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

Abstract

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.

The global pediatric nephrology workforce: a survey of the International Pediatric Nephrology Association

“…Neither the high degree of perceived workforce inadequacy in North America, nor the challenges to trainee recruitment identified by North American respondents, are surprising [ 1 , 12 , 19 ]. Lack of interest, hard work/poor work-life balance, and poor salary were obstacles to fellow recruitment reported by more than a third of North American respondents.…”

The US Pediatric Nephrology Workforce: A Report Commissioned by the American Academy of Pediatrics

“…7 A 2012 survey of pediatric subspecialty fellows who chose subspecialties other than nephrology found that a lack of positive mentoring and the perception of nephrology as a challenging subject, especially among women trainees, were primary disincentives to pursuing nephrology. 8 Women, who presently make up .70% of pediatric residency trainees, are less likely than men to choose a subspecialty or a research career and more likely to prefer part-time work. 9 Workforce adequacy concerns are compounded by the growing demand for pediatric nephrology services as care becomes more sophisticated and children with chronic conditions survive kidney-related complications.…”

Pediatric Nephrology Training Worldwide 2016: Quantum Educatus?

“…In the United States and Canada, concerns exist about workforce adequacy. 1 , 14 , 15 , 16 In 2015, only 30% of pediatric nephrology fellowship positions were filled in the National Residency Matching Program (NRMP), which improved slightly to 44% in the 2016 match. 17 Pediatric nephrology recruitment compares unfavorably to other pediatric subspecialties, with only child abuse having a lower percentage of positions filled in 2016.…”