Perspectives from the ASN Task Force on the Future of Nephrology: Development of Its Upcoming Recommendation

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The ASN Task Force on the Future of Nephrology was established in April 2022 to evaluate the specialty and develop a recommendation to ensure nephrologists are best prepared to provide care to people with kidney diseases. The ASN task force (see box) has been meeting weekly to discuss core and evolving elements of nephrology that must be considered in future training requirements. Additionally, the task force has hosted a series of listening sessions with various constituencies or partner organizations to understand the changing needs of the community as well as the evolution of medical education.

As medicine and health care continue to evolve and as nephrology continues to face a workforce shortage, it is imperative to pause and reflect on the past, present, and future. “Every profession evolves and changes over time,” reflects Benjamin D. Humphreys, MD, PhD, FASN. “I was drawn to serve on the task force because I wanted to contribute to planning for where our field is headed.” For these experienced task force members, there is an innate passion for the field of nephrology that exudes in the weekly questioning, discussion, and debate.

“Nephrology needs to reclaim our role as the ‘smartest doctors in the room,’” said Sharon Anderson, MD, FASN. “In addition to losing procedures to other specialties, some [specialties] are taking over some of the cognitive areas where nephrology traditionally led, such as treatment of hypertension (cardiology), acid-base and electrolyte disorders (critical care), and others.”

While reflecting on what may be lost or changing, there is excitement for current trends and future opportunities in the field. Samira S. Farouk, MD, MS, FASN, stated, “What excites me most about the future of nephrology is simultaneous growth and innovation in several spheres—including therapeutic advances, research, education, clinical care, and personalization of treatment options for our patients with kidney disease.” Her fellow task force member, Suneel M. Udani, MD, FASN, couldn't agree more. “The shift in focus of therapeutic interventions from dialysis to earlier in the course of renal disease and with more disease-specific therapies is exciting. The last few years have brought the identification of specific auto-antibodies in diseases such as membranous nephropathy and minimal change disease and the incorporation of genetic testing in diagnostic evaluation as well as the first ever FDA-approved therapy for rare renal diseases such as IgAN [immunoglobulin A nephropathy]. The momentum is clearly there for more progress,” Udani said.

With all the opportunity, the task force is listening hard for solutions to several challenges. “Ensuring diversity, equity, and racial justice is probably the most important task before us and will be the most difficult to accomplish. Initiatives to help us diversify our ranks, ensure that we provide culturally competent care, and empower future nephrologists to advocate on behalf of our patients will be needed to help improve the care of patients with kidney disease,” reflected Joshua S. Waitzman, MD, PhD.

“In general, training has been trending toward more specialization. I think we need to embrace that trend in nephrology, while making sure that we maintain general nephrology, especially to meet the demands in rural areas. In order to support both general nephrology needs and opportunities for specialization within nephrology, we will need more trainees. Thus, the selection of nephrology subspecialties to support and grow the trainee pool is critical,” shared Robert S. Hoover, Jr., MD, FASN, task force member and chair of the ASN Workforce and Training Committee.

Since April, the task force members have contributed hours to dissect and deliberate this challenge. One thing remains clear to Janis M. Orlowski, MD: “I love being a nephrologist and believe our specialty remains interesting, academically rigorous, exciting, dynamically changing, and professionally fulfilling. We need to carve a clear view of what nephrologists can and should contribute now and in the future. I’m honored to have been asked to serve on this committee.”

“On behalf of the ASN Council, I would like to thank and acknowledge the ASN Task Force on the Future of Nephrology on their commitment and thoughtful deliberation. I have enjoyed the presentation of data, diverse opinions, but more specifically, the focus on doing the right thing for the future of nephrology,” said Keisha L. Gibson, MD, FASN, MPH. “We are on target to release [the task force's] recommendation this fall and look forward to working with the community on implementation.”

For more information on the task force or 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