Foreign doctors can’t register in SA to help with Covid-19 crisis

Foreign-trained doctors in South Africa who are eager to help with the surge in Covid-19 cases are being prevented from doing so by red tape
Frustrated, helpless and dejected – that’s how foreign-trained doctors desperate to register with the Health Professions Council of SA (HPCSA) and help stem the Covid-19 coronavirus epidemic say they feel as they watch the health system and its workers struggle to cope with the mounting cases.
But their plight isn’t a new one.
Foreign-trained doctors who spoke to City Press last week say they’ve long decried the arduous process of registration with the medical profession regulator.
It’s taken one doctor almost two years to have her application processed and, even now, she’s still a long way from legally and fully practising in local hospitals.
Numerous reports have previously detailed not only the foreign doctors’ difficulties in registering with the HPCSA, but those of doctors who were born in South Africa, but trained abroad.
In May, the matter reached the courts in an effort to order the HPCSA to allow 38 of these doctors to write and pass the board exam, which would qualify them for internships at local hospitals.
What’s made the medics’ plight more urgent has been watching the toll the pandemic is taking on those hospitals, many of which are short-staffed and have increasing numbers of Covid-19 patients filling their wards each day.
City Press understands that many foreign-trained doctors volunteer at hospitals and work free of charge, pending the completion of their registration applications, to keep their skills sharp and gain workplace experience
However, the arrival of 187 Cuban medical specialists brought in for their primary healthcare expertise – at a hefty price tag of R239 million – to help the local response to the virus has embittered the other foreign-trained doctors, as the Cubans’ registration process took just three to 10 days on average, effectively bypassing all the red tape others have to negotiate.
This has been explained to be as a result of the bilateral ties between South Africa and Cuba, dating back to the early 1990s.
According to the HPCSA, there are currently 306 foreign-trained doctors who’ve applied for registration, but need to write the board exam before they get it.
Meanwhile, these medics are doing all they can to help combat the infection crisis, by whatever means.
City Press understands that many foreign-trained doctors volunteer at hospitals and work free of charge, pending the completion of their registration applications, to keep their skills sharp and gain workplace experience.
One doctor living in Johannesburg who’s applied for HPCSA registration says: “I started the process of registering with the HPCSA in 2018, after having graduated and qualified in Germany and worked at three university hospitals there.
“It’s been a very expensive and bumpy road trying to register here – I’ve easily spent €4 000 [R70 000] having all my documents including qualifications, affidavits and certificates of good standing translated and vetted via Epic [a global translation company] and sent to the HPCSA. Many doctors get frustrated and simply give up because it’s such a challenging process.”
Currently, the HPCSA requires doctors with foreign qualifications to use the US-based Educational Commission for Foreign Medical Graduates’ Electronic Portfolio of International Credentials Services to have their medical credentials verified.
The agency uploads their documents, which are then cross-confirmed by the graduating university and the feedback is given to the HPCSA.
“All documents need to be translated and uploaded to that platform, which is quite expensive – about $80 to $100 [R1 330 to R1 600] per document.
“They send an email to your university. The university then contacts you and also wants money to verify that it’s really you. They send their feedback to Epic and then a report is sent to the HPCSA. You pay for that report too.
“The process usually takes one year to 18 months. That’s how long it took me,” says the doctor.
“There are many documents that are wanted and what’s frustrating is that some of them are only valid for about three months. By the time you get all of them together, you’ll find some are no longer valid. I think I had to renew my certificate of good standing three times – and each time it cost me R2 000.”
In an article in the May edition of the SA Medical Journal by Jehane Michael le Grange, Sean James Dickenson and Jacques Robert Jeppe Davis (all of whom are international medical graduates themselves), the results were published of an online survey that yielded 644 responses showing that there were 458 foreign-trained doctors in the country.
These doctors are either unemployed or working in non-medical roles – and almost all of them are keen to help overburdened, exhausted hospital staff cope during the Covid-19 outbreak.
But it’s not that simple.
City Press understands that at least 120 foreign-trained doctors wrote the first round of board exams for this year in January.
According to HPCSA spokesperson Priscilla Sekhonyana, of the 120 candidates, only 74 passed.
“Subsequent board exams were suspended because of Covid-19, as the HPCSA couldn’t guarantee that candidates wouldn’t be exposed to risk of infection. However, the board is currently exploring the safest way possible to hold exams during the pandemic and lockdown,” she says.
While other countries such as the UK reportedly provided temporary registration to 11 800 doctors in March to improve its capacity for the Covid-19 response, and the US’s Harvard University also contemplated the early graduation of medical students to add to the health worker force, the SA Medical Association’s chairperson, Dr Angelique Coetzee, says South Africa currently has no plans for such concessions, despite the surge in infections, hospitalisations and deaths in several provinces.
She explains that the problem isn’t just bureaucratic or logistical, but ethical.
The professionals who spoke to City Press said they wanted to draw attention to the issue of registration and the processes required – particularly during the present surge of Covid-19 cases in the country
“South Africa hasn’t changed any regulations for Covid-19, or lifted moratoriums in terms of registration processes. The problem is that many of these people aren’t truthful and say they’re qualified when they aren’t, so they need to follow the guidelines for registering,” she says.
Sekhonyana adds that, while she didn’t know the exact costs prospective foreign-trained doctors incurred during the application and registration process, she acknowledged that these might indeed be high.
“However, it’s necessary to ensure that practitioners who are finally registered are competent to serve South Africans effectively and safely. The HPCSA has a legislative duty to protect the public and no cost is too high to ensure proper verification,” she says.
Regarding the Cuban specialists, Sekhonyana confirms that these doctors were registered on the basis of the two governments’ agreement, which was based on earlier assessments that found Cuban medical training to be equivalent to that offered by South African universities.
The professionals who spoke to City Press last week said they wanted to draw attention to the issue of registration and the processes required – particularly during the present surge of Covid-19 cases in the country.
The doctor who qualified in Germany said: “We always knew we’d have to undergo a process for registration, but now – during the pandemic – they’re still not allowing doctors in South Africa to help and contribute. Yet we hear the president saying that the country’s short of medical professionals.”

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