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Stop conning us

Look the reality is that you’re lying. It’s true. You’re making it seem as though you have some sort of magic healing powers, which you don’t, as though you have the power to diagnose with 100% certainty every patient just from their symptoms, which you don’t, as though you do some research in the course of your general training, which you don’t.

So on what basis are you demanding more money? Surely we should pay people on the basis of their qualifications? So if you have two bachelor’s degrees (MB and ChB) and 3 years of work experience you don’t qualify to be paid at the same level as someone with an honours, master’s or doctoral degree, because it’s about the notional hours of study and the productive research output and on both counts the medics are somewhat far behind.

We all know that medics in private practice get paid more, but because the training for specialists can only happen in public hospitals and even then only in some hospitals — most junior medics have to do some time after their 3-year community service and internship stint at the public hospitals just to be able to weasel their way into the MMed (FCP) or MCh (FCS) programmes — because there are limited seats and because you need to be on the right side of your registrars and consultants in order to get into these postgraduate training programmes.

Now I’m not saying it’s corrupt — far from it — I’m sure there is an unwritten rule which says senior medics may choose which junior medics get specialist skills, and that provision must be made for second, third and fourth generation “legacy” medics who need to inherit their daddy’s practices. And I have no problem with this — because I am opposed to lay ownership of healthcare practices — as long as the caste system is maintained.

You see, the fallacy of irrational economic stupidity has had us believing that medicine and healthcare are Brahmin professions. This is of course complete balls. The facts of the matter are that physicians have evolved from grave-digging, post-mortem directing, anatomists, while the first surgeons were blood-letting barbers — hence the red and white striped poles outside their barber shops.

And since medics were originally trained by apprenticeship and since specialist physicians and surgeons are still trained by apprenticeship — that’s why your consultant has to sign off your work — then it is clear that the medical and healthcare professions are no more than the occupations of the Vaishnava (tradesmen) caste, because they aren’t soldiers (even if they are in the SANDF MedCorps) — so they aren’t Kyshathriya’s (soldiers and nobility) and they aren’t teachers or priests in the real sense — because training apprentices is not like teaching spiritualism and scripture — so they aren’t Brahmins are they?

Now if our public hospitals had all of the facilities to subject every patient to a battery of tests to be able to determine what was actually wrong with each patient — then perhaps the quality of healthcare as delivered would be better, but since we have to rely on the supposedly god-like skill of the medics themselves, it is clear that we have patients leaving the hospitals in little better condition than in which they arrived.

Factually the treatment of HIV cannot be used as an excuse for why the modern young medics are overburdened by their public service or rather by their service in the public arena. And I have already described a system where HIV must become the sole responsibility of the SANDF and it therefore must be some other form of incompetence which drives this dishonest chicanery to which we are all being held hostage.

Factually every medic in South Africa, who qualified prior to 2003, had to work harder, under worse conditions and indeed to see more patients for less money, in both the nominal and real senses, than the medics of today. And yet the medics of today have displayed their menial labourer status and mentality, which proves that they are no more than tradesmen by taking Sama into Cosatu and taking the public service medics into the streets to toyi-toyi as though everyone had graduated from Medunsa or Unitra.

So in aid of giving my constituents some free advice I suggest the following:

  1. Fire every doctor who is on strike; tell them to go work in some other country.
  2. Strip them of their HPCSA registration for five years on the grounds of touting, itinerant practice and the solicitation of perverse incentives — as proved by the actions of the strike. These are criminal charges but stripping of their registration is punishment enough.
  3. Close all the medical schools and redeploy all of the medical school academics into the public hospitals and send the medical students to work in designated functions under their supervision so as to establish the old apprentice system.
  4. Triple the wages of all nurses, paramedics and other healthcare practitioners (who are not doctors or dentists).
  5. Invite all the healthcare and alternative healthcare practitioners in private practice to start working in the public sector, to close their practices and donate all their equipment to their local public hospital or clinic. In compensation we will cut their PAYE rate down to just 15% (from the current 25%).
  6. In future tie the compensation of each public healthcare practitioner to the volume of patients that are seen (per 15 minutes of consultation and attendance) and the rate of recovery. So if your patients are dying quickly then no matter how many you see you’re not going to make money.
  7. To offset the effects of HIV on this new salary regime implement the plan to make HIV the sole responsibility of the SANDF and relocate and enlist as many healthcare workers as is needed to be able to make this work. Medics in the defence force cannot go on strike, can they?

But for those who will whinge and whine about my suggestions, here are three truths about your demands that you are currently denying …

  • If you want more money and shorter hours go into private practice, become a prescription wallah and a generic-meds jockey but you can’t do this because you’re not an expert in anything (yet) and thus the risk of going into practice means that you will actually make less money than you are currently complaining about not making.
  • The real problem with the morale in the public hospitals is the disparity between the wages of the medics as compared to the wages of the nurses and other healthcare practitioners. Someone who has a master’s degree in nursing gets paid less than someone with a MBChB — and this is complete nonsense, especially since it’s the nurses who run the hospitals, provide primary healthcare and the vast majority of public health education
  • Finally you are all avoiding the debate about the rights of the vast majority of healthcare workers in South Africa, the traditional healers, and if the medics don’t shelve those consumptive bourgeois ambitions of theirs perhaps the need will be created for us to give every traditional and alternative healer the opportunity to study pharmacy or medicine at a university and then to work in public hospitals. And once we improve the production techniques and conditions, the muti that is sold by our nyangas and sangomas will be less toxic and will no longer be the source of one-third of the medical ailments as presented in hospitals.

None of you, not one, can do our jobs or run our practices and that’s why spindoctors get paid R2 500 per hour instead of the pittance you lot are currently whining about. So disabuse yourself of this delusion that your “pseudo-Brahmin” status entitles to you to something greater than the rest. Factually we could improve the quality of healthcare in this country overnight by removing the greed and parochial selfishness of this medical-class of people who really don’t care about helping people and are simply using our public hospitals as stepping stones in their training on their own path to private specialist practice and their S-Class Mercedes-Benz.

If you were actually being honest about your demands you would be campaigning for better working conditions for all. You would be campaigning for better wages for everyone but the doctors and dentists. You would be campaigning for three times as many registrar posts. You would be campaigning to be able to do the community service year in private practice or in another country (under supervision) and you would be doing all of these things while still working and saving lives and healing the poor, weak and downtrodden whose only hope for survival resides with the public hospitals.

And I stake my life on saying that if you haven’t found the cure for some disease, if you haven’t innovated a new form of treatment, if you haven’t participated in the development of new treatments, if you haven’t done any research in a healthcare discipline, if you haven’t changed the landscape of healthcare in any way, then shut up because the people in whose footsteps you claim to be walking, have. And they never went on strike, were never in dereliction of their duty and didn’t dance and whine in the streets like factory and dock workers. Decide who you are: tradesmen or professionals? And if you are professionals, get back to work NOW!