Nursed Back to Health? The Nephrology Workforce Crisis and Other Providers

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.

Despite the essential role of nurses in caring for patients, the future of nursing is less than certain. In 2008, the average age for nurses reached 46, reflective of an aging trend among nurses that has accelerated over the past decade (1). Nursing retirements—especially by nurse managers—coupled with the ever-increasing demand for their expertise could compound the nephrology shortage in the near future. According to the Health Resources and Services Administration, only 64 percent of the demand for nurses will be met by 2020 (2).

On a more positive note, the number of PAs has more than doubled during the past 15 years (3). In 1997, fewer than 40,000 PAs were eligible to practice in the United States. An estimated 87,000 are in practice today, including those with a Certificate of Added Qualifications in nephrology. The National Commission on Certification of Physicians Assistants predicts that 6277 PAs will enter practice in 2015, up from 2793 in 1997 (4).

Although the looming shortage of nephrologists remains ominous, the renal community should not lose sight of the parallel workforce shortage of other providers who care for patients with kidney disease. Only through the combined efforts of nephrologists, nurses, and PAs—as well as those who educate these caregivers—will the renal community provide essential care to patients with kidney disease in the future.



American Association of Colleges of Nursing, September 2010.


The impact of the national nursing shortage on quality nephrology nursing care. Nephrol Nurs J May–June 2009.


American Academy of Family Physicians Masterfile. Updates: Number of People in Clinical Practice as PAs. Alexandria, VA, 2008.


National Commission on Certification of Physicians Assistants. Johns Creek, GA.