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MED BRIEF A study conducted by the University of Stellenbosch and published in the journal PLOS ONE has revealed that the number of nephrologists in South Africa is not only insufficient to deal with the country’s growing burden of chronic kidney disease but that many of them are considering emigration or early retirement because of excessive workloads, unsatisfactory working conditions and inadequate remuneration. The study is the first in-depth report on human resources for nephrology in South Africa and is based on various data resources including the HPCSA register and the findings of a survey and focus group interviews conducted among local nephrologists. It shows that in 2018, there were 120 adult and 22 paediatric nephrologists in the country amounting to one per 2.5 million population. Ninety-two percent of them are working in the Western Cape, Gauteng and KwaZulu-Natal. Mpumalanga doesn’t have any nephrologists while the Northern Cape, North West and Limpopo only have one each. Fifty-seven percent of the nephrologists identified in the country participated in the survey and 13 of them were interviewed in the focus groups. Most of them reported positive attitudes to their chosen profession; however, 35 nephrologists (43%) reported an excessive workload, 9 (11%) were planning emigration and 15 (19%) were planning early retirement. A higher frequency of dissatisfaction regarding remuneration (39% vs. 15%) and unsatisfactory work conditions (35% vs. 13%) was observed amongst nephrologists working in the public sector compared to the private sector. Prominent positive factors identified in the study were the complex and challenging nature of the discipline, the diversity of clinical practice, the close relationships with patients and the ability to contribute to a drastic improvement in their quality of life. However, the challenges nephrologists face are numerous and include an overall shortage of nephrologists and an unequal geographic and sectorial distribution, some shortcomings in training and a heavy workload. In the public sector, nephrologists struggle with difficult decisions due to the rationing of renal replacement therapy (RRT), a severe lack of resources (including posts), and insufficient support from hospital management. In the private sector, nephrologists struggle with the administrative load imposed by medical schemes and are concerned about the potential impact of NHI, the study found. “Strong concerns were raised around the implementation of the NHI bill by the private sector nephrologists. Areas of uncertainty include the extent to which private financing mechanisms continue to pay for RRT, and the extent to which the NHI fund will purchase services from private providers. Nephrologists felt that the National Department of Health should actively engage the South African Renal Society in drafting the plans for the NHI’s renal services. Failure to do so may strengthen many nephrologists’ resolution to emigrate,” the researchers write. In the survey, nephrologists pointed out that although they are proficient and had adequate training for the traditional skills required of nephrologists, training on the use of ultrasound to evaluate renal anatomy and vascular access are aspects where there is room for improvement. Further training in the technical aspects of haemodialysis, peritoneal dialysis catheter insertion as well as management skills to run a dialysis unit or a clinical department are needed. Even though many nephrologists in the private sector do not perform renal biopsies in their practice, it is still seen as an essential competency for nephrologists in both health sectors. These data also highlight the array of skills of South African nephrologists, with higher self-reported competency rates at procedures compared to other countries,” the authors write. They propose a number of solutions including amendments to current labour legislation to allow nephrologists working in the state sector to work beyond the age of 65, flexible working hours, increasing the number nephrologists being trained and minimising the administrative burden of medical schemes.
Created at 2020/03/03 10:09 AM by Mediclinic
Last modified at 2020/03/03 10:09 AM by Mediclinic