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SAMJ: South African Medical Journal

On-line version ISSN 2078-5135
Print version ISSN 0256-9574

SAMJ, S. Afr. med. j. vol.98 n.2 Cape Town Feb. 2008




An 'amnesty' for health professionals?



J P Driver-Jowitt

3 Norfolk Road Newlands Cape Town,



To the Editor: The Health Professions Council of South Africa has acknowledged the large exodus of health professionals from South Africa, and has consequently embarked on a campaign to attract emigrant health professionals back to the country.

This campaign seems to have devolved upon changes in the costs of re-registering in South Africa. Previously, a 'penalty' had been imposed on medical practitioners who had not 'terminated' their registration after having left South Africa. (Is there any reason why they should have?) The penalty amounted to 10 times the annual registration fee, plus the registration fee for the year of re-registration. Subsequently this was reduced to 5 times the annual fee, but on condition that returning practitioners performed 100 hours of community service, as a form of 'amnesty'.

Has this campaign worked?

I conducted a poll of a number of health professionals who had emigrated from South Africa and established themselves successfully elsewhere in the world. They are all highly competent, well trained and in every way desirable contributors to society. Twenty-two subjects were questioned informally in an open-ended fashion. Some requested anonymity. While there was some variation in response, as one would expect, their overall views were remarkably consistent, as follows:

They all showed interest in and a surprising degree of familiarity with events in South Africa. This may be interpreted as their sustaining an interest in possibly returning to the country.

They all felt that the term 'penalty' for leaving South Africa without deregistering was entirely inappropriate. They commented repeatedly that there was no legal obligation upon them to do so. There was an emphatically negative attitude to the 'penalty' of 10 times the annual registration fee. They all felt that this was entirely inappropriate and demonstrated an unpalatable aspect of the HPCSA, which appeared to be motivated primarily by financial benefit to itself. It was noted that the administrative costs of re-registering were likely to be relatively small.

The use of the term, and the policy, of 'community service' was heavily criticised; it held all the implications of a sentence for a criminal transgression. Most people felt that 100 hours of community service, as an alternative to the fee, was insulting. It was generally agreed that they could earn far more in the 100 hours than relief from the fee penalty. They questioned the capacity of the HPCSA to objectively understand these relative values.

There was considerable knowledge about, and dissatisfaction with, the structure of the HPCSA, and almost all the subjects interviewed felt that nepotistic appointments, which were totally inappropriate for a body of its nature, had been made.

The reasons offered for not returning to South Africa were diverse, but many respondents felt that there was a universal degradation of infrastructure. In particular, a number of persons commented on their unwillingness to become subject to the authority of the HPCSA which, in their view, had shown itself to be insensitive, authoritarian, lacking in insight and perspective, unapproachable and rigid, as well as not adequately assuring the medical profession of freedom from corruption.

All the interviewees said they would not be prepared to return to South Africa if they had to register with the HPCSA as it is currently run.


Personal comment

Medical practitioners are generally capable, intelligent and versatile individuals with high ambitions and aspirations. They do not take kindly to gratuitous authoritarianism, or perceptions of mismanagement and corruption. They are wary about subjecting themselves to the authority of groups for which they have no respect. The activities of the HPCSA in recent years give no reason for them to respect that organisation. They believe that the Council would not support their aspirations to achieve an income comparable to that which they could make internationally, and in fact suspect that there is an active policy of the Council, in alliance with the government, to further reduce the income of health professionals.

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