Latest ASN Initiatives to Support Nephrology: Match, All-In Policy

Applications to Nephrology fellowships have declined significantly since 2010, yet the number of training opportunities has increased. Nephrology fellowship programs increased from 127 in 2000 to 147 in 2013, and the number of fellows in the first or second year of training jumped from 626 to 930 in that time period. However, the number of applicants participating declined from 576 in 2010 to an all-time low of 254 in the Match for the 2015 appointment year.

The Nephrology Match was designed to provide applicants and program directors opportunities to thoughtfully consider all options. Position offers to applicants outside the Match sometimes exert pressure on applicants to make early decisions, and degrade confidence in the integrity of the Match process.

As the sponsoring organization for the Match, the American Society of Nephrology (ASN) convened a Nephrology Match Task Force in January 2015 to review principles and practices of the Match and recommend improvements. The Task Force included members from diverse geographic areas, programs, and educational roles (Table 1). The task force also surveyed training program directors and nephrology fellows.

Table 1

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The recommendations outlined below received the unanimous support of task force members, and were unanimously approved by the ASN Council.

Recommendation 1: ASN should continue its relationship with the National Resident Matching Program’s (NRMP’s) Specialties Match Service (SMS).

Task force discussions centered on the interests of applicants and the need to identify excellent candidates and ensure the best fit between programs and candidates. Members concluded that continued participation in the Match offers the best way to protect the rights of both the applicants and programs.

Recommendation 2: All Accreditation Council for Graduate Medical Education (ACGME)-accredited nephrology training programs should participate in the NRMP Match and offer all positions through the Match.

As the number of Nephrology fellowship applicants has declined, the number of Nephrology positions filled outside the Match has increased. This has created frustration among training program directors and undermined applicants’ and program directors’ trust in the Match. This also risks exacerbating declines in Match participation.

Task Force members recommended Nephrology adopt an “all-in” policy, in which all accredited training programs participate and all positions must be filled in the NRMP Match, concluding that this policy would best serve the fellowship applicants, training programs, and the discipline. The Task Force recommendation and resolution (www.asn-online.org/match) were unanimously approved by the ASN Council. NRMP will support ASN’s policy, help monitor compliance, and apply sanctions in accordance with the NRMP Match Participation Agreement.

Recommendation 3: Nephrology programs should retain the ability to offer multiple tracks but offer only three options: “Clinical,” “Research,” and “Other.”

Internal medicine specialties vary in use of program tracks in the Match. Discussions centered on which approaches are most supportive and least confusing for applicants and programs, and noted that programs can “revert” unfilled positions to be filled from their rank list for clinical tracks. The group unanimously recommended that diversity in program tracks should remain, but options reduced from four to three: “Clinical,” “Research,” and “Other,” eliminating the “Basic” and “Clinical” research designations. The ASN Council also unanimously approved this recommendation.

Assessing Program Size

One of the most complex issues discussed centered on how individual programs and institutions determine the number of training slots. In future publications, ASN will address this challenge and provide self-assessment tools to help program leaders evaluate program size. During its retreat in May, the Nephrology Training Program Directors provided input regarding this challenge.

The Road Ahead

While outside the scope of this task force, broadening the appeal of nephrology is a priority for ASN: since 2010, the society has dedicated considerable resources to increasing interest in nephrology careers. The changes to the Match will help ensure that nephrology training programs continue to provide excellent candidates with high-quality educational experiences. The next generation of nephrologists must fuel advances to the complex and challenging care of patients with kidney disease.

To provide feedback or send questions about the Match, please write nephrologymatch@asn-online.org. More information on the Match is available at www.asn-online.org/match