Update on the Task Force on the Future of Nephrology. Reimagining Nephrology Fellowship Training

Mark Rosenberg Mark Rosenberg, MD, FASN, is a nephrologist, Professor of Medicine, and Vice Dean for Education at the University of Minnesota Medical School, Minneapolis.

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The ASN Task Force on the Future of Nephrology was charged in April 2022 to reconsider all aspects of the future of nephrology and determine how to best prepare nephrology fellows for the challenges and opportunities the future will bring. Consisting of a diverse cross-section of ASN members, the task force will provide recommendations to the ASN Council by September 2022. The timeline will meet the commitment made by ASN to the American Board of Internal Medicine (ABIM) and the Accreditation Council for Graduate Medical Education (ACGME), as these organizations determine what changes should be made to nephrology certification and recertification (ABIM) and fellowship training program (ACGME) requirements. To learn more about the task force, its charge, and membership, please refer to the April and June 2022 Kidney News articles (13).

Through weekly meetings, the task force has received input from multiple stakeholders, including representatives from ABIM and ACGME, the ASN Workforce and Training Committee (WTC) leadership, and people with kidney diseases. As this work progresses, plans are in place to engage other stakeholders, such as nephrology fellows, training programs, private practice nephrology groups, and nephrology professional organizations. The task force is taking a data-driven approach to the current state of nephrology training and practice that includes data from the ABIM Nephrology Procedures Survey Study of diplomates; questions assessing fellows' perspectives on nephrology procedures included in ASN's 2022 Nephrology Fellow Survey; and the ASN Data Resource Center's reports regarding the current and future workforce, nephrology practice patterns, and fellow assessments of educational needs.

The challenge of reimagining nephrology fellowship training to meet future practice requirements is determining what that future will look like. Recommendations need to account for the changing landscape of undergraduate and graduate medical education, including a greater emphasis on competency-based medical education, and changes that are happening in health care and nephrology practice. The task force will identify core strategies to ensure current and future nephrology fellows are prepared to best meet the needs of people with kidney diseases.

Key issues that the task force is considering include:

  • Procedural requirements for nephrology certification. These requirements currently include temporary vascular access placement for hemodialysis and kidney biopsy. Of importance, the ABIM 2021 procedural frequency survey sent to over 10,000 nephrologists (19.7% response rate) indicated 70.9% of respondents no longer performed temporary vascular access, and 14.7% performed between one and five procedures per year. For kidney biopsy, 83.1% of respondents no longer performed kidney biopsies, and 6.9% performed between one and five biopsies per year.

  • Subspecialization in nephrology. Although there will always be a need for “generalist” nephrologists, especially in rural areas, the trend is for increasing subspecialization whether in transplant nephrology, interventional nephrology, glomerular disease, or other emerging subspecialties, such as onconephrology, women's health, and cardiorenal. Nephrology has previously taken a “big tent” approach to training and practice, but is it time to consider embracing subspecialization and adjusting our training models to more effectively support subspecialization? Related to this issue is how to best recognize subspecialization.

  • Flexibility in the current fellowship training model—the “other 12 months.” Based on the current ACGME nephrology program requirements, fellowship length must be 24 months with a minimum of 12 months devoted to clinical experiences. This structure provides an opportunity for individualized pathways based on fellow interests, future practice goals, and the expertise available in the training program. Such pathways should have standardized outcomes. In a 2015–2016 needs assessment, nephrology fellows indicated interest in additional instruction in home hemodialysis, peritoneal dialysis, kidney ultrasound, pathology, glomerulonephritis, toxicology, and obstetric nephrology (4).

  • Changing landscape of nephrology. Changes include new and emerging therapies, a greater focus on home therapy, patient-centered care, health care justice, population health, and team-based care (see this edition's Kidney News article by Tod Ibrahim, entitled “Top 10 predictions about US nephrologists in 2035”).

  • Training program variability. Variability exists among the 148 ACGME-accredited fellowship programs that span both small and large programs as well as academic and community settings. The resources and training opportunities vary considerably based on this variability.

As the work of the task force continues, regular updates will be provided in Kidney News. To provide your thoughts and ideas on the future of nephrology, please email Melissa West, ASN's Senior Director for Strategic Relations and Patient Engagement, at mwest@asn-online.org.