Employment contracts for South African doctors.

To the Editor: There has been concern about the loss of health care professionals from South Africa, and while there are multiple factors contributing to this, one of them, in my opinion, is that health care professionals work under poor employment terms and conditions. My brief experience with South African employment after a period of time in the UK led to an unfair dismissal (Commission for Conciliation, Mediation and Arbitration (CCMA) case reference WE3402-04) because I refused to sign a contract that among other issues, included a clause in breach of South African labour law (notice period in violation of the basic Conditions of Employment Act). To illustrate the scenario, a selection of my points of objection follow. A set of clauses covered hours of service. These were not consistent between the employment contract and the conditions of employment document. Further, a separate clause dealing with out-of-hours work was not specific and did not refer to the clause on total hours of service. I wanted the contract to be consistent and clear about what was expected of my time. Another clause indicated that any submission for publication must be made through the librarian of the organisation. I can see the benefit in having all publications centrally recorded but do not see why the submission should be made through a central service. The contract as a whole had the appearance of a document that had been compiled from a number of other contracts without proper thought or organisation. It had clearly not been reviewed by any person with knowledge of the basic Conditions of Employment Act. While I was in the UK contracts between doctors and the National Health Service were extensively debated and negotiated between the British Medical Association and employers. Accepted understanding of a contract between an employer and an employee is that it clarifies the conditions of service of the employer and helps define the individual's position. The contents of the contract should be discussed and negotiated. In South African health care, contracts are presented to employees and are not negotiable. South African doctors sign these contracts and implicitly consent to poor labour practice. Apart from employment contracts for doctors, South African health care has many other issues to deal with. However, when health care professionals with access to international positions look at South Africa and find non-negotiable contracts that are poor in quality and incorrect in content …