Reconsidering the Future of Nephrology and Reimagining Nephrology Fellowship Training

Melissa West
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In March, the ASN Council responded to requests from the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Internal Medicine (ABIM) to provide feedback on what changes should be made to nephrology certification and recertification (by ABIM) and fellowship training program requirements (by ACGME). Rather than taking a narrow view on procedural or program requirements, the ASN Council established the ASN Task Force on the Future of Nephrology to reconsider all aspects of the future of nephrology and develop recommendations for how to best prepare nephrology fellows for the challenges and opportunities the future will bring. The task force is made up of a diverse cross-section of ASN members (see box). “Nephrology is a vital and rewarding specialty, but every profession evolves and changes over time. I was drawn to serve on the task force because I wanted to contribute to thinking about and planning for where our field is headed in the future,” shared Benjamin D. Humphreys, MD, PhD, FASN, a member of the ASN Task Force on the Future of Nephrology.

It is an exciting time for kidney care. Developments include the availability and use of big data, new payment models and value-based care, precision medicine, innovative therapies and devices, and a shifting perspective to protecting kidney health rather than managing kidney failure. These developments and others provide new career opportunities and considerations for the kidney care team. With the changing health care landscape, along with the ongoing evolution in kidney care, this year has provided an opportunity to reflect on the future of nephrology.

“I feel like we’re on the cusp of many exciting advances in nephrology—from work done to delay or prevent diabetic nephropathy [and] new home dialysis equipment/opportunities to give patients more freedom to the exciting work of xenotransplantation and/or an artificial kidney,” said Janis M. Orlowski, MD, ASN Task Force member. “This is an exciting time to be a nephrologist.”

Since April when the task force was established, many key stakeholders have had an opportunity to share their perspective on the future of nephrology, including training and certification. Through a series of listening sessions and written requests, the task force has digested and deliberated the perspectives of many diverse stakeholders, as well as reviewed data collected from fellows, ABIM diplomates, training program directors, and the ASN Data Resource Center's effort to better understand the workforce. Task force member Joshua S. Waitzman, MD, PhD, said, “The power of data has been striking. By understanding the current practice patterns of today's nephrologists, I think we can make more workable procedure requirements. By surveying our current fellows and younger attendings, we have a clear sense of what clinical needs they see and what additional training would be helpful to a next generation of nephrologists.”

The final draft report of the task force will be released in late October, and the recommendations will be discussed at a special ASN Kidney Week event entitled, “Reimagining Nephrology Fellowship Training: Recommendations from the 2022 ASN Task Force on the Future of Nephrology,” to be held on Thursday, November 3, from 10:30 a.m. to 12:00 p.m. in the Orlando Convention Center. Members of the task force will review the recommendations, including the rationale and potential next steps, followed by questions and discussion from attendees. “If the task force could accomplish one objective, I would prioritize enhancing and optimizing training opportunities for nephrology fellows, so they are educated and well-equipped to deliver high-quality, personalized treatment options for patients with advanced kidney disease, including home dialysis modalities, kidney transplantation, or conservative care,” suggested Samira S. Farouk, MD, MS, FASN, task force member.

“It has been an honor to serve ASN as the chair of this task force and to work with such highly engaged task force members and ASN staff. I have always felt a strong passion and commitment for nephrology fellowship education and feel this is the time to reimagine how to best prepare our fellows for future practice as well as to increase the attractiveness of our field. I hope ASN members find our final report to be invigorating and refreshing,” said Mark E. Rosenberg, MD, FASN. “Join us in Orlando for this special event—we want to hear from you.”