Motivations of South African physicians specialising in public health

Zweigenthal, Virginia; Pick, William M.; London, Leslie

doi:10.1080/16549716.2018.1475039

Cited by 6 publications

(12 citation statements)

References 20 publications

(30 reference statements)

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“…Most specialized to contribute to social change and to impact on health services, thus maximizing population level health outcomes and service quality. This motivation is consistent with findings from a SA PHM registrar study (10) and a New Zealand (NZ) study of PHM specialists (30). PH approaches are underpinned by values and concerns for social justice (31–34).…”

Section: Discussionsupporting

confidence: 89%

“…Consistent with a number of other studies, including a study of South African PHM registrars (10), PH practice in the UK (48), the USA (49), and Switzerland (50), as well as field epidemiology masters' programs in LMICs (51, 52), specialists in this study valued competencies in epidemiology, surveillance, and communicable disease control. They highlighted placements in hospital management, health informatics, and disease programs, which developed their skills in project management, policy analysis, and planning as core PH competencies.…”

Section: Discussionsupporting

confidence: 73%

“…Overall, fewer specialists were women but this was the converse for recent graduates who were predominantly female. This may reflect the general feminization of the medical profession in South Africa over the past decade (24, 25) and of public health specifically, with more women entering specialist training (10) and women physicians increasingly completing MPHs (26). The feminization of medicine is an international phenomenon both for general medical training (27) and for public health training, for example in Italy (28).…”

Section: Discussionmentioning

confidence: 99%

“…In this context, we set out to enumerate and describe the work of PH specialists, their motivations for specialization, job satisfaction, and their perspectives on the future of the specialty and training programs. While specialists-in-training (called registrars in SA) were motivated by a desire to improve SA's health system and communities' health status (10), it is not known what specialists overall motivations for practice are.…”

Section: Introductionmentioning

confidence: 99%

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Career Paths of Public Health Medicine Specialists in South Africa

Zweigenthal

Pick

London

2019

Front. Public Health

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Public health (PH) skills are core to building responsive and appropriate health systems, and PH personnel including medical specialists are embedded in many countries' health systems. In South Africa, the medical specialty in PH, Public Health Medicine (PHM), has existed for over 40 years. Four years of accredited training plus success in a single national exit exam allows specialist registration with the Health Professions Council of South Africa (HPCSA). However, there are few posts designated specifically for PHM specialists in SA's health system. In view of uncertain roles, this research was designed to determine specialists' career paths, their work, job satisfaction, and perspectives on the future of the specialty. We combined three databases to generate the study population and invited all specialists to participate in an online or hard-copy survey. We found that in 2010, PHM was a small specialty of less 200 physicians. Of the 151 contactable, eligible physicians, 55.6% completed the questionnaire. Participants represented an aging group (median age = 49) of specialists and recent graduates were increasingly women. They largely worked in academic institutions (as managers, teachers, and researchers) and in the public sector health system; were motivated by a sense of social justice and their training was formative, exposing them to work settings which they later entered; were largely highly satisfied at work, but many worked in non-specialist positions. Indeed, one fifth had not registered with the HPCSA as specialists. They were concerned about the specialty's poor visibility and identity, but did not see other PH professionals as a threat. They believed that the specialty should refine its competencies, demonstrate its value and advocate for service positions at all levels of the public sector health service. PHM has a contribution to make—reorienting services to protect communities, preventing ill health, analyzing disease burdens locally, identifying innovations in a resource-constrained health service, largely preoccupied with curative care services.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Career Paths of Public Health Medicine Specialists in South Africa

Zweigenthal

Pick

London

2019

Front. Public Health

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“…Previous research demonstrated that physicians are largely drawn to specialising in PHM by their commitment to social justice and desire to transform the health system, so that public sector health services address the health needs of the public and communities. [3]…”

Section: Introductionmentioning

confidence: 99%

Stakeholders’ perspectives on Public Health Medicine in South Africa

2019

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South Africa (SA) is reforming its health system in preparation for an anticipated national health insurance (NHI) scheme that aims to improve the delivery of affordable, equitable, accessible health care. Public health (PH) language is explicit in the policy and skilled PH professionals would be expected to play a key role in its implementation. In South Africa, training of doctors as Public Health Medicine (PHM) specialists is funded by the state, yet there are few positions for PHM specialists in the health services. We explored stakeholders’ perspectives about this absence, and their views on PHM specialist’ roles and contribution in an era of health reform. A qualitative study was conducted in 2012–13, using in-depth interviews with thematic analysis, which elicited perspectives of 31 key stakeholders nationally reflecting diverse employer and institutional backgrounds. While some were surprised by the absence of PH professionals in SA’s health system, most agreed the reason was due to factors internal to the profession, such as its low profile and uncertain identity. External factors such as legislation and political preferences for health managers impacted on the employment of PH professionals. However, given the competencies required to implement an ambitious restructuring of the health sector, all believed that PH and PHM personnel were vital. In view of the health system’s dominant curative orientation, embedding PH personnel in the services should ensure that health protection, promotion and prevention strategies will inform health priorities. This study, the first known from a low and middle-income country, contributes to the international literature about the identity and roles of PHM physicians, who are versatile professionals with broad skills-sets. In SA, through consultation with health sector employers about potential roles, curricular redesign and trainee recruitment, PHM can graduate fit-for-purpose specialists to work in a range of institutions to address health system reform.

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