Latest GWU Workforce Report Finds Nephrology a Specialty in Transition

A new analysis of the US nephrology workforce confirms the specialty is in a transitional state, driven in part by changes in the health care delivery system. The latest George Washington University (GWU) Health Workforce Institute report examines other issues affecting the specialty, including the “All-In” nephrology Match and geographic distribution of practicing nephrologists.

The US Nephrology Workforce 2015: Developments and Trends (available online at http://www.asn-online.org/workforce) is the third in a series of studies published by ASN and produced in collaboration with GWU. In addition to analyzing new quantitative data on current and future nephrologists, the report examines qualitative assessments of the specialty drawn from focus groups of practicing physicians and leaders of major dialysis organizations.

Several interrelated workforce issues indicate nephrology continues to be in transition. Fragmentation in kidney care delivery and ceding common procedures to other specialties are among the contributing factors, according to Edward Salsberg, MPA, who led the GWU research team. The report notes that increased efficiencies and other health care delivery changes could reduce future demand for nephrologists.

“While indications are that need for nephrologists is rising, it is not clear how changes in delivery and financing will impact on the specialty,” Salsberg told Kidney News. However, the move to population-based health plays to several of nephrology’s strengths (including continuity of care and care coordination) and may offer new opportunities for the specialty.

Evaluating supply, distribution, and demand for new nephrologists is a key concern. Salsberg and colleagues observed geographic maldistribution between physician supply and the demand for specialized kidney care (using ESRD patients as a surrogate metric). Better alignment of nephrologists with demand for nephrology services is needed to ensure underserved areas maintain access.

Determining the number of new nephrologists needed to provide adequate care has been complicated by declining interest in the specialty among internal medicine residents. A continued drop in nephrology fellowship applicants in the National Resident Matching Program Specialties Matching Service led to creation of the ASN Match Task Force and adoption of an “All-In” policy, where all programs and positions must fill through the Match.

Preliminary data from the first “All-In” nephrology Match for Appointment Year (AY) 2016–2017 demonstrated an increase in certified fellowship slots and programs, affording a more complete view of the nephrology training landscape. A slight increase in the number of applicants preferring nephrology, US medical graduate applicants, and matched fellows over AY 2015 reversed recent trends yet may be due to this more accurate accounting. Likewise, increased Match participation may account for the substantial rise in unfilled positions (57%) and programs (37%) over AY 2015. Of note, the number of IMGs choosing nephrology continued to fall, extending a 6-year decline. GWU will closely assess the “All-In” Match in the next year.

Although GWU’s in-depth analysis of the 2015 Nephrology Fellow Survey will soon be released, the report’s initial assessment of survey data noted an increase in recent graduates having difficulty finding a job they were satisfied with. “While the job market for new nephrologists is limited, the number entering the specialty is decreasing, which may lead to more opportunities in the future,” said Salsberg. “It will be important to continue to monitor these developments impacting on the specialty.”

In addition to a complete analysis of the 2015 Survey of Nephrology Fellows, GWU will conduct a more detailed examination of nephrologist supply and demand using modeling tools developed at the UNC Sheps Center for Health Services Research. Salsberg underscored that distribution and access issues, as well as changes in the delivery and financing of kidney care, will remain a focus of their research in 2016.

Workforce research is part of ASN’s commitment to ensure the highest quality care for the more than 20 million Americans with kidney diseases and millions more around the world. To learn more about ASN’s broad, multifaceted approach to increase interest in the specialty and support nephrologists at all stages of their careers visit http://www.asn-online.org/about/bythenumbers/?ID=2