Recent Trends in the Fellowship Match Highlight Nephrology’s Vulnerable State

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).

/kidneynews/3_5/13/graphic/13t1.png

In 2011, continuing the downward trend that has plagued the nephrology fellowship match in recent years, the fewest number of residents applied for positions than in any year since the ASN first joined the MSMP (1). In six years, the total number of ERAS applicants to nephrology fellowships declined by 25 percent, from 712 applicants in 2006 to 539 this year (Figure 6.1).

Figure 6.1

Applicants to nephrology fellowship programs

/kidneynews/3_5/13/graphic/13f1.jpg

Source: Electronic Residency Application Service. Fellowship Data: Applicants by Specialty, January 2011.

Behind this overall decline is the reality that nephrology fellowship programs received fewer applications in 2011 from graduates of both U.S. medical schools (USMGs) and international medical schools (IMGs) than in 2010. Applications from USMGs are down 38 percent since 2006, and applications from IMGs have declined by 18 percent in the same time period.

These data confirm that even as USMGs continue to constitute a shrinking portion of the total number of applicants to nephrology, the specialty is having a harder time attracting IMGs, who have historically contributed substantially to the nephrology workforce. For nephrology, attracting IMGs is not an idle concern: 54.6 percent of the current nephrology fellows are IMGs (2).

The declining trend for IMG applicants also holds true for pediatric nephrology, which saw a precipitous decline in the number of applicants from 2010 to 2011. Conversely, pediatric nephrology saw its largest number of USMG applicants in 2011, continuing a recent uptick in the number of USMG applicants—a lone bright spot in match data that are otherwise concerning (Figure 6.2).

Figure 6.2

Applicants to pediatric nephrology fellowship programs

/kidneynews/3_5/13/graphic/13f2.jpg

Source: Electronic Residency Application Service. Fellowship Data: Applicants by Specialty, January 2011.

Although the lessening competitiveness of the match itself is troublesome, the greater concern is the implication for the future nephrology workforce. For nephrology fellowship training program directors (TPDs), the decline in applications raises alarm bells.

“Training programs are having trouble filling positions,” explains Mitchell H. Rosner MD, FASN, a member of the ASN TPD Executive Committee. “Annually, nephrology falls further and further behind other specialties and the full impact of this decline will not be felt for a number of years.”

Rosner and ASN Past President Sharon Anderson, MD, FASN, represent the ASN on the Alliance for Academic Internal Medicine Fellowship Match Task Force. The task force, which includes representatives from the 10 specialties that participate in MSMP, is trying to reach a consensus to move the fellowship match from Postgraduate Year 2 to Postgraduate Year 3. The change would allow internal medicine residents more time to experience internal medicine specialties—including nephrology—and make an informed decision about their futures.

To learn more about the ASN’s efforts to alleviate a potential workforce crisis, or to see complete data on nephrology match applicants, please visit the ASN Public Policy page online at http://asn-online.org/policy_and_public_affairs/.

Notes

[1] Daniel Kochis is an ASN policy associate.

References

1.

Electronic Residency Application Service. Fellowship data: Applicants by specialty. January 2011.

2.

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