Generalists who stretch the HPCSA definition of being a specialist

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The law is clear on when you can call yourself a specialist. It’s not about being highly experienced or working only in a specialises field, writes Yash Naidoo, dispute resolution associate at ENSafrica.

Dr Naidoo writes: The Health Professions Council of South Africa (HPCSA) recently touched on the difference between a generalist and a specialist, and that there are healthcare practitioners who hold themselves out to be specialists, when they in fact are not. A doctor or dentist who has experience in a certain field or type of procedure may be contravening the law if they call themselves a specialist without any further qualifications.

Coincidentally, I was recently handed a business card headed “ANAESTHESIOLOGIST”. Underneath the heading, were the contact details and qualifications of the practitioner. The doctor, who is still awaiting his final specialist examination results, was reprimanded by me for adopting the title without first passing the final examination. He, however, is convinced of his entitlement to call himself an anaesthesiologist. Doping was all that he did, he explained.

Section 35 of the Health Professions Act, 1974 provides that a person who wishes to be registered as a specialist will be entitled to do so upon payment of a prescribed fee, provided that only certain prescribed specialist qualifications are registrable. Section 35(3) of the Act states that: “no registered person shall take, use or publish in any way whatsoever any name, title, description or symbol indicating or calculated to lead persons to infer that he or she holds any professional qualification which is not shown in the register as registered against his or her name, nor shall any registered person practise as a specialist or hold himself or herself out to be a specialist unless his or her speciality has been registered as prescribed”.

In addition, section 40 of the Act makes it an offence to contravene this provision, and on conviction, a person may be fined or imprisoned for up to five years, or both.

The Ethical Rules of Conduct for Practitioners Registered Under the Health Professions Act, 1974 define a medical specialist as a medical practitioner who has been registered as a specialist in the speciality or sub-speciality in medicine in terms of the Regulations Relating to the Specialities and Sub-specialities in Medicine and Dentistry. Dental specialist is given essentially the same definition, except that it refers to a dentist and not a medical practitioner, who is registered. Annexure 6 to the Ethical Rules is titled the “Rules of Conduct Pertaining Specifically to the Medical and Dental Professions”. Rule 4 of the Medical and Dental Rules stipulates that medical and dental specialists must adhere to the Specialities Regulations.

To determine whether the business card I received is inappropriate or not, we must therefore consider the Specialities Regulations.

The Specialities Regulations conveniently list all the specialities that are recognised and prescribed in terms of section 35 of the Act. At the top of that list is the speciality of “anaesthesiology”, which has been prescribed the designation “anaesthesiologist”.

Except for the speciality of pathology, a medical practitioner or dentist may only be registered as a specialist in one speciality and sub-speciality, and no medical practitioner or dentist may practise in more than one speciality or sub-speciality simultaneously, except for specialities that are deemed to be related specialities. A medical practitioner who holds registration in the category “independent practice” (the majority of South African-qualified practitioners who have completed their community service year) and who wishes to be registered as a specialist must: submit proof to the medical and dental board of the HPCSA that he or she has obtained an accredited relevant specialist qualification acceptable to the board; submit proof to the medical and dental board that he or she has fully complied with the period of community service prescribed (currently one year) and the period of education and training prescribed; submit his or her application for registration as a specialist to the medical and dental board on an application form supplied by the board; and pay the prescribed registration fee.

Apart from the requirements listed above, in the case of (among others) the speciality of anaesthesiology, a person must, in terms of the Specialities Regulations, have obtained at least four years’ satisfactory education and training as the holder of a board-approved post as registrar at a hospital, department or facility accredited by the board for specialist education and training.

The owner of the business card in question is a soon-to-be-qualified registrar (specialist in training) in anaesthesiology. I asked him whether he had submitted his application for registration as a specialist to the medical and dental board and paid the prescribed registration. He hasn’t, as he is awaiting his final examination results. He therefore isn’t registered in the category of specialist with the HPCSA. A quick search of his name on the HPCSA’s website reveals that he is registered in the independent practice (registrar) category.

It is misleading for the person to whom the business card belongs, to refer to himself as an anaesthesiologist. If he is convicted in terms of section 40 of the Act, he may be liable to a fine or imprisonment not exceeding five years. His conduct may also subject him to the disciplinary powers of the HPCSA set out in chapter IV of the Act.

It does not matter that he is highly experienced in the field. Any discerning member of the public can verify his credentials on the HPCSA’s website. I have advised him to hold onto his business cards until he receives his final results, and successfully applies for registration as a specialist with the HPCSA.

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