CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 6, July 2012
306
AFRICA
Editorial
First annual congress of the Faculty of Consulting
Physicians of South Africa, 18–20 May 2012
NAOMI RAPEPORT
The specialist physician has always played a pivotal role in the
healthcare of South Africans. Following specialisation, either
through the College of Medicine or a Master’s of Medicine
obtained from a university, many of these doctors have branched
out into the private sector and continue to play a vital role in the
management of patients.
The total number of specialist physicians registered with
the Health Professions Council of South Africa (HPCSA) in
both the public and private sector is fewer than 600 and these
doctors provide specialist healthcare for a population of over
40 million people. Over the past four decades there has been a
major ‘brain drain’ of academic and private physicians to North
America, Australia and New Zealand and this resultant shortage
of specialists places an enormous burden on those who have
remained in South Africa.
Due to the burgeoning epidemic of HIV and AIDS in our
country, patients withAIDS-associated conditions have swamped
medical admission wards, placing a huge load on clinicians. The
increase in prevalence of non-communicable diseases such as
diabetes mellitus and coronary artery disease in our previously
disadvantage populations has also contributed to an increased
work load as our population undergoes epidemiological transition
from famine and pestilence to degenerative and man-made
disease. South Africa now has the distinction of having one of
the most obese populations in the world.
All private-practice doctors are required to be registered with
the HPCSA as well as the Board of Healthcare Funders (BHF),
who are responsible for issuing MP and private practice numbers,
respectively. The latter is known as the practice code numbering
system (PCNS). The HPCSA, a statutory body, established
in terms of the Health Professions Act No. 56, is committed
to serving and protecting the public. It regulates the health
profession in aspects pertaining to registration, education and
training, professional conduct and ethical behaviour, continuing
professional development, and fostering compliance with
healthcare standards. Neither of these organisations is involved
in, or has the interests of the private practitioner at heart. This is
the role of the various professional associations.
Previously, as far as consulting physicians were concerned,
matters relating to cost coding for medical services, procedures
and the introduction of new codes were the responsibility of
the private practice committee of the South African Medical
Association (SAMA) and in particular the Association of
Physicians. Due to the political milieu of South Africa prior
to the abolition of apartheid, the Medical Association did not
represent the interest of most of our fellow colleagues and in
particular, the Association of Physicians did not have any active
membership. It consisted of a lone physician who did all the
coding work.
In 1997, a group of concerned specialist physicians in
Johannesburg, under the leadership of Dr Naomi Rapeport,
established the Faculty of Consulting Physicians of South Africa
(FCPSA) to try and unite all specialist physicians in private
practice into one professional group. No accurate data were
available from the HPCSA, SAMA or BHF as to how many
physicians were practicing in South Africa. Through networking
with colleagues in all the different provinces, a nucleus of
physicians was established. The work of coding, and interaction
with SAMA, BHF and HPCSA was undertaken by the Faculty,
who took over the role of the defunct Association of Physicians.
Countless hours were expended on the workings of the
organisation. Annual academic meetings were held from 1998
to 2002 in the major centres, and regular updates were sent to
members. Although there was a constant drive to encourage
doctors to join the Faculty, it was a persistent uphill battle.
To date, many doctors in private practice have no idea what
an essential role the organisation plays in terms of their daily
practice management.
In 2004, Dr Adri Kok took over the leadership of the
organisation from Dr Rapeport. The faculty has expanded
to include dermatologists, rheumatologists, pulmonologists,
neurologists and nephrologists in private practice, and consulting
physicians in the public sector who do limited private practice.
Through tireless ongoing effort, Dr Kok has continued to head
and run the organisation.
Due to major changes in the private practice arena, ranging
from the introduction of prescribed minimum benefits (PMB),
formation of the Council of Medical Schemes (CMS), the ruling
of the Compensation Commissioner on the so-called collusion
of doctors’ fees, and conflict between the Department of Health
and SAMA regarding ownership of coding, the Faculty has
continued to play a vital role. The organisation, together with
many of the other medical and surgical disciplines, have left
SAMA and now operate under the umbrella of the South African
Private Practitioners Forum (SAPPF) and continue to represent
the private practice specialist.
This umbrella group together with private hospital groupings
was awarded costs in a court case against the Department of
Health regarding ownership of coding in 2010. The case was
to challenge the validity of the reference price list (RPL) in
its present form. Despite numerous meetings with assigned
colleagues of the Department of Health to resolve this issue, it
ended in a stalemate.
The RPL is a list of fees for medical professionals based on
