Factors in Career Choice among US Nephrologists

McMahon, Gearoid M.; Thomas, Lynette; Tucker, John K.; Lin, Julie

doi:10.2215/cjn.03250312

Cited by 23 publications

(32 citation statements)

References 17 publications

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“…Early clinical experiences for medical students have been recommended by McMahon et al [17] to increase nephrology exposure in the preclinical years. Using casebased approaches [7] can synthesize the clinical relevance of the material and motivate students to understand the complexity of renal pathophysiology, a common challenge -and negative influencing factor for choosing the specialty -among medical students.…”

Section: Discussionmentioning

confidence: 99%

Increasing Medical Student Interest in Nephrology

et al. 2019

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Background: Interest in nephrology careers is declining, possibly due to perceptions of the field and/or training aspects. Understanding practices of medical schools successfully instilling nephrology interest could inform efforts to attract leading candidates to the specialty. Methods: The American Society of Nephrology Workforce Committee’s Best Practices Project was one of several initiatives to increase nephrology career interest. Board-certified nephrologists graduating medical school between 2002 and 2009 were identified in the American Medical Association Masterfile and their medical schools ranked by production. Renal educators from the top 10 producing institutions participated in directed focus groups inquiring about key factors in creating nephrology career interest, including aspects of their renal courses, clinical rotations, research activities, and faculty interactions. Thematic content analysis of the transcripts (with inductive reasoning implementing grounded theory) was performed to identify factors contributing to their programs’ success. Results: The 10 schools identified were geographically representative, with similar proportions of graduates choosing internal medicine (mean 26%) as the national graduating class (26% in the 2017 residency Match). Eighteen educators from 9 of these 10 institutions participated. Four major themes were identified contributing to these schools’ success: (1) nephrology faculty interaction with medical students; (2) clinical exposure to nephrology and clinical relevance of renal pathophysiology materials; (3) use of novel educational modalities; and (4) exposure, in particular early exposure, to the breadth of nephrology practice. Conclusion: Early and consistent exposure to a range of clinical nephrology experiences and nephrology faculty contact with medical students are important to help generate interest in the specialty.

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Section: Discussionmentioning

confidence: 99%

Increasing Medical Student Interest in Nephrology

et al. 2019

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“…In fact, surveys identify the cognitive challenges of nephrology as one of the features that attracts physicians to this specialty (4,5). However, the grind of daily practice can often make the excitement of deeply understanding the physiology and pathophysiology of a patient seem remote and a thing of the past relegated to our time as fellows.…”

Section: Stimulating the Cognitive Aspects Of Practicementioning

confidence: 99%

“…Many of us chose nephrology out of fascination with the complex physiology underlying our specialty and an enthusiasm for improving the lives of patients with serious medical problems (4,5). In recent years, this enthusiasm has been tempered by factors that have changed the face of nephrology practice.…”

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confidence: 99%

Transforming Nephrology

Rosner

Berns

2017

CJASN

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Much has been written about the troubles facing nephrologists and the specialty of nephrology. These include declining interest in nephrology as a career, lower salaries compared with many other subspecialties, difficulty attracting outstanding residents who are passionate about nephrology into fellowship programs, and high rates of burnout and career dissatisfaction among practicing nephrologists (1,2). There is no doubt that the work of a nephrologist can be hard. Many of us, whether in academia or private practice, work long hours caring for challenging patients. Some work within health systems where our efforts are perhaps not as appreciated as we would like. Similar to other areas in the practice of medicine, nephrologists spend substantial time during their workdays, evenings, and weekend on tasks that have little meaning, such as completing forms, ticking boxes in the electronic medical record (EMR), and other tasks that do not effectively use our clinical training. For instance, a study focusing on four specialties (nephrology was not included) determined that clinicians spend only 27% of their total time on direct clinical care and 49.2% of their time on EMR and clerical work, with much of this time occurring after hours during personal time (3). This issue may be worse for nephrologists, who typically have to use several different EMRs at multiple clinical practice sites, including chronic dialysis facilities. Furthermore, many nephrologists spend hours traveling between multiple dialysis units, seeing patients in facilities owned by large for-profit dialysis companies where our contributions to patient care may not be highly valued. Compounding this are reforms on payment models that emphasize data reporting and increase the burden of documentation rather than encouraging patient-centered care. There is no wonder that many of us feel discouraged and burned out. A consequence of these feelings is that nephrologists have developed a cynicism regarding our profession and a feeling that things are only going to get worse. This cynicism leads to a destructive self-fulfilling prophesy that engenders a sense of helplessness. Our professional dissatisfaction is transparent to medical students and residents who are deciding on career choices and likely acts as a deterrent to choosing careers in nephrology. It is against these feelings that we believe it is critical for us to take a step back, ask why we chose nephrology as our specialty, and consider how we can recapture joy and excitement in our practice of nephrology. Perhaps most importantly, we need to take the necessary actions that will be required to accomplish this. This article focuses on these critical issues and offers a starting point to engage further discussion on the future of nephrology.Many of us chose nephrology out of fascination with the complex physiology underlying our specialty and an enthusiasm for improving the lives of patients with serious medical problems (4,5). In recent years, this enthusiasm has been tempered by factors that have...

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“…1 This shortage is especially worrisome for pediatric nephrology due to inadequate recruitment of trainees and attrition due to retirement and dissatisfaction. American Board of Pediatrics (ABP) data show that in 2011, pediatric nephrologists had practitioners with the oldest mean age (57.4 years) of all 14 ABP subspecialties.…”

Section: Introductionmentioning

confidence: 99%

“…They also noted a higher dissatisfaction rate from pediatric nephrology fellows in smaller programs. 5 Concerns about the nephrology workforce are not limited to pediatrics 1,[6][7][8][9] nor solely to the United States. [6][7][8] In the US, NRMP data shows that the number of applicants for internal medicine (IM) nephrology fellowship dropped by 33% between 2009 and 2012.…”

Section: Introductionmentioning

confidence: 99%

Wanted: pediatric nephrologists! — why trainees are not choosing pediatric nephrology

Ferris

Iglesia

et al. 2014

Renal Failure

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A workforce crisis for many pediatric specialties, particularly nephrology, is due to growing retirement rates, attrition during training, and retention difficulties. To obtain specific information regarding pediatric nephrology trainee shortages, we administered two crosssectional surveys to non-renal pediatric subspecialty fellows and pediatric nephrology program directors. We characterized the fellows' experiences with nephrology and the program directors' experiences with their fellows as well as their outcomes in the last 10 years. We analyzed responses from 531 non-renal fellows (14.4% response rate). Overall, 317 (60%) fellows rated nephrology as difficult, particularly women (65.4% vs. 49.5%, p50.001), with American women medical graduates rating nephrology as more difficult compared to all others (p ¼ 0.001). More men than women (24% vs. 8%, p50.001) considered the monetary benefit as not adequate. Program directors (25; 64% response rate) represented 57% of all USA fellows in training, and 15 (60%) found it difficult to recruit qualified applicants. Of the 183 graduates in the past 10 years, 35 (19%) were reported as not in the USA pediatric nephrology workforce. These findings support our belief that a strong effort needs to be made by the academic community to teach nephrology in more interesting and understandable formats. While these are national samples, we were unable to contact non-nephrology fellows directly and program directors from larger programs were underrepresented. Difficulties in attracting/retaining trainees (particularly women) to nephrology must be addressed systematically, identifying incentives to practice in this field. Bold concerted efforts are required and we propose seven steps to achieve this goal.

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Factors in Career Choice among US Nephrologists

Cited by 23 publications

References 17 publications

Increasing Medical Student Interest in Nephrology

Increasing Medical Student Interest in Nephrology

Transforming Nephrology

Wanted: pediatric nephrologists! — why trainees are not choosing pediatric nephrology

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