Following community service, many doctors start to look for a registrar post in their chosen speciality. Others choose the route of general practice, where there is no need to embark on the rigours of postgraduate training.
In the public service, this is not a restrictive choice at all. It can allow you the freedom to move between different disciplines (this might be in the process of deciding which one you might like to specialise in at a later date), or to remain in one discipline developing the practical knowledge, wisdom and experience which make you a very dependable member of the healthcare team (the so-called career medical officer).
You can choose to work in any of the full range of public healthcare facilities – large urban hospitals, small rural district hospitals, community health centres (CHCs), or disease specific clinics (eg, HIV), or a non-governmental organisation (NGO).
Depending where you choose to work, you may end up using and developing different skill sets – the NGO may require you to develop project management or grant writing skills; the CHC may require you to develop expertise in ambulatory care of patients with chronic diseases and the skill to help people make healthier lifestyle choices; the district hospital may require a skill set that encompasses procedural skills and emergency care; the large urban hospital may require a skill set restricted to a specific discipline, but including outpatient, ward and theatre work. You could also pursue a career as a member of a research team.
One of the options for general practitioners who develop a particular interest in a discipline is to pursue a Diploma through the Colleges of Medicine of South Africa. Almost every constituent College (including the College of Family Physicians) offers a Diploma, which does not require the candidate to be in a registrar position in order to be eligible for the exam. This does give the general practitioner certification of a nationally recognised level of skill in the particular discipline.
Working as a general practitioner in the public sector in South Africa does mean that your potential career and pay progression is capped at a level lower than a specialist might reach, but deciding to pursue this path needs to be weighed up against other choices that you are confronted with about how you want to live life outside work. At least your working hours are set, and you will have a fixed income at the end of each month.
However, conditions can be quite difficult if the staff complement is not filled, there is inadequate maintenance of infrastructure, and inconsistent supplies of consumables. There are opportunities to build well-working teams (both inside the hospital and with the community-based healthcare providers) and to improve systems to provide more efficient care, so jobs in the public sector can provide both interesting challenges and chances to problem-solve in unique ways, to really make you feel that you are contributing to improvements in patient care.
Pursuit of a postgraduate qualification is not an essential requirement for a very fulfilling career in general practice in the public sector.