable position, particularly during emergencies, as hospitals face growing difficulties in providing essential care.

During the delivery of the Medium-Term Budget Policy Statement in November last year, Finance Minister Enoch Godongwana announced that there would be no adjustments to the health budget. 

While the Department of Health was allocated R62.2bn in July - an increase from the previous year's R60.1bn, medical unions quickly raised alarms about the lack of sufficient adjustments to meet growing healthcare demands. They warned that underfunding in the sector would lead to a shortage of doctors, ultimately compromising patient care.

Burden falls on nurses

When doctors are not available nurses often pick up the slack.

Democratic Nursing Organisation of South Africa (Denosa) Eastern Cape secretary Veli Sinqana says nurses have now decided to stick to their core duties. 

"It is true that there were no doctors on call at Oliver and Adelaide Tambo Regional Hospital on Monday night because doctors were unavailable for overtime. This poses a risk to patients, as some emergencies require immediate intervention by a doctor.

"Nurses had to communicate with the clinical manager or contact doctors from other hospitals for consultation, which is time-consuming and delays crucial care," he says.

South African Medical Association Trade Union (Samatu) Eastern Cape secretary Zukiswa Gonya said that the shortage of doctors is an issue across the province. 

“The doctors have tried to overstretch and work beyond the 80 hours, but it is too much. And they are not getting paid for the extra work. The provincial health departments are now threatening to remove the commuted overtime [duties performed in addition to the normal working 40 hours] which means doctors will work from 8am to 4pm everyday,” she says.

Gonya agrees that this will have an impact on the patients. "As it is, the Department of Health is faced with billions of rands of medico litigation. How will hospitals avoid these claims when patients have to be transferred to other hospitals? In rural Eastern Cape it can take about an hour to reach another hospital if you are lucky to get an ambulance,” she says. - Health-e News 

This article first appeared on Health-e News and is republished here under a Creative Commons license.