Trade unions, medical associations and universities are raising the alarm that Gauteng budget cuts at the cost of doctors’ take-home pay will have dire consequences for public sector health. Meanwhile, the National Minister of Health has convened a committee to review the future of overtime for state doctors.
The dysfunction within the Gauteng Department of Health severely impacted numerous public-sector physicians on April 29 when they discovered that their monthly overtime pay had not been issued.
The lack of payment occurred unexpectedly and impacted healthcare workers at various facilities throughout the province, as reported by the South African Medical Association (SAMA). It was not until May 6th that some physicians began noticing these payments appearing in their bank accounts. Additional payments should follow shortly since employers have up to seven days under the Basic Conditions of Employment Act to finalize them, stated SAMA.
However, tensions are escalating due to this financial error following an extended dispute regarding the department’s unilaterally deciding to reduce and alter the conditions of commuted overtime within the province. The proposals to decrease commuted overtime have emerged against the backdrop of a severely constrained provincial healthcare budget. Similar to many other provincial health departments, Gauteng’s healthcare budget has been diminishing in actual value for multiple consecutive years.
Delayed payments and an ongoing evaluation of reductions and modifications to commuted overtime pay have resulted in warnings of potential demonstrations and legal proceedings. According to SAMA, they plan to file civil suits to recover unpaid wages along with interest and legal expenses. The registrars and medical officers at Dr George Mukhari Academic Hospital in Ga-Rankuwa jointly sent a letter to the facility notifying them of their intention to stop providing additional hours until the payment issues are fully addressed. As of May 7th, the department head of anaesthesiology from Sefako Makgatho Health Sciences University informed the CEO of George Mukhari Hospital via a written communication that no anesthesia procedures would be conducted beginning May 8th due to the registrars’ and medical officers’ choice not to engage in extra-hours duties.
The individuals within the healthcare community who were interviewed by Spotlight highlighted a number of issues. They mentioned resignation waves, significant departures of physicians—particularly specialists—from the public sector, declining employee spirits, detrimental effects on doctor education due to reduced numbers of supervisors and senior professionals, thereby jeopardizing university accreditation for pelatihan programs. In conclusion, multiple informants noted that these problems ultimately lead to diminished quality of care provided to the general population.
Committee appointed
As of early April, the Gauteng health department seemed to retract its initial usulan to unilaterally reduce costs following discussions with SAMATU, the South African Medical Association Trade Union. During the same period, an official notice was distributed indicating that the national health department had initiated an audit of its operations and instructed provincial bodies to pause their respective cost-cutting measures. Subsequently, Health Minister Dr. Aaron Motsoaledi established a panel of specialists tasked with reassessing specific human resources policies within the country’s public healthcare system. The areas under scrutiny include evaluations of community service requirements, compensation for overtime worked, additional earnings from external professional engagements, as well as stipends associated with working in remote and underserved regions.
Scheduled overtime refers to a predetermined quantity of extra hours that physicians working for regional healthcare authorities are permitted to put in. This figure has traditionally been set by hospital administrators and takes into account factors such as the employee’s position, experience level, the particular division within which they operate, and how much additional time can be worked securely. It equates to a consistent multiplier of 1.3 over the relevant hourly pay rate corresponding to their job classification.
The five contract choices are as follows: Option A involves zero overtime hours; Option B includes up to 8 hours of weekly overtime, with at least 4 hours; Option C covers 9 to 12 hours of weekly overtime; Option D entails 13 to 20 hours of weekly overtime; and finally, Option E allows for authorization from a doctor to exceed 20 hours of overtime each week upon approval.
As a set sum, commuted overtime serves as consistent additional earnings, and for numerous physicians, this accounts for roughly one-third of their akhir paycheck.
Lengthy discussions about reducing overtime compensation have led to physicians needing to justify why they should stay on contracts that include higher payouts for tambahanwork hours. Junior doctors claim they’re facing pressure to agree to option C contracts, which offer reduced pay for overtime. Additionally, there are plans to modify certain conditions related to overtime, such as eliminating payment for doctors who are on call but not actually present at the medical center.
Numerous physicians surpass the maximum hours stipulated in their contracts due to the urgent character of their duties, severe understaffing, and accumulating backlogs at their medical facilities.
Costly, but essential?
The controversial nature of the commuted overtime pay system stems from its significant financial impact on the healthcare anggaran. A fiscal analysis carried out in 2022 at the request of the National Treasury revealed that South Africa’s health ministries allocated approximately R6.9 billion towards commuted overtime costs in 2021. This figure represents around 70% of the overall R9.9 billion expenditure on various forms of overtime payments.
An opinion piece featured in the South African Medical Journal in April 2025 criticized the management of compensation issues by the Gauteng health authority as denounced by academic experts, professional organizations, and labor unions. These critics contend that the mendasar wages for healthcare practitioners within the state-run health system are significantly beneath levels deemed justifiable remuneration.
“The COT [commuted overtime] has been an essential tool for ensuring that medical professionals are accessible outside regular working hours, maintaining continuous healthcare within the public health sector… Abruptly limiting this arrangement could weaken the support systems operating during off-peak times, potentially resulting in emergency departments, hospital units, and outpatient facilities becoming critically understaffed,” they noted.
The editorials’ co-author, SAMA CEO Dr Mzulungile Nodikida, informed Spotlight: “Doctors working in South Africa’s public healthcare system receive very low compensation. According to research conducted by SAMA, the yearly increases intended to cover the rising costs of living haven’t kept pace with inflation over the past five years. The use of commuted overtime appears to be disguising inadequate pay levels.”
He stated that the Gauteng health department has proven to be an “inconsistent employer,” noting that its connection with doctors continues to be strained due to growing distrust in the department.
This violation of fundamental employment duties—prompt payment—has far-reaching consequences. It undermines morale, impairs service provision, and casts doubt on the department’s dedication to its staff. Physicians currently work under an atmosphere of ambiguity, uncertain about receiving their wages by the end of the month. This stress infiltrates all facets of the employer-employee dynamic, affecting retention initiatives as well as readiness to take on extra tasks,” stated Nodikida.
View from the wards
Two physicians separately approached by Spotlight, each affiliated with distinct hospitals in Gauteng, assert that the issue surrounding commuted overtime payments represents merely one manifestation of inadequate human resource strategies and subpar administration within the Department of Health. They argue that suggesting cuts to these overtime compensations deflects attention away from critical issues such as resolving staff shortages, enhancing HR processes, and combating corruption, mismanagement, and unnecessary spending. Neither doctor wished to be identified due to concerns over potential repercussions.
Dr. A from the Charlotte Maxeke Johannesburg Academic Hospital stated, “Rather than implementing a mechanism to track the actual number of work hours performed by each physician along with their corresponding overtime pay, the department provides every individual a predetermined lump-sum payment… You might be a dermatologist or a psychologist logging minimal overtime hours, whereas another may be a surgeon putting in considerable ekstratime; yet, both receive identical compensation under the same contractual arrangement,” she explained. Dr. A added, “Currently, throughout my career, I am consistently exceeding my contracted work hours without receiving any form of reimbursement.”
Doctor A mentioned that the reductions in overtime compensation along with the suggested alterations will influence her choice regarding remaining within the public sector.
She mentioned that previously, people felt content specializing and staying put since their total earnings from both salaries and commuting-related overtime were sufficient—not as high as what they might get privately—but still reasonable for maintaining their positions.
She mentioned that she believes medical professionals are becoming undervalued and facing criticism from those they work for. She explained, “What we hear is essentially ‘If you’re unhappy, leave,’—but the department fails to realize that replacing somebody with ten years of experience or even three decades of service would have significant consequences.”
Our patients are enduring hardship; each day feels akin to playing Survivor. At Charlotte Maxeke, we operate several clinics within a single facility, yet this setup fails to provide effective services. The environment is chaotic with constant noise, non-functioning computers, and the intercom interrupting constantly.
The other day, a 90-year-old patient of mine experienced a panic attack in the waiting room. He had been waiting for some time and had left his wife, who is blind, alone in the car. Due to the unfinished repairs from the hospital fire that occurred in April 2021, he parked far away from the main building, which filled him with anxiety,” she recounted.
Dr. B is employed at Chris Hani Baragwanath Hospital, where he mentioned that the controversy surrounding physicians’ overtime compensation has left him feeling utterly overwhelmed. According to Dr. B, medical professionals are not only burdened with excessive workloads but also demoralized due to operating under an inefficient healthcare framework. At the close of April, when electricity was out for several days at the Soweto facility, he shared images with Spotlight depicting surgical theaters and patient areas shrouded in darkness.
He mentioned that employees supply their own toilet paper as they have been informed that none is available. More concerning, he stated doctors “aren’t receiving proper pelatihan and oversight,” often conducting operations and procedures lacking sufficient expertise and under inadequate supervision.
“Il est écrasé par le travail, débordé et effectue un nombre incalculable d’heures supplémentaires non rémunérées. En rentrant chez lui complètement fatigué, il se contente de manger une pizza, s’effondre pour dormir quelques heures puis recommence ce cycle jour après jour,” explique-t-il.
“We, as doctors, are essentially the ones endangering our patients’ lives,” he stated, mentioning additionally that he “is managing with antidepressants” and has occasionally locked himself in hospital storage rooms, overwhelmed by tears born from pure frustration, fatigue, and exasperation.
Doctor B still tallies up the victories even then. These are the times when he manages to clear out an impressively extensive list of young patients needing medical procedures. They’re moments when Doctor B and his team choose to persevere so that no child has their treatment postponed.
“These are the pleasant times – though unfortunately, they occur quite rarely. Now, the department is targeting us by reducing our overtime compensation and making us agree to new contracts that further decrease our earnings for tambahanhours worked,” he stated.
Withdrawals and their effect on instruction
Professor Shabir Madhi serves as the dean of the Faculty of Health Sciences at the University of Witwatersrand. According to him, the suggested reductions in funding along with the freeze on positions and modifications to commuted overtime compensation have led to several departures among high-ranking personnel at public hospitals.
Without having an adequate number of skilled consultants available for continuous oversight in these hospitals, both our specialist training programs and those involving undergraduate students end up being compromised.
In case the Health Professions Council of South Africa conducts an audit and discovers insufficient consultant coverage and supervision, they might revoke the accreditation of the training programs provided by these universities.
The medical schools rely entirely on the Gauteng Department of Health to keep consultants and various levels of personnel, and to guarantee that employees have designated time for supervising and educating upcoming medical practitioners, such as specialists, along with engaging in other scholarly pursuits.
He stated that decisions regarding reductions in overtime compensation should consider their comprehensive effects and not just focus on addressing anggaran limitations. This scenario requires thoughtful and well-informed choices.
COULD FAMILY DOCTORS BE THE SAVIOR? The health department has developed a plan emphasizing a stronger role for family physicians. These medical professionals are recognized for enhancing the standard of care at both primary healthcare centers and district hospitals.
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Dr. Phuti Ratshabedi, who serves as the Gauteng chairperson of SAMATU, stated that not receiving the commuted overtime pay in April felt like a rebuke from the provincial health department. This came after a meeting that month where the union thought they had an agreement with the department to honor their contractual obligations, ensuring that conditions regarding commuted overtime pay would remain unaltered until the conclusion of the fiscal year in 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.
During this review period, we aim to observe them targeting departments where overtime pay is issued without actual overtime work, while leaving other sections untouched—uniform treatment of all units should be avoided.
“If the government continues to provide repeated bailouts for entities such as Eskom and Transnet, why aren’t they giving priority to healthcare? This holds our nation back significantly, and as doctors, we won’t remain quiet about this,” stated Ratshabedi.
Spotlight directed inquiries to the Gauteng health department regarding multiple issues: the cause behind the delayed payments, the total number of individuals impacted, the measures being taken to address the extensive repercussions resulting from their planned reductions in commuted overtime pay, and the expected changes arising from the ongoing national review. Even after numerous follow-ups, the department failed to provide responses to these queries.
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