Training the Next Generation’s Nephrology Workforce

Abstract

The subspecialty of nephrology faces several critical challenges, including declining interest among medical students and internal medicine residents and worrisome declines in the number of applicants for nephrology fellowships. There is an urgent need to more clearly define the subspecialty and its scope of practice, reinvigorate meaningful research training and activities among trainees, and ensure that fellows who complete training and enter the practice of nephrology are experts in the broad scope of nephrology. This need requires a critical look at fellowship training programs and training requirements. A new workforce analysis is also needed that is not focused on primarily meeting estimated future clinical needs but rather, ensuring that there is alignment of supply and demand for nephrology trainees, which will ensure that those entering nephrology fellowships are highly qualified and capable of becoming outstanding nephrologists and that there are desirable employment opportunities for them when they complete their training.

Perspectives on the Nephrology Match for Fellowship Applicants

“…In recent years, there has been a marked decline in applicants to United States nephrology programs (1). Although a multipronged approach is clearly needed to increase interest in nephrology, it is important that we ensure that our applicants/future colleagues are treated in the most fair and equitable manner possible, and we believe that 100% participation in the National Residency Matching Program (NRMP) is vitally important to achieving that goal.…”

Comparing Two Models That Reduce the Number of Nephrology Fellowship Positions in the United States

“…One commonly proposed solution is to simply decrease the available number of fellow positions (Desai, 2014). Proponents argue that fellowship programs have grown too big and have overestimated the interest that resident physicians have in nephrology careers (Berns et al, 2014). From 2009 to 2013, the applicant-to-position ratio, a common metric used to characterize the demand for positions, has steadily fallen from 1.6 to 1.…”

“…01 (2010: 1.5; 2011: 1.3; 2012: 1.1) (National Resident Matching Program, 2013). Many influential voices, including leaders of the American Society of Nephrology (the largest professional society of Nephrologists) have voiced this recommendation through formal reports (Berns et al, 2014;Salsberg et al, 2014). However, there is no consensus on how the excess positions should be eliminated.…”

Comparing two models that reduce the number of nephrology fellowship positions in the United States

“…Proponents argue that fellowship programs have grown too big and have overestimated the interest that resident physicians have in Nephrology careers [Berns et al, 2014]. From 2009 to 2013, the applicant-to-position ratio, a common metric used to characterize the demand for positions, has steadily fallen from 1.6 to 1.01 (2010: In this investigation, we analyze two models that decrease the number of available training positions and compare them head-to-head to identify the least burdensome method by which this reduction should occur.…”