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Slim pickings as 2008 health staff crisis looms.

Government's best recruiting efforts so far stand to reduce next year's expected drop in available public sector doctors from 74% to 64% as it launched a belated campaign, hiring 100 Tunisians, haggling Iran and advertising in the British Medical Journal. Izindaba sources said Health Minister Manto Tshabalala-Msimang was 'sick and tired of being embarrassed' by the continual publicity over the health care staffing crisis and was tackling it with unprecedented energy since her return from sick leave. Her laudable if belated efforts may be too late, in the short term anyway. The clock is rapidly ticking down to 2008 when hospitals and clinics throughout the country – already on average 31% understaffed – have to make do with 74% less community service (Comserve) doctors due to the new 2-year medical internship constraint. Tshabalala-Msimang is reliably learnt to have upbraided a meeting of top provincial health officials for not supplying the National Office with detailed hospital and clinic staffing requirements. Meanwhile existing Comserve doctors are being courted with unprecedented ardour by provincial managements bearing gifts of entire notches in salary increases and other 'sweeteners' to stay on as medical officers. Foreign doctors with contracts due to expire are being offered 12-month extensions while a campaign to increase the numbers of private GPs doing session work has been launched. The country's rural health care system is kept afloat by foreign-qualified and local community service doctors as half of all new local medical graduates leave to work abroad and 73% of all locally qualified practitioners head for the private sector. Retention in the State sector remains the biggest bugbear in spite of generous rural and scarce skills allowances. Doctors most often burn out due to a combination of workload, working conditions, poor local management and dysfunctional administration, all or some of which are present at most facilities. Professor Marietjie de Villiers, vice chairperson of the Medical and Dental Professions Board (MDPB), said next year's unprecedented doctor shortage would worsen the 'vicious cycle' of pressure on young doctors in their 'most formative years', with long-term retention consequences. However, the new 2-year internship would produce doctors with a far wider variety of vital workplace skills, resulting in fewer referrals and reduced patient mortality. By their second year interns would be able to do 'some' of the Comserve doctor work, but only in MPDP-accredited hospitals with proper supervision. Izindaba learnt that 'final assessments' were being made …