Gauteng state doctors gear up to fight health department over proposed changes to overtime pay

News24

09-05-2025

Tensions are rising over a payment blunder that resulted in state medical staff in Gauteng not getting their overtime payments.
This comes amid a protracted row over a proposal to cut and change the terms of commuted overtime.
Meanwhile, the health minister has convened a committee to review the future of overtime for state doctors.
Dysfunction in the Gauteng Department of Health hit home hard for many public sector doctors on 29 April when their overtime payments due for the month went unpaid.
The non-payment came without notice and affected medical staff in facilities across the province, according to the South African Medical Association (SAMA). Only by 6 May did some doctors start to see payments reflected in their bank accounts, and more are expected soon, said SAMA.
However, tensions are rising as this payment blunder follows a protracted row over the health department's unilateral decision to cut and change the terms of commuted overtime in light of a tight budget. As with most other provincial health departments, Gauteng's health budget has been shrinking in real terms for several years.
The delayed payments and the ongoing review of cuts and changes to commuted overtime pay have led to threats of protests by doctors and legal action by SAMA. Registrars and medical officers at Dr George Mukhari Academic Hospital in Ga-Rankuwa gave notice of withdrawal of overtime services until the non-payment issue was completely resolved.
By 7 May, the head of anaesthesiology at Sefako Makgatho Health Sciences University informed the CEO of George Mukhari Hospital that no anaesthesia services would take place at the hospital starting 8 May, given the decision by registrars and medical officers to down tools outside of regular work hours.
Those from the medical fraternity that Spotlight spoke to have set out a series of concerns. These include resignations, an exodus of doctors - especially specialists - from the public sector, plummeting staff morale, and negative impacts on the training of doctors as fewer consultants and seniors are available to supervise, which puts universities' training accreditations at risk. Ultimately, several sources point out that it is the services offered to the public that suffer.
Committee appointed
By the beginning of April, there appeared to be some walking back by the Gauteng health department of its unilateral cutback proposals after meeting with the South African Medical Association Trade Union (Samatu). In the same week, a circular was issued announcing that the national health department was conducting its own review, instructing provinces to hold off on their plans.
Health Minister Dr Aaron Motsoaledi then set up a committee of experts to review certain human resource policies in the public healthcare sector. This includes a review of community service, commuted overtime, remunerative work outside the public service for health professionals, and rural and related allowances.
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Commuted overtime is a pre-determined amount of overtime that doctors employed by provincial health departments are allowed to work.
The amount is historically decided by hospital management and is based on an employee's role, seniority, the department they work in and the amount of overtime they are allowed to safely work.
It's a fixed rate of 1.3 times the applicable hourly tariff for a specific work grade.
There are five contract options. A is no overtime worked; B is overtime of between four and eight hours a week; C is overtime between 9 and 12 hours a week; D is overtime between 13 and 20 hours per week; and option E is where, on approval, a doctor can be authorised to work more than 20 hours of overtime a week.
As a fixed amount, commuted overtime is predictable supplemental income, and for many doctors, it amounts to about a third of their take-home pay.
The long rumblings to cut their overtime pay have forced doctors to motivate why they should remain on contracts that pay for more overtime hours. Junior doctors say they are being pressured to sign option C contracts, which will pay for fewer overtime hours.
There are also proposals to change some of the terms relating to overtime, including scrapping overtime payments for doctors who are on call but not physically present at a facility.
Many doctors already exceed the maximum hours of their contracts because of the emergency nature of their work, gross understaffing and backlogs at their hospitals.
Costly, but essential?
The commuted overtime pay model has been contentious for years because it adds up to a sizeable chunk of the healthcare budget. According to a spending review conducted in 2022 on behalf of National Treasury, the country's health departments spent R6.9 billion on commuted overtime in 2021. This made up about 70% of the total R9.9 billion spent on all types of overtime.
In an editorial published in the South African Medical Journal in April 2025, health sciences academics, associations, and unions slammed the Gauteng health department's handling of pay issues. They argue that the basic salaries of medical professionals in the public health sector were already much lower than what would be considered fair pay.
'COT (commuted overtime) has long served as a critical mechanism to ensure that doctors are available beyond the standard workday, safeguarding round-the-clock care in the public health system... The abrupt curtailment of this framework risks hollowing out the after-hours safety net, leaving emergency rooms, wards and clinics dangerously under-resourced,' they wrote.
SAMA CEO Dr Mzulungile Nodikida told Spotlight:
Medical doctors in South Africa's public sector are severely underpaid. A study by SAMA has shown that even the annual cost of living adjustments that have been made on the salaries have not matched inflation in the last five years. Commuted overtime has had the effect of masking a deficient salary.
He said the Gauteng health department has shown itself to be an 'unreliable employer', adding that its relationship with doctors remains fractured as a loss of confidence in the department deepens.
'This breach of the most basic employment obligation, timely remuneration, has cascading effects. It jeopardises morale, compromises service delivery, and calls into question the department's commitment to its workforce. Doctors now operate under a cloud of uncertainty, unsure whether they will receive their salaries at month-end. This anxiety permeates every aspect of the employment relationship, from retention efforts to the willingness to engage in additional responsibilities,' said Nodikida.
View from the wards
Two doctors who spoke to Spotlight say the commuted overtime pay disaster is yet another symptom of weak human resources and poor management. For them, proposals to cut commuted overtime are the department shirking from addressing the staffing crisis, the need to improve human resources systems, and rooting out corruption, maladministration and wasteful expenditure. Both doctors asked not to be named for fear of reprisals.
Dr A, who is based at Charlotte Maxeke Johannesburg Academic Hospital, said: 'Instead of having a system in place to record how many hours each doctor is actually working and what overtime that person should be paid, the department pays everyone this commuted overtime fixed sum....[Y]ou could be a dermatologist or a psychologist and have very few overtime hours or be a surgeon who is doing a lot of overtime, but you all get paid the same if you're on the same contract option,' she said. 'But right now, in my career, I'm working way more overtime hours than my contract, and I'm not being reimbursed for any of it.'
Dr A said the overtime pay cuts and proposed changes will impact her decision to stay in the public sector.
She said:
It used to be the case that you were happy, once specialised, to stay because the overall lump sum of money from your salary and commuted overtime made up a decent pay – not comparable to what you could earn in private – but decent enough to stay,
She said she feels like doctors are now being undervalued and coming under attack by their own employer. 'The message we are getting is that 'if you're not happy, there's the door' – but what the department doesn't understand is that you can't just replace someone with 10 years' experience or someone who has 30 years' experience, it has a huge impact,' she said.
'Our patients are suffering; and every day it's like a game of survival. We run multiple clinics in one clinic space at Charlotte Maxeke, but you can't offer a functioning service like that. It's noisy, the computers don't work, and the intercom is going off the whole time.
'The other day, I had a 90-year-old patient have a panic attack in the waiting room. He had been waiting for a while and left his wife, who is blind, in the car. He had to park far from the hospital building because the parking lot from the hospital fire [in April 2021] is still not properly repaired, and he was overcome with worry,' she said.
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Dr B who works at Chris Hani Baragwanath Hospital said doctors are already overworked and disheartened by working within a failing system.
He sent photos to Spotlight of theatres and wards in darkness as power went off at the Soweto hospital for days at the end of April.
He said staff bring in their own toilet paper because they're told there's none. Most alarming, he said 'doctors are not getting the training and supervision they need' and regularly perform surgeries and procedures without adequate experience and with no supervision.
'They are overwhelmed, overworked and doing way too many overtime hours that they're not being paid for. Then they go home overtired, eat a pizza and crash, sleep a few hours, then do it all over again the next day, and the next day,' he said.
'We, doctors, are literally the ones putting patients' lives at risk,' he said, adding that he is 'surviving on anti-depressants' and has sometimes shut himself away in hospital storerooms crying tears of sheer frustration, exhaustion and exasperation.
Dr B still counts the wins, though. It's days when he clears an impossibly long patient list of children who need procedures done. 'Those are the good days – they're just few and far between. And now the department is coming for us by cutting our overtime pay and forcing us to sign contracts to downgrade our overtime pay.'
Resignations and impact on training
Professor Shabir Madhi is dean of the Faculty of Health Sciences at the University of Witwatersrand. He said the proposed cuts and freezing of posts and changes to commuted overtime pay have already resulted in resignations of some senior staff at state hospitals.
'If we don't have the proper consultant staff complement in these hospitals who can provide supervision throughout the day, it compromises our training of specialists as well as of undergraduate students.
'If the Health Professions Council of South Africa were to do an audit and find that there isn't adequate consultant cover and supervision, they could remove the accreditation of the training programmes offered by the universities.
'The medical schools are completely dependent on the Gauteng Department of Health to retain consultants and other categories of staff and to ensure that staff are allocated time for supervision and training of future medical doctors, including specialists, as well as other academic activities.
'It means decision-making around cuts to overtime pay need to be cognisant of the overall impact that it would have, and not only in how it would assess budget constraints. This situation needs meaningful and informed decision-making,' he said.
Dr Phuti Ratshabedi, Gauteng chairperson of Samatu, said the non-payment of commuted overtime pay in April was a slap in the face as the union met with the department, and officials agreed to uphold their contractual deals to leave contract terms for commuted overtime pay unchanged at least till the end of March 2026.
'What we saw is that the department will promise one thing and do another. But we will be holding them to what they stated in their own circular, or we will look to legal action,' said Ratshabedi.
Spotlight sent detailed questions to the Gauteng health department. Despite several reminders, the department did not respond.