South Africa boasts 11 different official languages, is where the first heart transplant in the world took place, and is home to the Cradle of Humankind. It is an incredible place to live and practice medicine. For American doctors considering practicing in South Africa, it is important to understand more about the healthcare system and work culture.
For more information on medical registration, finding a job and immigration read our Ultimate Guide to Practicing Medicine in South Africa.
South Africa’s Healthcare System
The healthcare system is divided into the public and private sectors. The public sector cares for 84% of the nation’s population and the private sector serves the remaining 16%. The government-run public sector is comprised of primary, secondary and tertiary health facilities managed by local health departments. The majority of the primary care is provided by nurses within hospital clinics, district hospitals, and community-based health centers. The private health sector is comprised of individual practitioners or practices who provide care via private clinics or hospitals, most of which are located in urban areas. Medical care, in general, is communicated in English.
Medical school begins immediately after graduating highs school and lasts for 6 years. After graduating, South African physicians complete two years of internship. This internship provides very broad training, similar to family medicine training in the United States, but with greater emphasis on surgical, obstetric, anesthesia, and trauma surgery skills. After internship they register with the Health Professions Council of South Africa (HPSCA) and spend an additional year doing community service within rural or underserved communities. They then complete specialty and subspecialty training.
Foreign doctors can only work in the public sector, which includes positions in academics and non-governmental organizations. After 5 years of practice in the public sector, you can apply to the HPCSA for an unrestricted ‘independent practice’ license to practice in the private sector.
Public sector salaries are based on the years of training, experience, and amount of overtime; salaries are not specialty-specific. For example, the salary for pediatricians and surgeons are similar, typically ranging from R850,000 per year to R1.4 million per year (60,000USD to 100,000 USD per year at an exchange rate of $1 USD = 14 South African Rand). Physician salaries in private practice are substantially higher, typically more than double the public sector salary, depending on the specialty.
Rural doctors are expected to have very broad medical, procedural, and surgical expertise. They are responsible for trauma management, including placement of chest tubes, suturing lacerations, managing and/or casting fractures. They are also expected to be skilled in intubation, general anesthesia, C-sections, appendectomies, cholecystectomies, general medicine, and pediatrics. It can be challenging for US-trained physicians to adjust to the breadth of knowledge and clinical skills expected of a rural physician in South Africa.
In contrast, physicians in urban and academic hospitals tend to practice within their own specialty. Internal Medicine and Pediatric specialists in South Africa require greater proficiency in procedural skills when compared to their American counterparts. For example, internists and pediatricians are expected to place their own chest tubes, perform their own intubations, lumbar punctures, and bone marrow and liver biopsies.
Physicians in South Africa are required to be proficient in more procedural skills compared to their American counterparts. Physicians working in rural communities are expected to be true generalists with both medical, procedural, and surgical skills. For more information on medical registration, finding a job and immigration read our Ultimate Guide to Practicing Medicine in South Africa.
Dr. Ribka Berhanu is an infectious disease physician and research scientist in the Global Health Department at the Boston University School of Public Health. She is based in Johannesburg, South Africa. She has over 10 years of clinical and research experience working in the field of tuberculosis research and clinical care in South Africa.
Dr. Ashwini Bapat is a palliative care physician who attended medical school at Tufts University and completed residency and fellowship training at Yale-New Haven Hospital. She resides in Portugal and provides clinical care through telemedicine.