The country needs shared stewardship between the government and the growing cohort of retired clinical managers and doctors and their accumulated wisdom and experience. South Africa faces the reality of serious skills shortages in healthcare. There are many reasons, which need no repetition here.
What needs more attention is the parallel reality unfolding quietly alongside it. This is the rich reservoir of senior clinical expertise which is being relegated to lie dormant at the very moment when the system’s demand for judgement, continuity and mentorship is intensifying. This article proposes strategic recourse to this pool.
It attempts to raise a national stewardship issue between productive citizens and the government, what I call “shared stewardship”. Across the country there is a growing cohort of senior clinicians whose professional lives span decades of patient care, crisis navigation, institutional leadership and the development of younger clinicians of all disciplines. Their experience is more than just the volume of service historically rendered, but includes judgement under pressure, ethical tensions and travails, and tacit knowledge that cannot be replicated through protocols or accelerated training.
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Much of this expertise unwillingly exits the system rather abruptly, under prescriptive legislation informed by linear thinking. Their capacity does not vanish. Their potential and relevance never expired.
Instead, we have just failed as a country, over the years, to design a coherent pathway through which accumulated wisdom can continue to serve beyond formal retirement thresholds. Healthcare systems advance through more than numerical staffing levels. The value of head count and doctor-patient ratios lies in what might be called the clinical expertise-disease burden coefficient.
The challenge extends beyond staff shortages. The deeper question lies elsewhere. It is in how much experiential and tacit judgement-bearing clinical intelligence exists relative to the complexity and severity of the disease burden facing the nation.
This hypothetical coefficient would improve most reliably through intentional intergenerational transfer. Its advances will lie in experienced clinicians remaining in sustained professional proximity to those still developing and maturing into strategic leadership “beyond the stethoscope”. It requires a culture of clinical rites of passage, where maturity is cultivated, recognised and entrusted through lived practice, rather than being presumed on the basis of technical credentials alone.
This call to fellow senior clinicians reaches deeper than merely motivating for institutional rescue. It is an invitation into an intentional cycle of national stewardship, rooted in legacy formation rather than contract. It speaks to honour, continuity and responsibility, before any consideration for remuneration.
This responsibility does not rest on personal preference. It is embedded in the logic of life itself. Every enduring species survives by protecting and transmitting its most adaptive knowledge across generations, each generation nurturing and safeguarding the next.
When lived clinical wisdom is not carried forward deliberately and consistently, continuity is disrupted and vulnerability escalates. Modern economies already extract from the future through debt-based development. Health systems compound this extraction when they discard mature reservoirs of clinical skill even as disease complexity intensifies.
The deficit burden migrates forward, re-emerging as avoidable error, clinician burnout, ethical erosion and systemic fragility in the next generation. It will not disappear.
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