Pediatric Nephrology: Bear or Bull?

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.

During this time, more women also entered the specialty. In 2002, 34 pediatric nephrology fellows were women (53.3 percent); in 2009, 83 were women (67.5 percent). Yet pediatric nephrology may not be the bright spot it appears to represent at first glance.

“We worked very hard to increase our numbers over the last decade, and we were delighted by the fact that the increase was largely accounted for by USMGs,” says H. William Schnaper, MD, president of the American Society of Pediatric Nephrology (ASPN). “However, there are a number of concerning caveats.”

This growth begins from the nadir of interest in pediatric nephrology. Compared with other pediatric specialties, nephrology is experiencing greater attrition of fellows between the second and third year of the three-year fellowship training period. Furthermore, pediatric nephrology maintains, by two years, the oldest median age of any pediatric specialty. Consequently, the median age of pediatric nephrologists has not decreased during the past five years.

Most recently, early estimates of the 2011 match raise concern that the specialty observed a significant decline in the number and quality of candidates. Although official data on the most recent match will not be available until July 2011, ASPN Councilor Larry A. Greenbaum, MD, PhD, worries “that the surge in interest is beginning to wane.”

Greenbaum notes that the subspecialty faces unique challenges. Besides being affected by trends in interest in general pediatrics, pediatric nephrology has a limited number of fellowship sites, lower average starting salaries than those for general pediatricians, and the additional financial disincentive of a three-year fellowship requirement. Although the pediatric nephrology community hopes to prolong the upswing in interest and ASPN continues its recruitment efforts, the specialty’s future remains unclear.

References

1.

Brotherton SE, Rockney PH, Etzel SI. Graduate medical education, 2002–2003. JAMA 2003; 290:1197–1202.

2.

Brotherton SE, Etzel SI. Graduate medical education, 2009–2010. JAMA 2010; 304:1255–1270.