DISCUSSION
5.5 Main reason for seeking work abroad
5.5.1 Financial factors
5.4.8 Inferences on reasons for not contemplating work abroad
In this sample the main reasons for not seeking a job abroad are related to family and country attachment as opposed to national competitiveness or job satisfaction which are cited about once in every five reasons. These issues are what Padarath et al. (2003:20) termed as the 'stick' factors. It can be seen from the foregoing that inconveniences associated with going abroad are not considered a deterrent to seeking jobs abroad because registration exams, immigration requirements and relocation inconveniences were infrequently cited as reasons for seeking work abroad and were poorly rated based on degree of influence to seek work abroad.
and other' respondents respondents. The private sector also identified financial issues as the most important factor influencing decision to seek work abroad.
Despite the government efforts to address the issue of remuneration, it is still the most significant factor cited for seeking work abroad. The remuneration that would be deemed appropriate to make the doctors happy and not seek job abroad is a topic for possibly future research. This is a reflection that doctors are probably having a continuance commitment to the country by keeping their sights on salary scales and other opportunities in other countries. According to Birt & Winternitz (2004:25) continuance commitment is when the employee bases his/her decision to remain with the organisation on perceptions of other available opportunities as well as the cost of leaving the organisation rather than on a more emotional attachment to the organisation as is found in affective commitment. The perceived 'equity' or 'inequity' based on external comparisons with compensations offered by other organisations can strongly impact on the effectiveness of compensation as a tool to retain employees. This according to Birt and Winternitz is a market-driven turnover, which is an extrinsic factor.
Other authors have also noted the effect of this perceived equity or inequity based on external comparisons especially across different countries. Buske, 2002:682; McKendry et al. 1996:171; Miller et al. 1998:253; Padarath et al. 2003:9 have independently noted that this comparative effect is the cause of the cascade of movement of doctors from the less affluent to the relatively more affluent countries.
As can be noted from the South African Health Review report for 2004, 70% of the public sector spending is on personnel (Blecher & Thomas, 2004:276; Padarath et al.
2004:300) with up to 70% of the public sector health financing goes to personnel.
Currently the scarce skills allowance for doctors is 15% of the basic salary package while rural allowance is 18-22% of the basic pay (Padarath et al. 2004:305). If a total of 37%
increase in pay does not seem to be recognised by the sample one wonders at what levels will the financial incentives be deemed adequate. Since the government allocation to the
public sector does not seem to be increasing significantly (see appendix 4), any increase in pay might mean less allocation to other areas like capital expenditure; this in itself may worsen the working environment. Maybe a totally new way of remunerating doctors should be considered to relate the remuneration more with measurable outputs and targets.
It was notable from the degree of influence on decision to seek work abroad rankings that most financial related issues were given very high ratings by the sample as seen with 'Deterioration of my financial position over time' is ranked number 4 and 'To save money quickly for a purpose' is ranked number 9. This surely reaffirms the fact that the financial pinch is a reality affecting doctors and not a mere comparison with what the jobs abroad offer. In contrast to the above high ratings related to individual financial
issues decline in the general economic state of South Africa was ranked number 18, which suggests a relatively minimal effect of the general economic status of the country on the individual decision to seek work abroad. The ratings of the private sector for financial issues were similar to the 'public sector and other' respondents.
Current government efforts at addressing the financial aspects of the 'medical brain drain' with recent introduction of 'scarce skills allowance' and 'rural allowance' are rated poorly at rank number 22 and 28 respectively out of 31. The poor rating of rural allowance may be explained by the fact that the sample was predominantly from an urban area and as such they did not receive rural allowance. There is no explanation for the poor rating of the scarce skills allowance, bearing in mind that this sample was predominantly from public hospitals and as such receives this allowance. This implies that despite recent government efforts to improve remuneration by incentives such as rural and scarce skills allowance, the sample is not cognisant of these efforts or they have no impact on their decision to seek work abroad. Whether its ignorance on the part of the sample as to the intention of government efforts or the allowance is too little to have noticeable effect is a matter for further research. It is also unclear if the doctors' incomes have declined in real terms over time as compared to other economic indictors like cost of living, inflation and relative to incomes of other professions. The poor appreciation of
government financial efforts may also be a reflection of the weakness of financial incentives as retention factors in that the increased income is quickly incorporated into expenditure and the employee starts looking for a higher salary. This is also in agreement with most authors' observations that whereas money does matter in retention it alone is not enough to sustain long lasting retention (Delany & Turvey 2004:30 Kaye & Jordan- Evans, 2000:29; Mengel, 2001:32; Naidoo, 2004:37).
The findings differ significantly from previous studies that found crime was the most frequently cited reason for seeking work abroad (Jones 1999:19; Van der Vyer & De Villiers, 2000:18) and other earlier studies that highlighted dissatisfaction with the political dispensation of the time (Bourne, 1983:447; Wynchank & Granier, 1991:532).
The findings of the current study are likely to be a true reflection of the current situation as to why the doctors are seeking jobs abroad. Crime of all categories has also declined as shown by the statistics of the South African Police (SAPS, 2004), which may further support the leading role of financial issues. In support of this, financial issues are also ranked first in the ratings section and are the most frequently cited factors that employers and government must improve to keep doctors in South Africa. Crime according to Padarath et al. (2003:10) is an exogenous 'push' factor in the health workers decision to seek a job abroad, the reduction in this 'push' factor should ideally be followed by a decline in loss of human capital. Unfortunately this does not appear to be so, as crime seems to be replaced by other endogenous 'push' factors, namely financial and working environment.