Slaves of the state - medical internship and community service in South Africa

S Afr Med J. 2012 Jun 5;102(8):655-8. doi: 10.7196/samj.5987.


Owing to a chronic shortage of medical staff in South Africa, sleep-deprived medical interns and community service doctors work up to 200 hours of overtime per month under the state's commuted overtime policy. Nurses moonlight in circumvention of the Basic Conditions of Employment Act. For trainee doctors, overtime over 80 hours is unpaid, and rendered involuntarily under threat of not qualifying to practise medicine in South Africa. As forced labour, and sleep deprivation amounting to cruel and degrading treatment, it is outlawed in international law. No other professional group in the country is subjected to such levels of exploitation and discrimination by the state. These abuses should be challenged under the Constitution. Solutions include the installation of electronic time-recording in state hospitals, cessation of unpaid overtime, limits on medical intern shifts to a maximum of 16 hours, and an investigation by the Human Rights Commission of South Africa.

MeSH terms

  • Clinical Competence
  • Coercion
  • Community Health Services*
  • Education, Medical, Graduate*
  • Employment / legislation & jurisprudence
  • Humans
  • Internship and Residency* / legislation & jurisprudence
  • Quality of Health Care
  • Sleep Deprivation
  • South Africa
  • Work Schedule Tolerance
  • Workforce