Unpaid specialist training is becoming an increasingly visible feature of SA’s public healthcare system as doctors compete for a limited number of funded training posts. Some local doctors are working without salaries for extended periods to gain the clinical experience required to qualify as specialists. – Spotlight (September 2026)
Private funding is increasingly supporting specialist and sub-specialist training where Government-funded posts are unavailable.
Unpaid supernumerary posts expose trainees to significant legal and financial risks. Without Government payroll numbers, they may lack state indemnity, require private professional cover and have limited access to labour dispute mechanisms.
Regulations can also restrict their ability to undertake paid private work.
The growing reliance on unpaid trainees highlights weaknesses in SA’s healthcare workforce planning, with insufficient data and no specific strategy for these posts. Proposed reforms include a Workforce Intelligence Authority, ring-fenced training funds and subsidies for private-sector training. Ultimately, dependence on doctors able to work without salaries raises concerns about equity, workforce sustainability and the future supply of specialists.