Opinion Paper

Retaining doctors and reducing burnout through a flexible work initiative in a rural South African training hospital

Rachel Schaefer, Louis S. Jenkins, Zilla North
African Journal of Primary Health Care & Family Medicine | Vol 13, No 1 | a2799 | DOI: https://doi.org/10.4102/phcfm.v13i1.2799 | © 2021 Rachel Schaefer, Louis S. Jenkins, Zilla North | This work is licensed under CC Attribution 4.0
Submitted: 14 October 2020 | Published: 23 March 2021

About the author(s)

Rachel Schaefer, Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Louis S. Jenkins, Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; and, Primary Health Care Directorate, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa, South Africa
Zilla North, Department of Medical Management, George Hospital, George, South Africa


Background: South African doctors work up to 60 h per week to ensure 24-h service delivery. Many doctors are physically and emotionally exhausted, neglecting families, self-care, patient empathy and innovative thinking about complex health issues. Exposure to clinical work hours demonstrated a dose effect with burnout, suggesting cause and effect, affecting up to 80% of doctors. To retain good doctors, their complex needs must be recognised and allowances made for flexible work options.

Taking a risk: George Hospital, a large regional training hospital in a rural district, converted some full-time medical officer posts to part-time posts. This was in response to doctors’ requests for more flexible work options, often after returning from maternity leave or in response to burnout. Perceived risks revolved around institutional resource security and that part-time post vacancies would be difficult to fill.

Reaping the benefits: Employing doctors in part-time posts has created stability and continuity in the health team. The hospital had generated a cohort of young professionals who care with empathy and have emotional resilience to train others and plough their skills back into the healthcare service.

Conclusion: Reducing working hours and creating flexible options were concrete ways of promoting resilience and retaining competent doctors. We recommend that training and work of doctors be structured towards more favourable options to encourage retention, which may lead to better patient care.


part-time posts; resilience; burnout prevent; training; flexible work; retention


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Crossref Citations

1. Global best practices in recruiting and retaining healthcare workers in rural areas (literature review)
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