COVID-19 Placed Kidney Disease in the Limelight. Will That Attract More Physicians to the Specialty?

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Nephrologists have been challenged in recent years to attract young physicians to the specialty. Many attribute this difficulty to the field’s complexity, the younger generation’s focus on work–life balance, the vulnerability of the patients nephrologists serve, and limited exposure to the field during medical school and residency. Now that kidney disease has been thrust into the limelight by COVID-19, some observers are asking whether the specialty might be more attractive to young physicians in the future.

Such a change would be welcome. In 2019, only 62% of nephrology resident positions were filled during the annual match. That’s a slight increase from the lowest point in 2016 but a major drop from 94% a decade earlier.

“The fact that all slots are unfilled during the match clearly highlights the need for better recruitment,” said Stephen Sozio, MD, MHS, MEHP, associate professor at Johns Hopkins School of Medicine and associate director of the school’s nephrology fellowship program. “How can we care for patients that are critically ill from COVID-19 and other conditions without a stronger pipeline of nephrologists?”

This shortage is part of a larger trend in medicine generally. According to Michael Dill, director of workforce studies at the Association of American Medical Colleges, the growing physician shortage is largely a matter of demographics. As a significant portion of the population enters older adulthood, their need for medical care increases at the same time many physicians are aging out of the workforce.

“We cannot yet know what impact COVID-19 is going to have on physician retirement patterns,” Dill said. “Although the numbers are very small, some physicians are coming out of retirement to help out during the pandemic. At the same time, the burnout of caring for COVID-19 patients could result in more early retirements.” If it does, this could be problematic, with COVID-19 adding to the disease burden generally and, in some cases, increasing the need for physicians who can treat acute kidney injury.

The somewhat better news?

“The number of folks going into internal medicine and then subspecializing continues to run high,” Dill said, “but we’re still expecting future shortages because demand is growing even faster.”

“One of the things we’ve seen over the past several years is the emergence of subspecialization in nephrology,” Sozio said. “Critical care nephrology is one field that’s been blossoming, and we may see even more interest now with COVID-19.”

According to Sozio, nephrologists have proved invaluable in some hospitals hard hit during the pandemic. He has heard from colleagues who have been asked to spend more time in general internal medicine wards or intensive care units. “We see patients across the hospital, and we know how to care for patients with complex diseases,” he said. “That really does allow us to be flexible when it comes to internal medicine and critical care needs.”

A call to arms: “Yes, I belong in this field”

How does Sozio think COVID-19 may affect the future nephrology workforce?

“COVID-19 highlights some of the vulnerabilities that our population has in regard to infectious disease,” he said. “Our trainees have seen the COVID era as a call to arms to say, ‘Yes, I belong in this field to provide care to everyone that’s vulnerable.’ At the same time, we are seeing the exhaustion that comes with COVID-19 care, so I am unsure which way our trainees will go.”

To encourage more physicians to enter the specialty, ASN has instituted two programs to expose students and residents to nephrology early on: Kidney STARS, which funds participation by students and residents in the ASN annual meeting, and Kidney TREKS, which provides students with a mentored nephrology experience. Sozio said he believes these programs are effective in getting beyond students’ preconceptions of kidney care. “They see how one can be effective as a patient advocate and communicator,” he said, “and they see the value of research and using data. That’s the bright side of nephrology. Making a difference for your patient, and also making a difference for many patients with kidney disease.”

August  2020 (Vol. 12, Number 8)