Thieves of the state and the South African Medical Association.

354 June 2013, Vol. 103, No. 6 SAMJ Thieves of the state and the South African Medical Association (SAMA) ‘SAMA upholds the principles of honesty, integrity and patientcentredness and does not condone any unethical practice by its members.’ This is reassuring to see in print, even though it should go without saying for a nation’s official medical association. The same SAMA mass e-mail’s strident objection to the Free State government’s withdrawal of approval for RWOPS (Remuneration for Work Outside the Public Service) during office hours is therefore rather surprising. Surely the very principle of RWOPS is that the work is pursued outside of office hours? The fact is that doctors who do RWOPS are full-time state employees, and their primary obligation is to patients who use public medical services. It is therefore sheer hypocrisy to wail loudly about ‘a threat to [private] patients relying on the services of these doctors’ when it is public sector patients whose care is sadly compromised by RWOPS during office hours. All these doctors would need to do is to re-book their private patients for after-office-hours appointments. The Medigram refers to ‘the part-time private group practice in which they participate’. The problem is that there are full-time state employees, some at senior consultant level, who run full-on single-handed private practices, complete with medical aid payouts and practice numbers. They are not just moonlighting, they are daylighting too, and these are not ‘blanket allegations’. Nice to know that, according to the e-mail, such thieves of the state do not exist in the Free State, but SAMA also ‘acknowledged that the recently highlighted abuse of RWOPS by some in other provinces is recognised and is not acceptable’. Yes, indeed. One is not expecting SAMA to be at the beck and call of the national Minister of Health. However, when he is quoted in our official journal as saying: ‘Patients are actually dying because of specialist greed ... high mortality rates at certain hospitals correlate alarmingly with high RWOPS abuse ... would ‘far rather’ struggle to fill specialist vacancies caused by a clampdown on RWOPS than employ ‘dishonest professionals who are never there anyway’ ... here you have professionals stealing from the public and the nation ...’ – then the Association needs to sit up and take notice. Yes, SAMA is our trade union, albeit half-baked because of current legislation; and yes, it can and should defend its members well in industrial relations matters. Primarily however, a medical association is the mouthpiece of the medical profession in that country, its opinion available to the rest of the world. SAMA may need the wisdom of Solomon in this matter to show that it is acting in the best interests of healthcare in South Africa. At the moment it does not seem to have applied too much thought, proactiveness or responsibility to the larger implications of this awful blot on our medical landscape.