The pathology services, the foundation of medical care and research, are under threat in Gauteng as the government laboratory services experience a haemorrhage of expert staff.
Insiders say that over the past few months five of the country’s leading anatomical pathologists have resigned from the National Health Laboratory Services (NHLS) in the Gauteng region.
They blame management failures for the crisis, which include attempts to sideline pathologists in order to give less qualified staff greater managerial responsibility. Other disincentives are lack of staffing, relatively low salaries compared with other medical professionals such as surgeons, and increased workloads due to understaffing.
A senior staff member who asked to speak anonymously said the resignations were ‘absolutely catastrophic in terms of staffing†and added that a further three or four people have indicated they will be leaving this year.
Many doctors at Wits university have described the pathology services as a disaster, with one leading researcher saying that a service of this kind can be destroyed in months if key staff leave, while building it up again takes many years.
It takes over a decade to fully train a pathologist, and they are in high demand locally and overseas. The people leaving include the most senior staff who train the next generation of specialists.
In the past seven years the NHLS has been rebuilt with an increased budget for training and additional posts. This development now faces a serious setback.
Pathologists at the NHLS are employed on joint contracts with the medical schools. At the Wits medical school the resignations will have an impact on undergraduate training — pathology is considered the key to proper medical treatment and an essential skill for doctors. Postgraduate students training as specialists will also be affected, although their training could be adjusted by rotating them into private practice to learn from the pathologists working there.
NHLS CEO John Robertson said that the organisation’s growing capacity had enabled it to support three critical health campaigns: on TB, ARV roll-out and cervical cancer screening. The latter, in particular, is now suffering because of the resignations.
The shortage of pathologists in South Africa is especially acute in the state sector because they can earn huge salary increases by working for private laboratory services. As a result, resignations of newly qualified staff from the NHLS are quite common, as the organisation is a teaching centre and people leave after completing training.
Robertson said: ‘We train all the pathologists in the country, the private sector draws on us. We don’t like training for the international market, but these guys are very mobile.†Recognising this, researchers at Wits say management needs to pay attention to retaining those staff with the dedication to stay in the private sector.
Doctors working in Johannesburg fear that the result of these resignations, and more in the pipeline, could be a slowdown in processing samples and supplying results, and a decline in the quality of services.
Laboratory technologists can sign off reports from automated tests. However, many samples require an experienced person to look down a microscope to detect the very subtle changes that indicate disease.
Among the pathology examinations that require such experience and skill are assessments of cervical and breast biopsies for tumours — the two top causes of cancer deaths among women in South Africa — and assessment of biopsies for tuberculosis. The latter is particularly critical because of the many HIV-positive people who also have TB.
Cutting the death toll from cervical cancer is a high priority in South Africa, as it disproportionately affects black women who are unable to afford private sector screening and can easily be treated if detected early.
Slower turnaround of pathology specimens can lead to patients staying in hospitals for longer as doctors wait for accurate diagnosis to optimise treatment. A slowdown in sample processing may also affect the many clinical trials which rely on continuous monitoring of samples to ensure patient safety and test the effectiveness of treatment.
Researchers fear that they may be forced to send samples to private laboratories for processing, which is more expensive. This happened several years ago when a similar crisis occurred in government laboratory services.