Top docs a dying breed

A serious shortage of medical specialists could result in gynaecologists, anaesthetists and surgeons being hard to find within the next 10 years.

The shortage is causing massive backlogs, with experts warning of patients at state hospitals not getting adequate treatment and "many times, [they] will die".

The worsening shortage of urologists, neurosurgeons, cardiologists, oncologists, radiologists and critical-care specialists was discussed at yesterday's Hospital Association of SA annual conference in Cape Town.

Between 2002 and 2010, South Africa produced only 3500 medical specialists, of whom more than 2000 went into the private sector or emigrated .

Experts called for better coordination between the departments of health and of education to bring the number of graduating specialists more in line with the demand for their services.

Dr Adri Kok, president of the Faculty of Consulting Physicians of SA, said the shortage meant that newly referred patients might have to wait until April before they could be seen by her.

Mediclinic executive Nkaki Matlala said that because of the shortage of specialists public sector patients did not get adequate treatment.

"The situation is better in the private sector but we also struggle to get the specialists we need."

"Have your children now," warned Dr Chris Archer, CEO of the SA Private Practitioners' Forum, adding that it was likely to be almost impossible to find a gynaecologist in five years' time.

Archer said the high cost of insuring against malpractice litigation resulted in very few young doctors specialising in gynaecology or surgery.

Figures provided at yesterday's conference reveal that:

South Africa has a ratio of 0.18 specialists to 1000 people. Developed countries have a ratio of about 2 or more;

According to Department of Health data, there are 815 vacancies for specialists in the public sector; 3000 specialists are employed in the sector;

The number of specialists in Eastern Cape has fallen by 10% in the past few years;

The number of specialists in Limpopo has declined by almost 20% in three years;

In 2009, Colleges of Medicine research showed that 30% of registrar (trainee specialist) positions at universities were vacant and unfunded; and

South Africa is the fourth-biggest supplier of specialists to the UK after India, Pakistan and Ireland.

Dr Nicholas Crisp, executive manager of Benguela, a business division of consultancy EOH, said people were making the problem worse by consulting specialists about conditions that could be treated by general practitioners.

"We've created a shortage of specialists because we're not using specialists as they should be used - as consultants. Instead, they become the first port of call."

Dr Brigid Strachan, a consultant in the University of Stellenbosch faculty of medicine and health sciences, said disturbingly few young people became surgeons, gynaecologists or ophthalmologists, most probably because of fear of ruinous litigation.

Many doctors did not want to become specialists because of the workload, said Kok.

"We need to make specialist work attractive to young doctors," she said.

"The life of a private specialist has become almost untenable. The shortages means surgeons work at weekends and for excessively long hours."

Professor Bongani Mayosi, head of medicine at the University of Cape Town, said South Africa could not afford to employ more specialists.

UCT produces about 600 medical specialists a year but because of poor employment prospects they often seek work abroad.

Mayosi said that registrars had occasionally had difficulty completing all the aspects of their training because of the shortage of equipment in the public sector.

Dr Terence Carter, deputy director of the Department of Health, said the biggest problem was lack of planning.

"The number of people being trained is not linked to any rational planning process or to where the demand is greatest," said Carter.