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Cape Town - South Africa has huge imbalance of medical specialists, with wealthy provinces like Gauteng and Western Cape attracting many more doctors than the poorer provinces.
The deficiency is so dire in certain parts of the country that the national Department of Health is undertaking a strategic specialist review that could see medical schools compelled to train many more specialists than they currently do.
The universities could also be required to cut the numbers of registrars in certain specialties if these are deemed not to be in demand.
While provinces such as the Eastern Cape, Limpopo, Mpumalanga and the Northern Cape were struggling to fill posts such as anaesthetists, gynaecologists and obstetricians, the Western Cape, Gauteng and KwaZulu-Natal were doing well with most of their specialist posts filled.
Specialities in short supply in the public service included gynaecologists, haematologists, urologists, cardiologists, oncologists, critical care specialists and neurosurgeons.
Speaking at the Hospital Association of South Africa (Hasa) in Cape Town, Dr Terrence Carter, deputy director-general in the department’s National Tertiary Hospital Services and Human Resources, said a national body would soon be established to look into the inequities of tertiary medical services in less resourced provinces.
This was last week approved by the National Health Council, the department’s highest policy-making body.
The new body will be composed of people from organisations including the Health Professions Council of South Africa, medical schools, the South African College of Medicine and the Department of Higher Education. It will assess specialist demand around the country and recommend to medical schools the number of specialists needed, and in which specialities.
“Currently the number of specialists trained is not determined by the needs of the country, but is determined by the capacity of the universities,” he said.
“We want to change that... the body will look at the country’s needs. We might have to dramatically increase some specialists and reduce numbers of those not in such high demand.”
Apart from having well-resourced health facilities in bigger cities, Carter said other social issues, such as good schools and roads and great opportunities, attracted doctors.
Dr Brigid Strachan, from Consultant Health Care Financing and Human Resources for Health and who also works at Stellenbosch University, discussed the disparities between different provinces.
The Western Cape has the most doctors with 56.7 per 100 000 people, compared to Limpopo which has the least – 30.6 doctors per 100 000.
Gauteng has 52.3 doctors per 100 000 people and KwaZulu-Natal 40.5 doctors.
Of the almost 12 000 doctors trained between 2002 and 2010, more than 6 000 have either emigrated or had gone into private practice – showing the gap of skills between the private and public sector.
Professor Bongani Mayosi, head of the Department of Medicine at UCT, suggested that South Africa was a victim of its own success, arguing that because its medical schools produced such good quality doctors, its specialists were sought locally by the private sector and abroad.
Despite having a “resilient training system” of medics, and the ability to increase the number of students at medical schools, Mayosi said the unemployment of such specialists was a concern.
He said the country should exploit the “low-hanging fruit and use what we already have”.