Career interest and perceptions of nephrology: A repeated cross-sectional survey of internal medicine residents

Abstract

BackgroundInterest in nephrology careers among internal medicine residents in the United States is declining. Our objective was to assess the impact of the presence of a nephrology fellowship training program on perceptions and career interest in nephrology among internal medicine residents. A secondary objective was to identify commonly endorsed negative perceptions of nephrology among internal medicine residents.MethodsThis was a repeated cross-sectional survey of internal medicine residents before (Group 1) and 3 years after (Group 2) the establishment of nephrology fellowship programs at two institutions. The primary outcome was the percentage of residents indicating nephrology as a career interest in Group 1 vs. Group 2. Secondary outcomes included the frequency that residents agreed with negative statements about nephrology.Results131 (80.9%) of 162 residents completed the survey. 19 (14.8%) residents indicated interest in a nephrology career, with 8 (6.3%) indicating nephrology as their first choice. There was no difference in career interest in nephrology between residents who were exposed to nephrology fellows during residency training (Group 2) and residents who were not (Group 1). The most commonly endorsed negative perceptions of nephrology were: nephrology fellows have long hours/burdensome call (36 [28.1%] of residents agreed or strongly agreed), practicing nephrologists must take frequent/difficult call (35 [27.6%] agreed or strongly agreed), and nephrology has few opportunities for procedures (35 [27.3%] agreed or strongly agreed). More residents in Group 2 agreed that nephrology is poorly paid (8.9% in Group 1 vs. 20.8% in Group 2, P = 0.04), whereas more residents in Group 1 agreed that nephrologists must take frequent/difficult call (40.0% in Group 1 vs. 18.1% in Group 2, P = 0.02).ConclusionsThe initiation of a nephrology fellowship program was not associated with an increase in internal medicine residents’ interest in nephrology careers. Residents endorsed several negative perceptions of nephrology, which may affect career choice.

Global nephrology workforce: gaps and opportunities toward a sustainable kidney care system

“…Although this study's results showed adequate current nephrology trainee densities in high-income countries, many studies have shown decreased interest in the field. 14,27 Some high-income countries rely on foreign-trained doctors to cover shortages in nephrology manpower. For example, a study from Oman showed that the majority of practicing nephrologists were expatriate physicians, with local doctors representing only 14% of the workforce.…”

Safety and adequacy of percutaneous kidney biopsy performed by nephrology trainees

“…Many of the trainees found the topic to be unappealing [ 2 ]. According to a survey from 5 medical schools in the United States: renal pathophysiology courses were too complex, lacked relevance or simply failed to stimulate interest [ 3 ]. Many students reported minimal nephrology exposure during their clinical rotations and even fewer were aware of the procedural work in nephrology, a feature than often attracts students to other specialties.…”

Why do people choose nephrology? Identifying positive motivators to aid recruitment and retention

“…Previous works have shown that some doctors are discouraged from a career in nephrology following experiences of the specialty at a junior level [ 25 , 26 ]. Examining the reasons behind this attrition should be a research priority for the specialty, as these trainees represent a missed opportunity for recruitment to the specialty.…”