Report Details Nephrology Fellow Demographics, Job Market Concerns

ASN’s latest nephrology workforce report provides a detailed portrait of future nephrologists and their perceptions of, and experiences in, the current job market. Findings from the 2014 Survey of Nephrology Fellows is the second in a series of workforce studies authored by George Washington University (GWU) investigators. The analysis of the 2014 ASN Nephrology Fellow Survey provides clues about demand for the specialty and a baseline for future research.

The report confirms recent trends in nephrology training. International medical graduates (IMGs) comprised the majority of respondents (64 percent), reflecting the continued decline in the number of US medical graduates (USMGs) choosing the specialty. Despite an increase in women entering nephrology, most of the 1st and 2nd year fellows who answered the survey were men (61 percent). Fellows’ racial and ethnic composition remains unrepresentative of the communities they will serve—only 9 percent of fellow respondents were African American and 8 percent Hispanic.

Distributed to ASN fellow members in June 2014, the survey is an important component of ASN’s ongoing collaboration with GWU to study all aspects of the specialty. Workforce research is one of ASN’s many initiatives to increase interest in nephrology careers. Although this initial survey elicited a low response rate (35.8 percent), the participants’ demographic characteristics were similar to those of all nephrology fellows, according to information from the Accreditation Council for Graduate Medical Education database.

“This kind of survey can provide a good picture of the future supply,” said lead author Edward Salsberg, MPA. “The experience of new entrants into the job market can also provide a valuable snapshot of the regional and national demand.”

Job search experiences and market perceptions differed between IMGs and USMGs. IMGs were more likely to practice in a Health Professional Shortage Area and to report difficulties in finding a satisfactory position. USMGs were more likely to note a lack of jobs in desired locations and to perceive more job opportunities nationally than locally.

A substantial proportion of nephrology fellows looking for employment reported changing their plans because of limited practice opportunities (43 percent). Although nephrology fellows’ perceptions of local job opportunities (within 50 miles of their training site) were disappointing (71 percent said there were no, very few, or few nephrology practice opportunities), a vast majority indicated they would still recommend the specialty to medical students and residents (72 percent).

The report’s release extended a continuing dialogue among the kidney community that started with the disappointing nephrology Match for academic year 2015–2016, which has expanded to social media. An ongoing discussion of the report, the Match, and nephrology careers on Twitter—at the #NephWorkforce hashtag—has explored many themes. These include the hurdles IMGs encounter in locating employment and research funding, student debt, and the importance of mentorship. ASN encourages all stakeholders to join this discussion using the #NephWorkforce hashtag.

Salsberg, together with Principal Investigator Leah Masselink, PhD, will focus future reports on the effects of changes in care delivery on the specialty, as well as geographic distribution of practicing nephrologists and training programs.

As of press time, ASN announced the Nephrology Match Task Force will be chaired by ASN President-Elect Raymond C. Harris, MD, FASN. Composed of Nephrology Training Program Directors, Division Chiefs, and ASN Councilors, the task force will address issues surrounding the Match, including an assessment of its future viability and identifying ways to ensure its integrity.

The nephrology fellow survey report is available at