Surgery in South Africa – challenges and barriers

Abstract

Background: Sustaining a surgical career can be challenging and there are numerous barriers to pursuing a career in surgery. These barriers and challenges are well reported in international literature, but there is a lack of knowledge on how this affects surgeons in South Africa. This study aimed to determine the barriers and challenges that South African surgeons face in their training and careers.
Methods: A 15-item questionnaire was designed and distributed via the Research Electronic Database Capturing software from 1 February–3 April 2020. Data were analysed in Stata 15 SE. All responses were anonymised.
Results: One hundred and twenty-nine participants responded to the questionnaire, 33 (26%) of whom were female. The majority were specialist surgeons (n = 87; 71%). One hundred and eleven participants (90%) reported they did not regret pursuing surgery. Barriers to pursuing surgery included limited personal time (n = 98; 76%), heavy surgical workload (n = 92; 71%), and difficulty taking leave of absence (n = 64; 50%), limited postgraduate training (n = 34; 26%), and verbal discouragement (n = 22; 17%). Challenges included difficulty maintaining work-life balance (n = 74; 56%), racial discrimination (n = 29; 23%) and gender discrimination (n = 15; 12%). Fifty-three per cent of participants experienced burnout.
Conclusion: Despite high career satisfaction, South African surgeons face numerous barriers to pursuing and challenges in sustaining a career in surgery and often experience burnout. These barriers and challenges disproportionately affect female surgeons and can be mitigated through formalised mentorship programmes, flexible work schedules, funding for postgraduate training, and training in diversity and discrimination.