The Health Professions Council of South Africa (HPCSA) stipulates that junior doctors should work 40 hours per week, with a maximum of 20 hours overtime, and rest periods, including a 12-hour break, between weekend shifts. However, in practice, these regulations are often ignored.
In the country’s overburdened public health facilities, junior doctors routinely work between 80 and 120 hours per week.
“While standard contracts may list 40 to 60 hours a week, this excludes the excessive overtime that is almost always required due to chronic understaffing,” Dr Mvuyisi Mzukwa, chairperson of the South African Medical Association (SAMA), tells Health-e News.
“It’s not uncommon for interns and community service doctors to work 24 to 36 hour shifts, often with minimal or no breaks and very little supervision. Consecutive calls where a doctor works a full day, stays overnight on call, and continues into the following day still happen at many institutions.”
The consequences are serious, not only for the physical and mental health of these junior doctors but also for the safety of their patients. A 2024 study shows that the prevalence of burnout among doctors in South African health facilities ranges between 57.9% and 78.0%, a staggering statistic that points to a profession in crisis.
A tragic wake-up call
Last week, the harsh conditions faced by junior doctors were tragically brought back into focus when Dr Alulutho Mazwi, a 25-year-old medical intern at Prince Mshiyeni Memorial Hospital in KwaZulu-Natal, died while on duty – on the same day he was supposed to be admitted to the hospital. According to reports, Mazwi-who had collapsed twice before- had informed his superiors about feeling unwell but was allegedly still expected to report for work. He was allegedly threatened that if he did not report for duty, he would have to repeat his rotation.
Mazwi’s death is not an isolated incident.
In 2016, a junior doctor in Cape Town died in a car accident after falling asleep behind the wheel following an extended shift. That same year, junior doctors called for the HPCSA to review the 36–39-hour shifts, then considered standard. In response, the Western Cape Health Department introduced a 24-hour shift limit for interns.
However, junior doctors continue to report gruelling working conditions.
Nadia*, a second-year intern at Paarl Provincial Hospital, says the workload and staff shortages are relentless.
“On a normal day, we work from 7:30 a.m. to 4 p.m., and technically we’re allowed a 30-minute break, but there’s just too much work. You can’t even find time to eat,” she tells Health-e News.
She often snacks between patients and procedures to keep her energy up.
“From 4 p.m. until 10 a.m. the next day, we are on call. But we don’t leave at 10 a.m. Sometimes we stay into the afternoon because you can’t go home without finishing your work,” she says.
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Xolani*, a 26-year-old intern at Chris Hani Baragwanath Academic Hospital, describes the long hours as emotionally and physically taxing.
“We’ve been told many times that this is how you ‘earn your stripes’, so we’re led to believe it’s normal,” he says. “It’s become normal for me to spend two days at the hospital, working with very little rest. The moment you try to take a break, you’re called for an emergency.”
Dr Cedrick Sihlangu, General Secretary of the South African Medical Association Trade Union (SAMATU), says the HPCSA recommends that junior doctors take a break after every five hours of continuous work.
“This includes a one-hour meal break, which is considered mandatory. However, most junior doctors go for hours without even getting this break because they simply can’t afford to stop in the middle of attending to patients,” he says.
He explains that in departments like surgery, for instance, a junior doctor might be involved in a complex operation that takes up the entire day.
“There’s enormous pressure in public hospitals due to the disproportionate doctor-to-patient ratio, and unfortunately, many supervisors don’t even check if interns have had time to rest or eat,” he says.
South Africa faces a significant shortage of doctors, with a doctor-to-patient ratio of 1: 2230 (0.44 per 1000) of the population. The World Health Organization recommends a ratio of one doctor per 1,000 people.
Mental health consequences
SAMATU stresses that junior doctors are the backbone of the healthcare system, delivering essential care under extreme conditions.
“The death of this young doctor [Mazwi] must serve as a wake-up call to all in the profession. We can no longer ignore the inhumane treatment and severe strain these young doctors endure,” says Sihlangu.
He says the demand for interns arises from high patient volumes, severe staff shortages, and the need for continuous care. But the result is prolonged hours without adequate rest, leading to fatigue, impaired cognitive function, poor decision-making, and slower reaction times.
“In healthcare, this isn’t just about performance, it directly impacts patient safety. Medical negligence claims, which are a growing challenge for the Department of Health, are sometimes linked to doctors working under these extreme conditions,” Sihlangu explains.
Mzukwa adds that the physical toll is also severe. “Junior doctors frequently experience extreme exhaustion and dehydration while on duty,” he says.
“In the worst cases, mental health consequences can lead to suicide. Many suffer in silence, facing untreated mental health conditions because of stigma and the lack of accessible, confidential care.”
He says this is a systemic issue and a serious safety concern that demands urgent attention.
Reporting unsafe working conditions
Mzukwa acknowledges that while there are internal grievance processes within provincial health departments and some oversight by the Office of Health Standards Compliance, most junior doctors find these mechanisms ineffective.
“Reports are often ignored, and whistleblowers may face victimisation, including delayed contract renewals or threats to not be signed off at the end of their rotations,” he says.
He says without independent oversight and stronger enforcement, the current systems fail to provide real accountability or protection. – Health-e News
*Not their real names
