Distribution and demographics of critical care subspecialists for adult patients in South Africa

Background. Critical care has been a recognised subspecialty in the Health Professions Council of South Africa (HPCSA) since 1992, with a formal examination to obtain the Certificate of Critical Care established in 1999 with the Colleges of Medicine of SA. SA is a country fraught with inequality, which is reflected in the population’s unequal access to subspecialist-driven critical care. Intensive care units (ICUs) led by critical care subspecialists deliver more efficient and higher-quality care, with improved mortality rates and reduced lengths of ICU stay. Objective. To count registered critical care subspecialists in SA, make comparisons with similar upper-middle-income countries, describe the workforce density across the provinces and report its make-up with regard to ethnicity and gender. Methods. We combined a retrospective record-based review and an anonymous survey. De-identified data describing the number, location, ethnicity and gender of registered critical care subspecialists in 2023 were gathered from the HPCSA. An anonymous survey was sent to members of the Critical Care Society of Southern Africa. The density of critical care subspecialists per 100 000 adult population was calculated using publicly available data from the 2022 population census. Results. As of December 2023, the total number of adult critical care subspecialists registered with the HPCSA was 82. This is almost double the number present in 2010. However, the density per 100 000 population grew by only 28%, as the adult population has also increased over time. Conclusion. This study has contributed new findings on the subspecialist critical care workforce by doing an official count of critical care subspecialists as recognised by the HPCSA. SA has an inadequate supply of critical care subspecialists per 100 000 population compared with similar upper-middle-income countries. There is also a maldistribution of specialists between provinces, with the more urbanised and densely populated provinces having a disproportionally high number of critical care subspecialists, leading to unequal access to this field of care.