Division of Nephrology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
Centre for Health Professions Education, Stellenbosch University, Stellenbosch, South Africa.
PLoS One. 2020 Feb 13;15(2):e0228890. doi: 10.1371/journal.pone.0228890. eCollection 2020.
The global nephrology workforce is shrinking and, in many countries, is unable to meet healthcare needs. Accurate data pertaining to human resources in nephrology in South Africa is lacking. This data is critical for the planning and delivery of renal services and the training of nephrologists in South Africa to meet the challenge of the growing burden of chronic kidney disease.
A cross-sectional study of adult and paediatric nephrologists currently delivering nephrology services in South Africa was conducted. Participants were identified using various data sources, including the register of the Health Professions Council of South Africa. This cohort of doctors was described in terms of their demographics and distribution. A survey was then conducted among these nephrologists to collect additional information on their training, scope of practice, job satisfaction, challenges and future plans. Finally, two focus group interviews were conducted to probe themes identified from the survey data.
A total of 120 adult nephrologists and 22 paediatric nephrologists were identified (an overall density of 2.5 per million population). There is a male predominance (66%) and the median age is 45 years. The bulk of the workforce (128 nephrologists, 92%) is distributed in three of the nine South African provinces, and two provinces have no nephrologist at all. The survey was completed by 57% of the nephrologists. Most reported positive attitudes to their chosen profession; however, 35 nephrologists (43%) reported an excessive workload, 9 (11%) were planning emigration and 15 (19%) were planning early retirement. A higher frequency of dissatisfaction regarding remuneration (39% vs. 15%) and unsatisfactory work conditions (35% vs. 13%) was observed amongst nephrologists working in the public sector compared to the private sector. A total of 13 nephrologists participated in the focus group interviews. The themes which were identified included that of a rewarding profession, an overall shortage of nephrologists, poor career planning, a need for changes to nephrologists' training, excessive workloads with inadequate remuneration, and challenging work environments.
There are insufficient numbers of nephrologists in South Africa, with a markedly uneven distribution amongst the provinces and healthcare sectors. Qualitative data indicate that South African nephrologists are faced with the challenges of a high workload, obstructive policies and unsatisfactory remuneration. In the public sector, a chronic lack of nephrologist posts and other resources are additional challenges. A substantial proportion of the workforce is contemplating emigration.
全球肾脏病学劳动力正在减少，在许多国家，无法满足医疗保健需求。南非肾脏病学人力资源的准确数据尚不清楚。这些数据对于规划和提供肾脏服务以及培训南非的肾脏病学家以应对不断增长的慢性肾脏病负担至关重要。
对目前在南非提供肾脏病服务的成人和儿科肾脏病学家进行了横断面研究。参与者是通过各种数据源确定的，包括南非卫生专业人员委员会的登记册。该医生队列根据其人口统计学和分布情况进行了描述。然后对这些肾脏病学家进行了一项调查，以收集有关其培训、实践范围、工作满意度、挑战和未来计划的其他信息。最后，进行了两次焦点小组访谈，以探讨从调查数据中得出的主题。
共确定了 120 名成人肾脏病学家和 22 名儿科肾脏病学家（总人口密度为每百万人 2.5 人）。男性占主导地位（66%），中位年龄为 45 岁。大部分劳动力（128 名肾脏病学家，92%）分布在南非的 9 个省份中的 3 个省份，而有 2 个省份根本没有肾脏病学家。调查完成率为 57%。大多数人对自己选择的职业持积极态度；然而，35 名肾脏病学家（43%）报告工作量过大，9 名（11%）计划移民，15 名（19%）计划提前退休。与私营部门相比，在公共部门工作的肾脏病学家对薪酬（39%比 15%）和工作条件（35%比 13%）不满意的频率更高。共有 13 名肾脏病学家参加了焦点小组访谈。确定的主题包括这是一项有益的职业、肾脏病学家总体短缺、职业规划不佳、需要改变肾脏病学家的培训、工作量大但薪酬不足以及工作环境具有挑战性。
南非的肾脏病学家人数不足，在省份和医疗保健部门之间分布明显不均。定性数据表明，南非的肾脏病学家面临着工作量大、政策障碍和薪酬不理想的挑战。在公共部门，长期缺乏肾脏病学家职位和其他资源是额外的挑战。相当一部分劳动力正在考虑移民。
