Commentary: Interest in Nephrology: A sad decline!

Interest in nephrology amongst US medical graduates has been steadily decreasing since 2002. This might not be so worrisome if the number of kidney patients was remaining the same. Unfortunately, the burden of kidney disease in America increases each year. With a concomitant decline, one worries about the domestic supply of Nephrologists. While a number of studies address the causes and/or solutions to this problem, most investigators have ignored the method by which interest has been measured.

Conventionally, the measurement most often used to determine the direction of interest in nephrology has been the eventual number (or percent) of nephrology training positions filled by US medical graduates. The greater the number of US medical graduates (USMG) filling fellowship spots, the more likely that USMG, as a whole, are interested in nephrology. While you can debate the pros/cons of this method’s accuracy, it is certainly a retrospective measurement. As a result, nephrology educators would always be “behind the eight-ball”; that is, interventions designed to increase interest in nephrology could only be measured after the fellowship match. This could result in resources and time spent on interventions that, unfortunately, do not increase the number of USMG filling a training position. The potential for unproductive resource and time allocation was the main reason for developing an earlier prediction model.

Given the importance of having a supply of nephrologists in the coming years to adequately meet the rising numbers of patients with kidney disease, we want to know, in advance, if our interventions to increase interest actually worked. Though such a model doesn’t shed light on the reasons why interest has waned, it gives educators a forward look at how our collective interventions are (or are not) achieving our goal. With this new tool, educators who design novel programs can assess the effectiveness of such programs, and in a prospective manner, make adjustments if the percent of US medical graduates entering nephrology fellowship is less than expected.

To view the full article by Desai et al, please see AJKD
Tejas P. Desai, MD
eAJKD Advisory Board Member

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