The Nephrology Workforce Crisis

The Nephrology Workforce Crisis

To facilitate the matching of internal medicine residents with nephrology fellowship training programs, nephrology first participated in the Electronic Residency Application Services (ERAS) in 2006 and the Medical Specialties Matching Program (MSMP) in 2007. MSMP—part of the larger National Residency Matching Program—is a service that pairs residents with available fellowship positions. Currently, 10 internal medicine specialties participate in MSMP (Table 6.1).

Responding to concerns about the future of the nephrology workforce, the ASN is currently establishing a Workforce Committee. “A key goal of the ASN Strategic Plan is to advance patient care and research in kidney disease by strengthening the pipeline of clinicians, researchers, and educators,” explains ASN President Joseph V. Bonventre, MD, PhD, FASN.

The ASN Workforce Committee will help the society meet this goal by

From boom to bust, the projections for the physician workforce in the United States reverse every 20 years. In the 1960s, experts projected a shortage of 40,000 physicians by 1975. During the 1980s and 1990s, some of the same experts predicted a surplus of up to 165,000 physicians by 2000. A few years ago, the country was expected to face a shortage of 55,000 physicians by 2020 (1).

In contrast to adult nephrology, pediatric nephrology significantly increased its number of USMG fellows in recent years (1, 2). From 2002 to 2009, the number of pediatric nephrology fellows grew from 65 to 123, and the number of USMGs in pediatric nephrology fellowships jumped from 31 to 71, bringing USMGs up to 57.7 percent of the total from 47.4 percent.

As mounting evidence makes the waning interest in nephrology obvious to all of us, we must ask, “Why have we been asleep behind the wheel?” The accompanying articles in this special issue of ASN Kidney News detail many of the problems that have finally gotten our attention.

Interest in nephrology as a career among United States medical graduates (USMGs) is declining—and has been on the decline for the better part of a decade. From 2002 to 2009, all internal medicine subspecialties increased the number of available positions, with the exception of geriatric medicine (which shrank overall) (1, 2).

The workforce crisis hitting the field of nephrology extends beyond physicians to nurses, nurse practitioners, and physician assistants (PAs), who are often on the front lines in the battle against kidney disease. Nurses and nurse practitioners provide essential services to patients with kidney disease, working in hospitals, dialysis centers, and homes. They help bridge the growing gap between the number of patients with kidney disease and the availability of nephrologists.

As is the case with many chronic diseases in the United States, chronic kidney disease (CKD) is on the rise. The recent recognition of CKD as a public health problem may be driving patients to nephrologists at earlier stages. At least 26 million Americans have some stage of CKD (Figure 3.1), and minority populations are disproportionately affected.