DISCUSSION
CHAPTER 6 CONCLUSION
6.1 Conclusions
There is a high level of awareness of the 'medical brain drain' among this sample of doctors with more than 99% of sample knowing at least one doctor who has left, and most candidates knew more doctors who had left than returned. A significant number of respondents (25%) did not know any doctor who had returned from abroad to work in South Africa.
Most doctors (57%) in this sample had a foreign registration with almost a similar percentage (55%) intending to go abroad within the next five years, and an additional 15% possibly considering going abroad after five years. Sixteen percent of the total sample were making active efforts to go abroad by either looking for a job or processing documents for departure. Only 35% of post internship doctors did not hold a foreign registration at the time of study. In this sample only 26% had no intention of seeking a job abroad at any time. Almost half (46%) of the sample surveyed had worked abroad, returned and were working in South Africa. It is however unknown what percentage this is relative to those that initially left. Although the relationship between holding a foreign registration and seeking a job abroad is complex, it appears from this research that holding a foreign registration is closely associated with a tendency to seek a job abroad.
Once a doctor goes abroad it is difficulty to predict if that doctor will return to work in South Africa.
Among the private sector respondents, only 26% had foreign registration and 29% had worked abroad. A much larger percentage (54%) of the private sector respondents had no
intention of going abroad at any time with 72% not likely to go abroad in the next 5 years. The 'public sector and other' respondents showed a much larger percentages registered abroad (70%: excluding interns and the private sector) only 22% had no intention of going abroad at any time while 62% were likely to go abroad in subsequent five years. It can be inferred from the above that doctors in the private sector are much less likely to seek a job abroad than 'public sector and other' respondents.
The most frequently cited reason for coming back after going abroad was specialising, family, patriotism and no intention to migrate. The most frequent reasons cited by those with foreign registration but had not worked abroad were specialising, waiting for opportunity, community service, and hoping things get better. Most of these reasons are transitory which means these doctors are possibly likely to leave at some point. Though specialisation is a positive aspect in attracting doctors to come back to the country, it does not appear to have a lasting effect, as the intentions of the doctors after specialisation are not known. The most cited reasons for not considering a job abroad were family, settled/home is here, age, and I am happy with current job. There were generally few cited reasons that are related to satisfaction with current job or a national competitive advantage for not considering a job abroad.
The most frequently cited reason for seeking a job abroad was related to financial issues.
Solutions related to financial matters were consistently cited most frequently as the solutions likely to stem the 'brain drain'. The prominent financial issues include mainly remuneration, unpaid extra hours worked, to pay student loan, save money quickly for a purpose and tax. The cited solutions include increased remuneration, pay for extra hours worked, work in student loan, increase consultation fee and sort out medical aids.
The second most cited reason for seeking work abroad was poor working environment.
The issues cited under working conditions included poor condition of facilities, lack of equipment, poor services, poor funding of health services in general and others. The suggested solutions include better maintenance of services, better management, improved funding of health services in general. The respondents specifically cited increased
workload as a problem; this was either related to amount of work per person or number of working hours. They suggested employment of more doctors by unfreezing posts, use of part time doctors to relieve the workload or pay for extra hours worked.
Exposure to and to experience first world practise of medicine was cited by many respondents as the reason for seeking a job abroad. This medical exposure may be partly related to the idealisation of medical practise as it is practised in the first world by the university curriculums. This may also be to escape from the problematic working environment in the country. Related to this is the adventure tourism to see and experience other places and cultures, the cost of which is usually financed by working abroad. There were no specific suggestions on how to address these issues but it is the researchers view that if the remuneration were adequate there would be no need to seek a job abroad to finance a travel holiday.
Security and safety was sighted less prominently than in previous studies, relative to financial and working environment. The suggested solutions to this problem include that the government must control crime. Some respondents suggested reintroduction of the death penalty. The relatively low prominence of security and safety may be a reflection of government efforts in combating crime, which is showing that crime in all categories has decreased.
The respondents frequently cited lack of confidence in the current government. The issues related to lack of confidence that were specifically cited included lack of dialogue with doctors, no appreciation of doctors efforts, and government not doctor friendly. The cited suggestions included changes of minister of health, better dialogue with doctors, stop imposing decisions on doctors and professional appreciation and respect. Certificate of need was frequently cited as a reason that may cause some respondents to seek work abroad; the suggestions were that it should be abolished. The private sector respondents cited similar issues to the rest of the group except that certificate of need, dispensing and frustration with medical aids took a more prominent position.
Specific 'pull' factors from abroad such as a better lifestyle and better prospects for children were infrequently cited as reasons for seeking job abroad. Age was also found not to be a significant factor in seeking a job abroad. Advertisement by recruitment companies from overseas were also found not to be a significant factor. One reason cited for holding a foreign registration was that if things should go down in South Africa then there is a'Plan B'.
The ratings by respondents were closely related to the cited issues which further confirmed the internal validity of the findings. The issues were ranked based on weighted averages, this also closely followed the cited reasons. The most significant factors cited for keeping doctors at home or encouraging their return to South Africa were family ties, love of South Africa, being settled, I love it here and weather or sunshine. This shows a high level of national pride among South Africans. There were few job or national competitive factors cited by the respondents for staying or returning to South Africa.
There were no specifically cited 'push' factors from the foreign countries.
It can be deduced from the foregoing that the 'medical brain drain' is a major challenge for the nation, multiple factors are cited though mainly financial and working environment seem to be most prominent. The most notable difference among the private sector respondents is that they seem less likely to join the 'medical brain drain' than the 'public sector and other' respondents. The current situation whereby more than two thirds of the sample are contemplating departure within 5 years is a major threat to human resource of the country.
As clearly illustrated above, most issues cited by respondents are 'push' factors from home, the respondents have a high level of national patriotism and love of their country South Africa. It follows therefore that the decision to leave is not an easy one for the doctors but as Meja, (1978:207) noted "no matter how strong the 'pull' factors are of the recipient countries, migration only seems to result if there are also strong 'push' factors from the donor country". Therefore the challenge is upon us to put our house in order.