ASN Forms Nephrology Match Task Force

Insights from recent research into the nephrology workforce will inform discussions about nephrology’s future in 2015. Researchers from George Washington University (GWU) will continue their collaboration with the American Society of Nephrology (ASN) and expand upon their initial nephrology workforce research. Discussion of workforce trends and developments in the specialty is timely and has become more urgent after results of the Match for appointment year (AY) 2015–2016 were released on December 3, 2014.

Nephrology workforce trends

In February 2014, ASN Council approved 50 initiatives to increase interest in nephrology careers among medical students and residents. Included was an analysis of the current nephrology workforce and job market for recent graduates.

ASN contracted with a research team led by Edward Salsberg, MPA, and principal investigator Leah Masselink, PhD. A pioneer in the field of health workforce research, Salsberg worked at the Association of American Medical Colleges and Health Resources and Services Administration. He also helped establish the University at Albany’s Center for Health Workforce Studies before joining GWU.

“The goal of our research is not to find ‘the answer’ but to provide the nephrology community with better data and information so that they can make better, more informed decisions,” Salsberg told ASN Kidney News.

He noted that one of greatest challenges for nephrology—as well as workforce planners—is an evolving delivery system. “This reflects the organized efforts to change the delivery system, such as through reimbursement changes to control costs and increase value, as well as the development of new interventions and staffing mixes,” Salsberg said. “This makes it very difficult to project future needs.”

The initial report, The US Nephrology Workforce: Developments and Trends, was published in advance of ASN Kidney Week 2014. The analysis of the current state of nephrology prompted discussion and debate at the meeting. Many of the conversations centered on the question of whether the United States is overproducing nephrologists and if so, how it should be addressed. Salsberg believes that by closely examining recent trends and developments and assessing the impact of alternative scenarios the research can help stakeholders make more informed decisions.

Challenges for the future generation

GWU’s next report on nephrology fellows, including data from its 2014 fellow survey, was scheduled to be published in December 2014 as of press time. Its release comes after the disappointing AY2015–2016 National Residency Match Program (NRMP) Specialties Matching Service (SMS) nephrology Match. Half of nephrology training programs and nearly a third of nephrology fellowship positions went unfilled. This represented a 6 percent and 24 percent increase in just one year.

“The results of the NRMP specialty match for the 2015 appointment year were discouraging,” Salsberg said. “It may be that the number of new nephrology fellows has increased more rapidly than the demand for new nephrologists.”

“It would appear that the changing delivery system and the bump up in the number of nephrology fellows being trained each year has contributed to a soft job market nationally,” Salsberg noted. “However, it is important to do additional research to assess the possibility of regional or local shortages at the same time we have more than enough in other areas. Similarly, we need to look at the subspecialty areas in nephrology to better understand if supply/demand is different for different subspecialty areas.”

At the same time as the nephrology Match results were released, a new modeling analysis by the Centers for Disease Control and Prevention determined that Americans have a high lifetime risk for CKD and that its prevalence will continue to increase (2).

The dismal Match results and other challenges nephrology faces are in no way unique to the specialty. “Many other specialties have faced similar issues,” Salsberg told ASN Kidney News. “One of the better known examples is the case of anesthesiology in the early 1990s. When reports came out that new anesthesiologists couldn’t find jobs, the number of U.S. medical school graduates (USMGs) applying to enter the specialty dropped by more than half over about three years. Some programs closed, others cut back. After several years of lower production, demand rose and anesthesiology again began to attract a very high percentage of USMGs.”

ASN Nephrology Match Task Force

The AY2015–2016 Match results prompted the ASN Council to form the Nephrology Match Task Force. The Task Force will be comprised of Councilors, nephrology fellowship training program directors, division chiefs, ASN Workforce Committee members, and other key leaders and stakeholders.

The Task Force will need to quickly assess the future viability of the Match, identify ways to ensure the Match’s integrity, and attempt to clarify the ideal number of offered fellowship positions (based on recent estimates of the demand for nephrologists throughout the United States).

“While there is no authority to decide who should reduce fellowship positions if that was decided to be a wise course, the specialty should try to identify the values and goals of training that are important to assuring the nation access to high quality kidney care,” Salsberg said.

By the spring of 2015, ASN and the academic nephrology community will need to decide whether the specialty will continue in NRMP SMS Match. As of press time, the Task Force members and its charge weren’t available, but are expected to be announced shortly.

For 2015 the GWU researchers will expand their focus to examine the care delivery system, geographical distribution of nephrologists, and training programs, among other topics. Current and future GWU reports, as well as ASN’s brief analysis of the AY2015–2016 NRMP SMS nephrology Match are available at http://www.asn-online.org/education/training/workforce/.

References

1. 

Salsberg E, et al. The US Nephrology Workforce: Developments and Trends. Washington, DC: American Society of Nephrology; 2014.

2. 

Hoerger TJ, et al. The future burden of CKD in the United States: A simulation model for the CDC CKD Initiative. Am J Kidney Dis 2014, in press. doi: http://dx.doi.org/10.1053/j.ajkd.2014.09.023.