Wits Donald Gordon Medical Centre (WDGMC), a private academic hospital, was established in 2002 to respond to the Faculty of Health Sciences at the University of Witwatersrand concerns around the future of specialist and sub-specialist training within the public sector. These concerns which remain as real a threat today as they did 17 years ago include the lack of dedicated posts in public sector training facilities for sub-specialist training, the effect of Remunerative Work Outside the Public Sector (RWOPS) on academic medicine, and the affordability of high-tech equipment to support specialist and sub-specialist training.
The initial vision for this private academic medical centre was to develop a privately funded university healthcare infrastructure conducting world-class teaching and research while providing state-of-the-art healthcare to both private and low-income patients. Seventeen years after its establishment, this vision has largely been realised, albeit through a route that has, through necessity, been somewhat different from what the University's leadership envisaged at its inception.
The founding documents described a service led by groups of public sector clinicians, formed into Faculty Practices, delivering a service after hours. This would harness the private work being done by public sector doctors into a single site for certain key disciplines. The reality of running a service with part time doctors, and as an “independent hospital” proved disastrous, bringing the facility to the brink of bankruptcy.
A change in strategy was required. This involved changing the doctor model to one of recruiting established practices from the private sector with academic aspirations, in order to have a sustainable 24 hour service, while providing a convenient outpatient and inpatient facility for doctors participating in RWOPS, which respected the public sector commitments of these practitioners.
At the same time, a partner in the private sector was sought, while still retaining the University as the major shareholder. The partnership with Mediclinic in 2005 was a turning point for the hospital, and since that time, the hospital has managed to achieve financial sustainability as well as going a long way to contributing to the future generation of specialists and sub-specialists.
While the hospital functions in the private sector, the shareholders do not take out any dividends, leaving all surpluses generated available for the funding of the hospital's training programme, as well as funding the research office that supports clinical research within the facility. This currently amounts to more than R50 million per year.
The training areas at WDGMC, at the inception of the hospital in 2002, were identified by the Academic Heads at the Faculty of Health Sciences at the University of Witwatersrand. All training units are registered with HPCSA as satellite units. Selection of candidates for the training posts takes place as part of the central interview process for selection of candidates in the relevant academic department. Trainees are paired with consultants or groups of consultants.
Trainees, funded by WDGMC, are employed through Wits Health Consortium, a wholly owned subsidiary of University of Witwatersrand. Salaries for trainees are equivalent to those of trainees employed in the Public Sector. No billing is done for trainees services, apart from surgical assistant fees, which are used to offset the salary cost of the trainees.
Trainees funded by WDGMC rotate through all the University Academic Complex training sites, as they may only spend 25% of their total training time at WDGMC. This allows other trainees to also rotate through WDGMC, thus broadening their experience.
WDGMC is unique in that it not only funds training posts but it also provides an additional training platform for specialist areas within the University Academic Complex, which differentiates it from other private entities that fund specialist training. To date, 80 specialists and sub-specialists have been trained. At the same time, the integration of the private training platform with the existing public sector platform has allowed more than 1000 trainees to rotate through the training units at WDGMC, which has added a different dimension to their training experience.
Apart from the impact of the additional trainees produced by WDGMC (92% of whom have remained in South Africa and 35% of whom are working in the Public Sector), the Liver Transplant Programme and the Research Office are arguably its most meaningful contributions to the healthcare and academic landscape in recent years.
The Research Office, established in 2014, is central in implementing critical quality improvement projects within the hospital while at the same time providing much needed strategic guidance, ethics and statistics support, as well as writing assistance. As a consequence, the number of publications emanating from WDGMC has increased from 1–2 per year, up to 15–20 per year. In addition, the Research Office has supported 37 undergraduate and postgraduate research projects including 8 PhDs, four of whom are clinicians or researchers in full time employment at WDGMC.
The highly successful Liver Transplant Programme has provided a prototype for integrated training, multi-disciplinary patient care, a unique doctor employment model, as well as a model for creating access to highly specialized care for patients within the public sector, by providing Liver Transplant to Public Sector patients through a collaboration with the Charlotte Maxeke Johannesburg Academic Hospital.
At a time when our country is looking for innovative ideas to providing access to healthcare, as well as ways in which to retain highly skilled professionals, this private academic medical centre model presents some valuable and sustainable solutions.