Doctors are neglecting their jobs at state hospitals in Pretoria to perform private work, according to the Health Professions Council.
A spokesperson for the council said: "Their mandate is to provide an efficient service to patients in state hospitals. Continued absenteeism to moonlight undermines the patients' right to medical treatment.
"These doctors are guilty of neglecting their patient responsibilities."
An investigation last year by the Public Service Commission (PSC) found 55 percent of staff at Pretoria academic hospital were involved in moonlighting while more than 600 nursing posts stood vacant.
The investigation noted that these statistics and nurse shortages were cause for concern about service delivery if, under such circumstances, nurses failed to report for duty in order to moonlight.
The PSC also found that more than 50 percent of specialist doctors employed in the public health sector owned private clinics and were often absent from their posts in order to moonlight.
PSC research concluded that poor remuneration, staff shortages and poor working conditions in public health facilities resulted in staff performing illegal work outside the public service.
Current salary scales provided by the South African Medical Association for doctors in the public sector, excluding last year's six percent increase, start at R89 805 per annum for an intern, with a ceiling-level of R425 000 for a chief practitioner.
Nurse salary scales from the Democratic Nursing Organisation of South Africa (Denosa) show that entry-level nurses begin at R67 887 per annum, reaching a maximum of about R105 018 for a chief professional nurse, excluding the latest six percent adjustment.
Moonlighting rates for nurses offer an attractive means of supplementing their income, Denosa says, with hourly rates of up to R130 per hour paid to experienced professionals.
Doctors can demand up to R360 per hour, depending on their field of expertise.
Sylvia Raputsoe, 34, a senior nurse at a Pretoria state hospital, says poor salaries provide the motivation for nurses to perform illegal work.
"Our salaries are minimal in terms of our workloads. Staff shortages mean that we have to perform extra duties for the same money."
"It is easier to take time off and work elsewhere to earn extra money," she said.
With 12 years' experience, eight of which have been in casualty, Raputsoe takes home about R3 800 monthly, excluding overtime.
"With a family to support, my state salary is inadequate to cover expenses," she said, saying she pockets an additional R3 000 each month from moonlighting.
A senior medical officer at Pretoria academic hospital said doctors who moonlight did not necessarily do so for financial gain.
"Working part-time at private hospitals is a good way to increase your knowledge and expertise without the uncomfortable burdens found in public hospitals," he said.
The doctor, who asked not to be named, admitted he took home about R6 000 monthly in moonlighting pay.
Excluding overtime, his monthly gross state salary is about R15 000.
But the Health Professions Council warned that citing poor salaries was not an acceptable excuse for moonlighting.
"Salary differentials between the public and private sectors are not so large as to warrant illegal work by health professionals employed in the public service," said spokesperson Tendai Bxliwayo.
Spokesperson for Denosa, Nelouise Geyer, said poor salaries and working conditions must not be seen in isolation in terms of nurses working illegally outside of the public service.
"Government needs to increase staffing ratios in public hospitals in order to improve service delivery."
"Nurses bear the brunt of ineffective health service delivery to patients that results from poor remuneration and working conditions," said Geyer.
Popo Maja, Gauteng health department spokesperson, said the department agreed with the PSC report's findings.
"We are presently investigating salary structures with a view to adjustments and ways in which working conditions for staff can be improved," he said.