Community service is just what the doctor ordered
But more mentoring is needed, as well as more effort to keep them in rural areas once their stint is over, a review has found
Compulsory community service has been excellent medicine for doctors and patients, a long-term review has concluded.
But the prescription can be improved, say Steve Reid and colleagues, who have published the results of their study in the South African Medical Journal.
Better mentoring and support was required, especially in KwaZulu-Natal, Limpopo and Mpumalanga, and more effort was needed to keep doctors in rural areas once their community service was over.
Between 1998, when community service began, and 2014, 17,413 doctors completed a year-long placement in a public health facility.
The scheme was expanded to dentists, pharmacists and eventually all health professionals, including nurses, and the annual cohort of 8,000 was now “an indispensable part of the provincial health services”, said Reid, professor of primary health care at the University of Cape Town medical school.
After “uncertainty and resentment” in the first few years of community service, the study found an overwhelmingly positive attitude had developed among doctors.
“The great majority believed that they had made a difference [91%] and developed professionally [81%] over the course of the year,” said Reid. “But only about half felt adequately supported clinically and administratively.
“[Community service] has largely met its original objectives of redistribution of health professionals and professional development.”
Statistics reported in the research paper include:
• 89% of doctors turn up for their community service. “The 11% who do not take up community service annually is cause for concern, as these 120-150 young doctors represent the output of one entire medical school,” said Reid;
• The proportion of black doctors increased from 17% in 2001 to 45% in 2012, while the proportion of whites decreased from 50% to 33%. “These reciprocal changes were particularly rapid in the period 2009-2012”;
• 80% of applicants found places in one of their first-choice facilities, with the rural provinces (Eastern Cape, Limpopo, Northern Cape and North West) finding it hardest to attract doctors; and
• 30% of doctors decided to stay at their placement site once they completed community service, and 15% said they were prepared to work in rural or under-served areas.
“Clearly the community service workforce is a reliable recruitment strategy, bring 8,000 fresh young graduates into the public service each year to fill the posts vacated by their predecessors,” said Reid.
“But the temporary contract nature of these posts creates a situation of constant staff turnover and does little to create a stable long-term workforce. It is better to have one doctor for 10 years than 10 doctors for one year, as the continuity of relationships in medicine is not only more efficient but also leads to greater job satisfaction.”
Reid said having the skills and confidence to make a difference during community service, which followed a two-year internship, “allows young doctors to stand on their own feet professionally and fulfil a real need”.
He added: “The direct exposure to the consequences of resource restraints in the public health service, including a relative lack of supervision and support, while not ideal, nevertheless serves to develop resilience in our young professionals for the challenges of future practice.
“By comparison, those trained in well-resourced settings do not cope as well.”