Why Don’t Trainees Want to Become Nephrologists?

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Lack of interest in the subject is the most common reason why medical students and residents say they wouldn’t want to pursue a career in nephrology, reports a survey study in the open-access journal BMC Nephrology.

The researchers distributed an anonymous survey regarding specialty choice to 4199 US upper-level medical students and internal medicine residents. The survey targeted respondents at institutions with an associated nephrology fellowship program. Perceptions of nephrology and factors affecting specialty choice were evaluated.

Response rate was 15.3%, including 315 medical students and 308 residents from 30 institutions. Ninety-two percent of trainees cited personal interest in a subject as the most important factor affecting their choice of a specialty. Other factors included work-life balance, access to mentors, and exposure to the subject.

Lack of interest was the most common reason for not choosing nephrology as a specialty, cited by 79% of respondents overall. Other factors included concerns about remuneration, 43%; work-life balance, 39%; and lack of exposure to nephrology, 32%. For residents, financial compensation was the most common reason.

Responses to open-ended questions raised other issues such as frustrations in dealing with hemodialysis patients, including perceived nonadherence. Several trainees expressed interest in a combined nephrology-critical care program. Respondents who said they would consider nephrology cited an interest in renal physiology and interactions with a respected mentor.

Despite the rising prevalence of advanced kidney disease, 40% of nephrology positions went unfilled in the 2018 fellowship match. This survey explores some of the reasons why trainees may not choose nephrology as a specialty. The authors discuss approaches to help “sustain a passionate and dynamic nephrology workforce” [Nair D, et al. Perceptions of nephrology among medical students and internal medicine residents: a national survey among institutions with nephrology exposure. BMC Nephrol 2019; 20:146].