While there has been an increase in the number of nephrologists in South Africa over the past 15 years, a substantial further increase is required to address provincial inequalities and achieve realistic nephrologist density targets by 2030, found a University of Stellenbosch study.
The study, in PLOS One, analysed the country's nephrologist workforce between 2002–2017 and current training capacity, then used this to forecast the nephrology workforce for 2030.
“At the current rate of production of just 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 per million population (174 nephrologists).
“This will 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 retirement and compromised quality of care for patients with kidney disease,” writes Professor Razeen Davids, the lead researcher and head of Stellenbosch University's division of nephrology.
The study found that the number of nephrologists increased from 53 to 141 (paediatric nephrologists increased from 9 to 22) over the period 2002–2017. The density in 2017 was 2.5 nephrologists per million population (pmp). The number of female nephrologists increased from 4 to 43 and the number of black nephrologists increased from 3 to 24.
There were no nephrologists practising in the North West and Mpumalanga provinces and only one each in Limpopo and the Northern Cape. The current rate of production of nephrologists is eight per year. At this rate, and considering estimates of nephrologists exiting the workforce, there will be 2.6 nephrologists pmp in 2030.
There are 17 government-funded nephrology trainee posts while the potential number based on the prescribed trainer-trainee ratio is 72. To increase the nephrologist density of all provinces to at least the level of KwaZulu-Natal (2.8 pmp), which has a density closest to the country average, a projected 72 additional nephrologists (six per year) would be needed by 2030. Benchmarking against the 25th centile (5.1 pmp) of upper-middle-income countries (UMICs) reported in the Global Kidney Health Atlas would require the training of an additional eight nephrologists per year.
“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 upper-middle income countries. 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 study found.
Study details
Trends in the nephrologist workforce in South Africa (2002–2017) and forecasting for 2030
Dominic Dzamesi Kumashie,Ritika Tiwari, Muhammed Hassen,Usuf M. E. Chikte, Mogamat Razeen Davids
Published in PLOS ONE on 12 August 2021
Abstract
Background
The growing global health burden of kidney disease is substantial and the nephrology workforce is critical to managing it. There are concerns that the nephrology workforce appears to be shrinking in many countries. This study analyses trends in South Africa for the period 2002–2017, describes current training capacity and uses this as a basis for forecasting the nephrology workforce for 2030.
Methods
Data on registered nephrologists for the period 2002 to 2017 was obtained from the Health Professions Council of South Africa and the Colleges of Medicine of South Africa. Training capacity was assessed using data on government-funded posts for nephrologists and nephrology trainees, as well as training post numbers (the latter reflecting potential training capacity). Based on the trends, the gap in the supply of nephrologists was forecast for 2030 based on three targets: reducing the inequalities in provincial nephrologist densities, reducing the gap between public and private sector nephrologist densities, and international benchmarking using the Global Kidney Health Atlas and British Renal Society recommendations.
Conclusions
South Africa has insufficient nephrologists, especially in the public sector and in certain provinces. A substantial increase in the production of new nephrologists is required. This requires an increase in funded training posts and posts for qualified nephrologists in the public sector. This study has estimated the numbers and distribution of nephrologists needed to address provincial inequalities and achieve realistic nephrologist density targets.
See more from MedicalBrief archives:
SA's first black woman nephrologist
DA demands commission of inquiry into state of public health
SAMA's warnings on NHI Bill met with hostility