Becoming a Doctor in South Africa

Leana S. Wen, M.D.

Greetings from beautiful Cape Town, South Africa!

I am here for the month based out of the University of Cape Town/Stellenbosch University to work on a project examining the perceptions and experiences of the first group of emergency medicine (EM) graduates from the first EM training program in sub-Saharan Africa.

South Africa is a country that’s twice the size of Texas with a population of 50 million. At least 10% of the population subsists on under U.S. $1 a day. At the same time, it is a country where wealthy Europeans come on holiday and buy multi-million dollar vacation homes. In Cape Town, one can go from seeing dozens of the most expensive yachts in the world to tin shacks within a five-minute drive.

Healthcare in South Africa is relatively advanced. It is the training site for doctors from all over Africa; in fact, many American and European medical students come to South Africa to gain trauma and procedural experience. It is also a study of contrast. The private sector that serves less than 20% of the population exhausts over 70% of resources, and it’s possible to receive a very high level of medical service in South Africa. The public sector, on the other hand, is vastly over-burdened, and the lack of resource is most prominently felt in remote rural areas.

The training of doctors follows the UK convention: medical school starts immediately after high school and lasts for six years. Following a one-year internship, new doctors are assigned to do another year of community service, usually in a remote, underserved part of South Africa. This national service model exists in many other countries, and is a powerful way for doctors to give back to their country. It also instills and reinforces the idea of service as being integral to our profession. The U.S. has explored similar service-in-exchange-for-training models, including the novel concept of a national medical school devoted to public health and service to the community. http://www.cogme.gov/18thReport/default.htm. Unfortunately, the idea of compulsory service is not one that has taken hold in capitalist U.S. society.

Most doctors in South Africa practice as general practitioners or non-specialist medical officers. While GPs work exclusively in the primary care setting, medical officers can choose to work on any specialty service. Many graduates enjoy the flexibility of choosing to work in orthopedic surgery for six months, then internal medicine, then anesthesia…. It’s quite a difference from our training system where we choose our specialty while in medical school.

The downside for South African doctors is that for those who wish to specialize in an area, there are few specialty training posts (called registrarships). Also, even after the registrar completes their training, there are problems finding consultant—our equivalent of attending—positions. In my discussions with EM program graduates, the major concern seems to be that after their four years of training, they can’t find EM posts, and as result, have to go back to being a medical officer—the same position they held before their registrarship. Their training and skills are not put to use, and they wonder what is the point of undergoing such a rigorous and difficult training program. It’s a dilemma I’m sure we as US graduates can relate to as well!

I’ll be writing my thoughts on the practice of medicine and specifically EM in a separate post. Until then, stay well, and thanks for reading. Comments welcome at wen.leana@gmail.com.