South Africa: Exploited and Exhausted, South Africa's Ghost Doctors Start to Rattle Their Chains

What the report says

Spotlight, published by AllAfrica, reports that South Africa’s public hospitals are increasingly relying on unpaid trainee specialists, as aspiring doctors work without salaries to secure scarce registrar and sub-specialist posts. The article says the practice has become more visible in provincial health systems affected by years of austerity, staffing shortages and poor administration, leaving many young doctors competing for limited training opportunities in the public sector.

The report focuses on how these unpaid roles, sometimes called supernumerary or volunteer positions, can stretch on for years and are often used as a way to build experience for future specialist applications. Doctors interviewed by Spotlight described financial strain, pressure to accept unpaid work, and concerns about bullying, unclear hiring expectations and difficult exam pathways. Several said the system particularly disadvantages doctors from poorer backgrounds and can undermine broader transformation goals in health care.

The article adds that while the country needs more specialists, the current arrangement may also be strengthening private health care by helping train doctors who later move out of the state system. It notes that some private foundations and hospital groups now help support certain trainees, which may ease pressure on government to create permanent posts. Spotlight says it was unable to fully quantify the number of unpaid trainees, but the pattern appears to be growing in provinces including Gauteng, KwaZulu-Natal and the Western Cape. The story matters because it points to a workforce pipeline that keeps hospitals running while potentially deepening inequality and weakening the public sector’s long-term staffing base.