The keynote presenters included Prof Johan Fagan who gave the overview of the CMSA, Prof Johan also presented the Journal of CMSA that was launched in July 2023 as a diamond open access journal, and progress so far and challenges encountered. Main challenges being the high publication fees and the article processing charges. The purpose of the journal is to showcase research in South Africa/Africa and low-income countries, challenge the need to publish in high impact to increase the academic worth and also the great need to have additional journal capacity. The author assist programme as well has been an achievement to assist poorly written articles and mentor them. Prof Karen Fieggen explored advances in genetics and gene therapy influences specialist medicine. She looked into the sequencing of human genome and its influence in health and curative medicine, insights into biology including raising questions of ethical and social relationship between biology and people.  

Dr Madaree discussed CMSA in the health ecosystem and its position in the future progresses in the health system, further indicating that there are challenges in specialist medicine in KZN, with referral system that is impacted by the low number of specialists, The role of HPCSA, CHE, Universities were also discussed. The role of CMSA in advocacy, education, ethics, training of fellowships.  Prof Richard Hipt discussed future specialist medicine in KZN. The province has fewer specialist, maldistribution of specialist in Urban and rural areas, decrease generation of specialist and poor retention for them in the public sector. Challenges in human resource in the province was presented, including academic and training capacity issues in the province. He concluded by saying that the future of specialist in the province depends on balancing rural and urban distribution, increase in digital platforms and telemedicine, remote mentoring that includes professional development and clinical support for doctors.

The need to grow and retain workforce including modernisation of infrastructure. He further stated that the number of registrars has declined and there is a need to adapt training to new realities by exploring new models of shared education, engage DOH, get external funding. He compared the CMSA fellowship and MMED at universities where CSMA focuses on professional competencies and standards while universities focus on academic standards. The panel discussion had points on budget constraints to address training of specialists, crisis and shortage in oncology including training and retention of specialists. KZN is shortchanges when it comes to the distribution of specialist compared to provinces such as GP and WC.  

In conclusion, the seminar highlighted a number of critical points, the main ones being the few registrars in the province due to lack of funding and finance, the lack of equity and disparities in distribution of specialist in provinces, The need to have compulsory community service in public sector after DOH has funded posts, Public and private partnership to be intensified to assist in funding of trainings as well, the retention of specialist noted as a challenge as well and the need to renew the health system in the country to improve health outcomes. Commitment to the future of specialist medicine means it should be accessible, innovative and just.