I interviewed for fellowship from an office at our downtown campus. It was a shared space with my co-chiefs, who were often on the other side of a very thin wall. Early on in the season, one of them commented that my interviews sounded “the most fun.” Reflecting on my experience over the 3 months leading up to the Match, I agree.
I have known I wanted to be a nephrologist since my fourth year of medical school. I came into the fellowship interview season with the goal of finding a program that would empower and challenge me to grow as a physician, educator, researcher, and leader. Throughout several weeks of interviews, it became clear that each program shared this same goal. Through virtual social events, open houses, and the interview days themselves, I quickly felt that everyone I interviewed with was invested in bettering the future of our field and that they knew this started with recruiting their trainees.
During my interviews, we discussed career goals, tracks, advanced degrees, and other opportunities. Faculty all over the country offered advice and insight into the 5-year plans that I shared. I felt many of my interviews mirrored meeting a new mentor with a shared investment in my future—regardless of where I would ultimately match. Through these interactions, I learned about myself through the lens of others and their own experiences, and I began to shift some of my own career and fellowship goals. This was unexpected to me and something I am incredibly grateful for.
Ultimately, through the nephrology match process, I connected with a community that, despite a very wide geographic range, felt close. Meeting many of these individuals at Kidney Week 2023 further solidified this impression. I look forward to investing in next year's applicants and elevating them as they experience their own personal and professional growth.
My experience applying for nephrology fellowship last year was incredible. I had the pleasure of interviewing at wonderful academic programs throughout the country. I was thoroughly impressed by the progressive changes that several programs are implementing to provide an excellent training experience—such as point-of-care ultrasound training and home dialysis education. Throughout my application process, I had the pleasure of meeting and connecting with incredible nephrologists—relationships I hope to continue to foster over the course of my career. I personally was looking for an academically rigorous training program that would expose me to the various facets of nephrology, give me a well-rounded education, and allot me time and resources to pursue my own career interests. Because I am interested in glomerular diseases, I was seeking a program that would provide me with that exposure. I also desired a supportive environment with excellent mentors.
The interviews that stood out to me most were with those who took the time to review my application and were extremely knowledgeable about their program. A part of my interview days, which I enjoyed and sought out, was watching fellow didactics and observing fellows engaging with one another in work rooms/lecture rooms. I would recommend this for future cycles, as it not only shows applicants the quality of education that fellows are receiving but also allows applicants to observe fellows and faculty in their work environment. Additionally, it would be wonderful to see programs showcasing the scholarly work/publications of their fellows along with the work of faculty. Ultimately, when speaking to my co-applicants, I think that nephrology programs that provided exposure to adequate outpatient nephrology, subspecialties, and home dialysis modalities; offered resources for research; and were front-loaded to provide second years with time to pursue their career interests were favored. However, location and the culture of a program remained highly prioritized among all applicants.
I developed an appreciation for nephrology during my internal medicine residency. After experiencing several rotations, I knew that I would not be happy in any other specialty. It is a privilege to care for patients with kidney diseases, who often feel overwhelmed with the weight of their illness. It is no secret that interest in nephrology has been declining. I was constantly reminded that I should consider other choices in internal medicine. I was fortunate to join a fellowship program that offered the best resources to treat my future patients in all facets of general nephrology, including transplantation, onconephrology, POCUS (point-of-care ultrasonography), and in-house renal pathology.
In our program, fellows are the first contact for other medical teams on their respective services and take ownership of the patients they are caring for. With fewer available renal fellows and less filled services, opportunities for patient education and advancing medical knowledge with residents and students are going to be limited. Additionally, the thought of less education and more frequent call shifts may exacerbate the problem and drive others away from our field. Lack of fellows may discourage applicants who are interested but undecided about fully committing to nephrology. This hesitation often stems from the perceived cost with increased workload, stress, and fewer benefits compared with practicing general internal medicine as hospitalists or primary care physicians immediately after residency. While each unfilled program may handle this situation differently, one potential mitigation involves a continued, heavy focus on inpatient medicine into the second year, which could detract from much-needed outpatient training, involving home hemodialysis and peritoneal dialysis. Additionally, academic centers with in-house fellowships may face challenges in hiring future faculty members if additional clinical responsibilities and coverage arise due to a scarcity of trainees, potentially shifting the focus away from research and medical education. I am passionate about nephrology and all that we offer, but real changes must be made to safeguard our specialty and ensure a thriving future.
