South Africa desperately needs more medical specialists (nephrologists) to diagnose and manage patients with kidney disease, according to a new study at Stellenbosch University (SU).
A group of researchers at SU's Faculty of Medicine and Health Sciences analysed trends in the country's nephrologist workforce for the period 2002–2017, described the current training capacity and used this as a basis to forecast this workforce for 2030. They also assessed the training capacity by determining the numbers of government-funded posts for consultant nephrologists and nephrology trainees (“senior registrars") at training institutions and their affiliated hospitals, as well as the number of Health Professions Council of South Africa (HPCSA) training posts for nephrology at each training institution.
The findings of their study were published recently in the peer-reviewed open-access journal PLoS ONE.
“A properly functioning nephrology workforce is critical to addressing the growing burden of kidney disease and to improve the quality of kidney care in the country. Unfortunately, there aren't enough nephrologists, especially in the public sector and in certain provinces," says senior author and Head of SU's Division of Nephrology Prof Razeen Davids who conducted the study with colleagues Dominic Kumashie, Ritika Tiwari, Muhammed Hassen and Usuf Chikte.
The researchers point out that although the number of nephrologists has nearly tripled from 53 in 2002 to 141 in 2017, the overall density is only 2,5 per million population (pmp), which is well below the median of 10,8 pmp for upper-middle-income countries (UMICs).
“At the current rate of production of eight nephrologists per year, and with 71 nephrologists expected to leave the profession in the next 12 years, the nephrologist density in 2030 is forecasted to be 2,6 pmp (174 nephrologists). This will simply not be enough to address the increasing burden of kidney disease in the country. It will also increase the workload for the active nephrologists which may result in burnout, early retirements and compromised quality of care for patients with kidney disease."
“The problem is compounded by the markedly unequal distribution of nephrologists by healthcare sector, with 78 working in the private sector, serving the 16% of the population who are medically insured, while the remaining 63 serve the 84% of the population reliant on the public sector."
According to the researchers, the lack of posts in the public sector for newly qualified nephrologists fuels the maldistribution between the two sectors as well as between urban and rural areas.
“The inability to retain nephrologists in the public sector (which is responsible for all the training of nephrologists) does not augur well for the future of the nephrology workforce in this sector and, by extension, for our training capacity."
Regarding the number of registered nephrologists per province in 2017, they say Gauteng, the Western Cape, KwaZulu-Natal had the most, followed by the Free State, Limpopo and the Northern Cape. At the time of the study, the North West and Mpumalanga provinces had none.
Looking ahead to 2030, the researchers point out that a substantial increase in the numbers of nephrologists being trained is needed if inter-provincial disparities are to be reduced and if we are to approach the average nephrologist density of other UMICs. Aiming for even modest targets means producing 14 and 16 nephrologists per year, respectively, instead of the current eight.
“Training is currently operating well below the potential capacity, based on the numbers of consultant nephrologists and the allocated HPCSA training post numbers at the training institutions."
They point out that actual training capacity is dependent on government-funded trainee (“senior registrar") posts and these are grossly inadequate, setting the limit on the production of new nephrologists at approximately eight per annum.
“We need more funded training posts and posts for qualified nephrologists in the public sector. Should these actions be taken, there is a realistic chance of successfully addressing provincial inequalities and achieving nephrologist densities comparable to other UMICs."
“In the short term, the retirement age for public sector nephrologists could be increased or retired nephrologists could be retained on a part-time basis to assist with service delivery, training and research."
The researchers urge government and training institutions to explore partnerships with the corporate sector to increase funds for training. They say the delivery of comprehensive kidney care requires a multi-disciplinary team and that studies are needed to investigate human resources issues relevant to the other categories of healthcare professionals who form part of this team.
- SOURCE: Kumashie DD, Tiwari R, Hassen M, Chikte UME, Davids MR (2021). Trends in the nephrologist workforce in South Africa (2002–2017) and forecasting for 2030. PLoS ONE 16(8): e0255903. https://doi.org/10.1371/journal.pone.0255903
