The Real Cost of Understaffing: Why Quality Locum Staff Is an Investment, Not an Expense
/The conversation about locum staffing costs in South Africa often starts in the wrong place. Finance directors and facility managers look at the hourly rate and compare it to the permanent employee equivalent. That comparison, while logical, misses most of what is actually at stake.
The real cost of understaffing in healthcare is not captured in a salary spreadsheet. It appears in medicolegal claims, staff turnover, overtime liability, regulatory penalties and patient outcomes. Measured against those, a locum staff investment looks less like an expense and more like insurance.
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The medicolegal cost of understaffing: South Africa’s R68 billion problem
As of March 2023, approximately R68 billion in medicolegal claims had been lodged against the South African state’s healthcare system. Separately, the cumulative value of all claims recorded in 2021/22 reached R125.3 billion, with 96% classified as medico-legal. Claims in the public sector have grown at 23% annually since 2014.
The root causes cited consistently in these cases include critical staff shortages in high-risk areas, clinical errors attributable to overworked clinicians, poor documentation, and delayed responses due to inadequate cover. A 2023 South African Medical Journal analysis identified staff shortages as a direct contributing factor in leading categories of litigation.
Private-sector healthcare facilities in South Africa also face medical malpractice risks. Obstetricians in private practice have historically faced high indemnity insurance premiums, reflecting the financial risks associated with obstetric claims.
Every preventable adverse event linked to understaffing is both a patient harm and a legal liability that dwarfs the cost of the staff who were absent.
Healthcare staff burnout: the cost of losing clinicians you cannot replace
South African doctors currently work an average of 60 hours per week, well above the 45-hour maximum under the Basic Conditions of Employment Act (BCEA). When overtime is restricted to manage costs, as several provinces have done by capping it at 8 hours per week, the immediate effect is further shortages in already understaffed areas.
Research published in PubMed Central found healthcare staff burnout prevalence among South African doctors ranging from 58.9% to 78.0% in post-pandemic assessments. In rural Northern KwaZulu-Natal, 68.5% of doctors in hospital settings screened positive for burnout. Among nursing professionals, 20-40% of early-career staff leave within their first two years of practice.
Burned-out clinicians make more errors, provide lower-quality patient experiences, and leave. When they leave, the facility carries recruitment costs, vacancy-period risk, and the overtime burden on remaining colleagues that drives the next round of burnout. This cycle is measurable and preventable.
A well-deployed locum team relieves overtime pressure on permanent staff. The cost of that relief, set against the cost of replacing a burned-out senior clinician, is consistently favourable.
The locum staff investment case: what an unfilled position really costs
Most finance directors run the direct calculation: locum cost per hour against permanent employee cost per hour. Fewer ask the more useful question: what does a three-month vacancy in this position cost us in revenue, risk and overtime?
Take an unfilled GP post at a private clinic. At 20-30 consultations a day and an illustrative R475 per consultation, that is R9,500-R14,250 in daily consultation revenue that does not happen. Over a 90-day vacancy, that is R855,000-R1.28 million in foregone revenue. This is gross revenue before overheads, and it excludes patient retention loss (patients who rebook elsewhere and do not return) and the overtime cost for colleagues covering the gap.
Against that, a locum GP at R500 per hour over a 10-hour day for 90 days costs R450,000. That is roughly half the conservative revenue loss, before counting retained patient relationships and avoided burnout costs. Adjust the figures to your own fees and volumes, and see our locum pay rates for current rates.
Run these numbers for your own facility. Every practice has different fees and volumes. Let us show you what a vacancy is costing you and what quality locum cover would cost instead. WhatsApp us on 0600 702 327, email locum@a24.co.za, or view our current pay rates to start your comparison.
Regulatory risk: BCEA working-time compliance
BCEA violations related to working time, such as excessive overtime, inadequate rest periods and insufficient night shift allowances, carry both financial penalties and reputational consequences. Facilities that routinely push permanent staff past BCEA thresholds to cover vacancies are accumulating regulatory exposure. Structured locum coverage removes that risk by providing the additional clinical hours within a clearly defined contractor framework.
What quality means when you hire locum staff
Not all locum cover is equal, and the cost comparison above only holds for quality placements. A locum who creates documentation problems, misses handover procedures or generates patient complaints creates costs of their own. The investment argument applies to verified, credentialed locum professionals placed by a rigorous agency, with these checked before placement, not after:
Malpractice insurance
Clinical references
Ambition24hours Locums, part of the A24 Group, places only fully verified candidates. Every placement includes credentialing documentation, written contracts and a defined process for performance feedback. Our standard is that a locum placed by Ambition24hours Locums should be indistinguishable from your best permanent staff in professional conduct and clinical reliability.
Frequently asked questions
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Approximately R68 billion had been lodged as at March 2023, with annual growth of 23% in the public sector since 2014.
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Not once the full overtime calculation is applied. Overtime is paid at 1.5 times the normal rate under the BCEA, and double on Sundays and public holidays. Locum cover at market rates is often comparable or lower, without the BCEA compliance risk.
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Well-managed locum integration relieves pressure on permanent staff and is generally perceived positively. Poorly managed integration, where locums are not briefed and create additional administrative burden, does the reverse.
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Rates depend on specialty, location and shift type. Our locum pay rates page sets out current rates, and the R500 per hour used above is an illustration, not a quote.
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Before placement we confirm HPCSA registration, CPD compliance, malpractice insurance and clinical references. Each placement includes credentialing documentation and a written contract.
Ready to reduce your facility’s operational risk and staffing cost at the same time? Speak to Ambition24hours Locums today and we’ll talk through your staffing needs. You can also call 087 357 0645 or email locum@a24.co.za.
